Primary prevention of cerebrovascular disease refers to prevention before the onset of the disease, that is, through early change of unhealthy lifestyles and proactive control of various risk factors, so as to achieve the purpose of not occurring or delaying the onset of cerebrovascular disease. From the epidemiological point of view, only primary prevention can reduce the incidence of disease in the population. Therefore, for cerebrovascular disease, which has a high mortality and disability rate, the significance of paying attention to and strengthening primary prevention is much greater than that of secondary prevention.
Risk factors of cerebrovascular disease and their intervention management
The risk factors of cerebrovascular disease are divided into two types of interventional and non-interventional, and age and gender are two non-interventional risk factors. The risk of stroke continues to increase with age, with the risk of stroke increasing 1-fold every 10 years after age 55. There are significant differences between genders worldwide, with a higher incidence of stroke in men than in women, with a ratio of 1.1 to 1.5:1. In addition, non-interventional risk factors include race and family heritability. Some of the major risk factors that can be intervened include hypertension, heart disease, diabetes, smoking, alcohol abuse, dyslipidemia, and carotid artery stenosis.
Hypertension
The goal of treatment for hypertension is primarily to improve control rates in order to reduce comorbidities such as strokes. It is equally important for patients to achieve systolic and diastolic blood pressure, and the focus should be on achieving systolic blood pressure. Strokes are significantly reduced when blood pressure levels are <140/90 mmHg. Patients with diabetes and renal disease should have a lower BP target of <130/80 mmHg. Promoting a healthy lifestyle is important for the prevention of hypertension and is an essential component of the prevention and treatment of hypertension, and is particularly important for people with blood pressure levels at high normal values Recommendations.
(1) Further strengthen the publicity and education efforts, and strive to raise awareness of stroke prevention among residents and take the initiative to care about their blood pressure; it is recommended that those ≥35 years old should have their blood pressure measured once a year, and patients with hypertension should have their blood pressure measured frequently (at least once every 2-3 months) to adjust the dose of medication.
(2) Hospitals at all levels should establish a system for measuring blood pressure in adults at the first visit as soon as possible.
(3) Localities should actively create conditions to establish model communities of a certain size to regularly screen the population for hypertensive patients and give them appropriate treatment and follow-up.
(4) Patients with early or mild cases should first be treated with lifestyle changes, and those who still have poor results after 3 months should be treated with additional anti-hypertensive drugs.
Non-pharmacological measures for prevention and treatment of hypertension.
Measure objectives
Weight loss.
Dietary salt restriction.
Reduction of dietary fat.
Increasing and maintaining appropriate physical activity.
Maintaining an optimistic mindset and improving stress capacity.
Smoking cessation and alcohol restriction.
Reducing calories, having a balanced diet, increasing exercise and keeping BMI at 20 to 24.
Reducing the average daily salt intake per person to 8g in the north first, and then to 6g later.
In the south, it can be controlled to less than 6g.
Total fat <30% of total calories, saturated fat <10%, increase fresh vegetables 400~500g daily, fruits 100g, meat 50~100g, fish and shrimp 50g, eggs 3~4 per week, milk 250g daily, oil 20~25g daily, and less sugar and sweets. If you feel good about yourself after exercise and maintain your ideal weight, it indicates that the amount of exercise and exercise is appropriate. Improve the ability of the population to prevent diseases on their own through education and consultation. Promote the selection of cultural activities such as sports and painting that are suitable for individuals, and increase social opportunities for the elderly to improve their quality of life. Do not smoke, limit alcohol, and drink <20-30g of alcohol per day for men and <15-20g for women who are alcoholics, and do not drink alcohol for pregnant women.
Heart disease recommendations.
(1) Adults (≥40 years old) should have regular medical checkups for early detection of heart disease.
(2) Patients diagnosed with heart disease should actively seek treatment from a specialist.
(3) For patients with non-valvular atrial fibrillation, anticoagulation with warfarin can be used in hospitals where available, but the international normalized ratio (INR) must be monitored and controlled in the range of 2.0 to 3.0; for those aged >75 years, an INR between 1.6 and 2.5 is appropriate; or oral aspirin 50-300 mg/d, or other anti-platelet aggregation drugs.
(4) Patients at high risk of coronary artery disease should also take small doses of aspirin 50-150mg/d, or other anti-platelet aggregation drugs
Diabetes recommendation.
(1) People with risk factors for cardiovascular disease should have regular blood glucose testing and, if necessary, measurement of glycated hemoglobin (HbA1c)
and glycated plasma albumin if necessary. The diagnostic criteria for diabetes mellitus are consistent with the Chinese guidelines for the prevention and treatment of diabetes mellitus.
(2) Patients with diabetes mellitus should first control their diet and strengthen physical exercise, and those whose blood glucose control is still unsatisfactory in 2 to 3 months should be treated with oral hypoglycemic drugs or insulin. The control goals of diabetes are shown in Table 5.
(3) Patients with diabetes mellitus should more actively treat hypertension, control weight and lower cholesterol levels.
Lipid recommendations.
(1) Those with dyslipidemia, especially in combination with other risk factors such as hypertension, diabetes, and smoking should first change their unhealthy lifestyle and have their blood lipids reviewed regularly. If lifestyle changes are not effective, medication should be used.
(2) Patients with previous history of TIA, ischemic stroke or coronary artery disease and TC higher than 5 mmol/L should be treated with statins and those with increased TG should be treated with betulinic acid.
Smoking recommendations.
(1) Advise smokers to quit smoking (mobilize relatives of smokers to participate in persuasion and provide effective methods to quit smoking)
(2) Involve the entire community and use comprehensive tobacco control measures to intervene with smokers in the community.
(3) Promote local government departments to enact smoking regulations as soon as possible, such as setting up smoke-free areas in public places such as offices, conference rooms, airplanes, and trains, where smoking is available only in designated locations, to reduce the harm of passive smoking.
Obesity recommendations.
(1) Persuade overweight and obese people to reduce their weight by adopting healthy lifestyles and increasing physical activity to
(1) Advise overweight and obese people to reduce their risk of stroke by adopting a healthy lifestyle and increasing physical activity.
(2) Promote healthy lifestyles and good dietary habits. The BMI (kg/m2) of adults should be controlled at <28 or waist-to-hip ratio <1, and the weight fluctuation should be within 10%.
Other risk factors
(1) Hyperhomocysteinemia
(2) Metabolic syndrome
(3) Lack of physical activity Recommendation.
Adults should engage in moderate physical activity at least 3 to 4 times a week, with each activity lasting at least 30 minutes (e.g., brisk walking, jogging, bicycling or other aerobic metabolic exercise). It is important to emphasize that increasing regular and moderate physical activity is an important part of a healthy lifestyle, and its role in disease prevention is very obvious
(4) Irrational diet and nutrition (1 serving (or 1 plate) of fruits and vegetables per day can reduce the risk of stroke by 6%.)
(5) Oral contraceptives
(6) Pro-coagulation risk factors