Primary Prevention of Ischemic Stroke

Goldstein, Larry B.; Adams, Robert J.; Becker, Kyra J.; Furberg, Curt D.; Gorelick, Philip B.; Hádemenos, George J.; Hill, Martha N.; Howard, George; Howard, Virginia J.; Jacobs, Bradley S.; Levine, Steven R.; Mosca, Lori; Sacco, Ralph L.; Sherman, David G.; Wolf, Philip A.; Zoppo, Gregory J. del

doi:10.1161/01.cir.103.1.163

Cited by 402 publications

(208 citation statements)

References 349 publications

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“…[3][4][5] The incidence of stroke is directly related to blood pressure and age, 1,2 and is expected to rise significantly in the future as the age of the population increases putting a great financial burden on society. 7 The direct and indirect costs of strokes in the US have been projected at $56.8 billion for 2005 and account for one-third of the total health expenditure ( Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…Stroke, besides being a cause of long-term disability for the affected person, is also a significant burden on society and healthcare expenditures. [3][4][5] Stroke ranks as the third leading cause of death in the United States and accounts for 700 000 incident strokes annually and 4.4 million stroke survivors, 5,6 with direct and indirect cost estimates for 2005 of $56.8 billion. 7 The estimated expenditures for all cardiovascular diseases in the United States for 2005 are depicted in Figure 1.…”

Section: Introductionmentioning

confidence: 99%

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Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Chrysant

2005

J Hum Hypertens

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Stroke is a major cause of death and disability and its incidence increases linearly with age and the level of systolic and diastolic blood pressure. Stroke, besides being a cause of long-term disability for the affected person, also imposes a significant burden on society and healthcare costs. Although good blood pressure control is very critical for stroke prevention, angiotensin receptor blockers (ARBs) may be superior to angiotensin-converting enzyme inhibitors (ACEIs) for the same degree of blood pressure control. This hypothesis has clinical and experimental support. ARBs prevent stroke incidence by blocking the angiotensin II (AII), AT 1 receptors preventing brain ischaemia and allowing AII to stimulate the unoccupied AT 2 receptors, which improve brain ischaemia. ACEIs, by reducing AII generation, are less effective in preventing stroke. This hypothesis provides evidence that AII plays an important role in the prevention of stroke. Certain ARBs like losartan, and telmisartan, irbesartan and candesartan possess additional properties which may play a role in stroke prevention, which is independent of AII. These include antiplatelet aggregating, hypouricemic, antidiabetic and atrial antifibrillatory effects. However, the most critical factor in stroke prevention is good blood pressure control irrespective of drug used.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Chrysant

2005

J Hum Hypertens

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“…7-10 Data from studies indicate that use of the beta-hydroxy-betamethylglutaryl-CoA reductase inhibitors or statins (cholesterol-lowering drugs) offers stroke protection and reduces the amount of carotid atheroma, although the mechanisms involved are unclear. [7][8][9][10] Lifestyle factors, such as obesity and smoking, and use of a number of chemical substances, including alcohol and both legal and illegal drugs, have been associated with cardiovascular disease in general and stroke in particular. 7,11,12 Some prescription medications have been associated with an increased incidence of stroke.…”

Section: Stroke and Heart Disease Shared Pathology And Risk Factorsmentioning

confidence: 99%

“…12,18 Elevated levels of homocysteine may be a factor in both disorders as well. 7,11 As is true of many chronic illnesses, genetics play a substantial role in both stroke and heart disease. The underlying mechanisms of atherosclerosis and hypertension are determined in part by genetics.…”

Section: Stroke and Heart Disease Shared Pathology And Risk Factorsmentioning

confidence: 99%

“…[7][8][9][10] Lifestyle factors, such as obesity and smoking, and use of a number of chemical substances, including alcohol and both legal and illegal drugs, have been associated with cardiovascular disease in general and stroke in particular. 7,11,12 Some prescription medications have been associated with an increased incidence of stroke. In the past, early-generation oral contraceptives were found to increase stroke risk, 13 and controversy has surrounded hormone replacement therapy (HRT), with recent findings from the Hormone and Estrogen/progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) indicating an increased stroke and heart attack rate among women using HRT.…”

