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Richard C Senelick, MD posted:
A recent article in the New England Journal of Medicine on "Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack" provides an excellent review of what you need to do.

Studies estimate that 80% of recurrent strokes can be prevented with diet modification, exercise, blood pressure control, cholesterol reduction with the help of statins, and treatment with anti-platelet medications. Ideally, you will focus on every possible risk factor, but we will start with the three main risk factors.

Blood Pressure Control

Hypertension is the single most common cause of stroke and it is estimated that 75 million people.that's one-fourth of the United States population.have high blood pressure. When you control your blood pressure through the use of antihypertensive medication you reduce the risk of a first stroke by 32%. In patients who have had a TIA or a stroke, treatment of high blood pressure reduces the risk of a recurrent stroke by 28%. The exact blood pressure number you need to shoot for is a decision unique to each person and should be made in consultation with your physician
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Statins to Lower Cholesterol

Statins are a group of medications that have revolutionized the treatment of high cholesterol. They have been touted for the treatment of many disorders, but the facts are clear: statins reduce the risk of a recurrent stroke by 25%.

Statins lower LDL. our "bad cholesterol." Over the last few years doctors have steadily lowered the ideal level for LDL in people who are at risk for stroke or have an elevated LDL. The latest goal is less than 70mg/dl. The lower we drive the LDL level, the greater we can reduce the risk of a stroke or myocardial infarction.

Most physicians now add statin therapy to the discharge instructions that you receive when you leave the hospital after a stroke. An exception may be hemorrhagic strokes, an event where the stroke is caused by bleeding in the brain.

Anti-Platelet Agents

Commonly referred to as "blood thinners," anti-platelet agents attack the tiny platelets and make the blood less sticky and less likely to form blood clots. This is good if you are trying to prevent a blood clot from forming in an artery in the brain or heart. More good news.anti-platelet agents reduce the risk of a recurrent stroke by 25%.

The most commonly used medication is low-dose aspirin (25mg to 325mg), which is just as effective as higher doses and has fewer side effects. If you watch television, you have seen numerous ads for the one of the other two antiplatelet agents. Clopidogrel (Plavix) and aspirin plus dipyridamole (Aggrenox) both decrease the risk of recurrent stroke to the same degree as aspirin. All three are acceptable forms of treatment, but low dose aspirin is much less expensive. A study looked at whether the combination of aspirin and clopidogrel might be more effective, but the study was discontinued because of excessive episodes of bleeding in the brain and death. As a result, combination therapy is not recommended.
After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been. You still can achieve new goals.
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Richard C. Senelick M.D. is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He did his undergraduate and medic...More

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