Control of high-risk factors for stroke is the primary prevention of cerebrovascular disease. It refers to prevention before the onset of the disease, i.e., through early change of unhealthy lifestyle and proactive control of various risk factors, so that cerebrovascular disease does not occur or the age of onset is delayed. From the epidemiological point of view, only primary prevention can reduce the incidence of disease in the population.
I. Hypertension
Hypertension is the most important risk factor for cerebral hemorrhage and cerebral infarction. Studies have shown that for every 10 mmHg increase in systolic blood pressure, the relative risk of stroke incidence increases by nearly half, and for every 5 mmHg increase in diastolic blood pressure, the relative risk of stroke incidence increases by nearly half. The mortality rate of stroke was reduced by more than half after antihypertensive treatment. Once antihypertensive drug therapy is started, the medication or dose should be adjusted regularly until the target blood pressure level is reached.
Heart disease
All types of heart disease are closely related to stroke. The risk of stroke is more than two times higher in people with heart disease than in people without heart disease. Atrial fibrillation, in particular, is a very important risk factor for stroke. Effective treatment can prevent the occurrence of stroke.
Diabetes
Diabetes is an important risk factor for cerebrovascular disease. Patients with type II diabetes mellitus have a twofold increased risk of stroke. Therefore, prevention and control of diabetes mellitus should be emphasized. Patients with diabetes mellitus should first control their diet and strengthen physical exercise, and those whose blood sugar control is still unsatisfactory in 2-3 months should be treated with oral hypoglycemic drugs or insulin.
D. Dyslipidemia
A large number of studies have confirmed that elevated serum total cholesterol, low-density lipoprotein and reduced high-density lipoprotein are closely related to cardiovascular and cerebrovascular diseases. Studies have shown that the application of statins and other lipid-lowering drugs can reduce the incidence of stroke and mortality.
V. Smoking
Regular smoking is a recognized risk factor for ischemic stroke. Its pathophysiological effect on the body is multifaceted, mainly affecting the systemic vascular and blood system. Such as: accelerate atherosclerosis, increase the level of fibrinogen, promote platelet aggregation, reduce the level of high-density lipoprotein. Smoking is an independent risk factor for stroke, and its risk increases with the amount of smoking. Long-term passive smoking can also increase the risk of stroke.
Sixth, alcohol consumption
Studies have shown that alcohol intake has a direct relationship to hemorrhagic stroke. Chronic heavy alcohol consumption and acute alcoholism are risk factors for cerebral infarction in young people. Similarly, heavy alcohol consumption is a risk factor for ischemic stroke in the elderly.
VII. Carotid artery stenosis
Studies have found that nearly 1 in 10 men and women over the age of 65 have carotid artery stenosis greater than 50%. Carotid artery stenosis increases the risk of ischemic cerebrovascular disease. For patients with asymptomatic carotid artery stenosis, surgery or endovascular intervention is generally not recommended, but for patients with severe carotid artery stenosis (>70%), carotid endarterectomy or endovascular intervention can be considered where available.
VIII. Obesity
Obesity leads to hypertension, hyperlipidemia, hyperglycemia, more than 1/5 of the standard weight of obese people suffering from hypertension, diabetes or coronary heart disease risk increased significantly. Abdominal obesity type is more likely to suffer from stroke disease.
IX. Other risk factors
(A) Hyperhomocysteinemia
Hyperhomocysteinemia is associated with the development of stroke. It is recommended that the general population should be treated with dietary modifications and that folic acid and B vitamins should be considered for patients with homocysteinemia.
(ii) Metabolic syndrome
The characteristic factors include abdominal obesity, dyslipidemia, elevated blood pressure, insulin resistance (with or without abnormal glucose tolerance), and so on. Insulin resistance is its main pathological basis, so it is also known as insulin resistance syndrome. The syndrome aggregates a variety of risk factors for cardiovascular disease and is interrelated with some newly identified risk factors, therefore, it has important clinical value for its diagnosis, evaluation and appropriate intervention.
(iii) Lack of physical activity
Appropriate physical activity can improve cardiac function, increase cerebral blood flow, and improve microcirculation. It needs to be highlighted that increasing regular and moderate physical activity is an important part of a healthy lifestyle, and its preventive effect is very obvious.
(iv) Irrational diet and nutrition
Excessive intake of fat and cholesterol can accelerate the formation of atherosclerosis, which in turn affects the normal function of the heart and brain vessels and can easily lead to strokes. Excessive salt intake can increase blood pressure and promote the formation of atherosclerosis, which has been confirmed to be closely related to the occurrence of stroke in some studies in China, Japan and Europe.
(E) Oral contraceptives
For women over 35 years of age who smoke and have hypertension, diabetes mellitus, migraine, or previous thrombotic events, the use of oral contraceptives may increase the risk of stroke. Therefore, it is recommended that long-term oral contraceptive use should be avoided in women with these risk factors for cerebrovascular disease.
(vi) Procoagulant risk factors
Procoagulant risk factors closely related to stroke include platelet aggregation rate, fibrinogen and coagulation factor VII. The regulation of procoagulant risk factors has a significant role in the prevention of cardiovascular diseases.