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confidence: 99%

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Pathophysiology and therapeutic targets for ischemic stroke

Levine

2004

Clin Cardiol

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Summary:The increased risk for stroke among those who have had a previous stroke or transient ischemic attack (TIA) and the tremendous burden of disability among stroke sufferers make both primary and secondary preventative strategies imperative. An understanding of the pathophysiology of stroke and TIA can help identify appropriate therapeutic targets. Stroke and Heart Disease Shared Pathology and Risk FactorsUnderlying atherosclerosis, which plays a significant role in both ischemic stroke and myocardial infarction (MI), is similar in both conditions. Despite this similarity, however, these two disease states are characterized by distinct differences in pathophysiology that go beyond the mere location of the thrombus. Coronary artery lesions tend to be more fibrotic than those found in the cerebral vasculature. 1, 2 Stroke patients are an extremely heterogeneous group compared with those who have had an MI. There is a variety of sources for the thrombus as well as numerous areas in which ischemic occlusion can occur. The evolution of the consequences of the ischemic event also differs in stroke and MI. Stroke pathology pursues a much longer course than MI, with secondary damage and metabolic sequelae occurring at times up to a month after the initial event. 3 The neurological complications and clinical manifestations following a stroke vary considerably as well, depending upon which areas of the brain were affected and to what degree. Patients may suffer from any combination of cognitive, motor, visual, sensory, language, speech, or mood deficits. Deficits can be discrete or global. Finally, despite the pervasive notion that stroke patients are at increased risk for acute MI, in up to 75% of stroke survivors a subsequent cardiovascular event could be another stroke. 4 However, both stroke and MI share many risk factors. Hypertension and diabetes mellitus are important modifiable risk factors for both stroke and heart failure. 5 In fact, cardiovascular disease, including stroke and heart disease, is the primary cause of death in persons with diabetes. 6 Hyperlipidemia is an accepted risk factor for coronary artery disease, and its contribution to ischemic stroke is also important. 7-10 Data from studies indicate that use of the beta-hydroxy-betamethylglutaryl-CoA reductase inhibitors or statins (cholesterol-lowering drugs) offers stroke protection and reduces the amount of carotid atheroma, although the mechanisms involved are unclear. [7][8][9][10] Lifestyle factors, such as obesity and smoking, and use of a number of chemical substances, including alcohol and both legal and illegal drugs, have been associated with cardiovascular disease in general and stroke in particular. 7,11,12 Some prescription medications have been associated with an increased incidence of stroke. In the past, early-generation oral contraceptives were found to increase stroke risk, 13 and controversy has surrounded hormone replacement therapy (HRT), with recent findings from the Hormone and Estrogen/progestin Replacement Study (HERS) a...

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Treatment of Hypertension in Patients With Diabetes

Sowers

2004

Arch Intern Med

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At least 17 million people in the United States have diabetes mellitus, and another 50 million have hypertension. These chronic diseases increasingly coexist in our aging population. Both diseases are important predisposing factors for the development of cardiovascular disease (CVD) and renal disease, and the coexistence of these risk factors is a very powerful promoter of CVD and renal disease. There is accumulating evidence that the rigorous treatment of hypertension and other risk factors such as dyslipidemia and hyperglycemia considerably lessens the burden of CVD and renal disease in patients with diabetes mellitus. There is considerable evidence that strategies addressing diet and exercise reduce the development of diabetes and are an important component of treatment in persons who have established diabetes. There are also considerable data suggesting that the treatment strategies that interrupt the renin-angiotensin system have special benefits in patients with diabetes and may prevent the development of clinical diabetes in hypertensive patients with impaired glucose tolerance. Data from a recent study indicate that the control of systolic blood pressure, using a diuretic agent as part of antihypertensive therapy, reduces the risk of stroke and other CVD end points. Recent reports indicate that angiotensin receptor-blocking agents decrease the rate of development of proteinuria and diabetic renal disease. These observations will likely have a significant impact on treatment of hypertension in patients with type 2 diabetes mellitus.

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Primary Prevention of Ischemic Stroke

Cited by 402 publications

References 349 publications

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Pathophysiology and therapeutic targets for ischemic stroke

Treatment of Hypertension in Patients With Diabetes

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