Cerebrovascular disease, also known as stroke, causes 2.5 million new cases of cerebrovascular disease worldwide each year, and 1.5 million deaths from stroke each year, 2/3 of which are left disabled. Cerebrovascular disease is a serious disease that threatens human health, with little benefit from treatment in the acute phase and a focus on prevention of cerebrovascular disease. This article will focus on the secondary prevention of cerebrovascular disease.
I. Prevention of cerebrovascular disease
Individuals at high risk of cerebrovascular disease provide treatment of relevant threat factors to future patients, which is the scope of primary prevention. Early treatment programs are provided for early stage patients, for example: patients with transient ischemic attack and TAA, and strive for complete cure. Further identification and treatment of cerebrovascular patients who have already developed the disease. Known which? Risk factors of cerebrovascular disease prevent death, disability and recurrence that is the secondary prevention of cerebrovascular.
Second, the risk factors of cerebrovascular disease
Risk factors for recurrence are divided into two main categories. Non-modifiable risk factors. For example, age, race, gender and family history. There is no possibility to intervene by medical means. Modifiable risk factors are controllable and can be changed. The first and foremost is hypertension, in addition to diabetes, smoking, asymptomatic carotid artery stenosis and sickle cell disease, dyslipidemia, atrial fibrillation, obesity, reduced physical activity, excessive alcohol consumption, hyperhomocysteinemia, and many other risk factors, which can be controlled through the intervention of our clinicians.
1.Hypertension
(1) The effect of hypertension on cerebral circulation.
(1) Hypertension leads to vascular hypertrophy and resorption, and these proliferative reactions alter vascular compliance and promote atherosclerosis.
(2) Hypertension alters the ability of endothelial cells to release vasoactive substances, resulting in increased vasoconstriction tension throughout the body and in the brain.
(3) Hypertension alters cerebral circulatory autoregulation, shifting the regulatory curve to the right.
(2) When blood pressure averages it is 124/76 and rises to 175/105 mm Hg, then its incidence rises rapidly from less than 5% to about 4%.
(3) Anti-hypertensive therapy in stroke patients needs to refer to the following aspects.
Timing of antihypertensive initiation, slow progress, individualization, maintenance of smoothness, and target organ protection. Hypertension is the most important risk factor for stroke. Blood pressure is positively associated with the occurrence of stroke regardless of sex and age and type of stroke. A history of hypertension prior to stroke onset was found in 42.4% of cases, and blood pressure increased on physical examination after stroke onset in 63.9% of cases. Increased systolic or diastolic blood pressure increases the risk of cerebral hemorrhage and cerebral infarction. Hypertension is not only a risk factor for the development of cerebrovascular disease, but also plays an important role in the recurrence of cerebrovascular disease. Therefore, active and good control of blood pressure should be given sufficient attention in the secondary prevention of cerebrovascular disease. The benefits of antihypertensive treatment mainly come from the antihypertensive itself, and it is important to understand the antihypertensive ability of various antihypertensive drugs under the guarantee of safety.
(4) Antihypertensive drugs
The use of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists is emphasized based on their protective effects on the cardiovascular system in addition to antihypertensive therapy as demonstrated in the HOPE and LIFE trials. B-blockers (beta-blockers) are also considered to play an important role in stroke prevention because of their clear effects on hypertension control.
(5) Blood pressure control goal
Blood pressure should be controlled at 140/90 mmHg and Q130/80 mmHg in patients with combined diabetes mellitus, and should be controlled by medication according to individual conditions. Studies on the possible relative advantages of different classes of antihypertensive drugs in certain aspects suggest that angiotensin II receptor antagonists (ARB) are superior to beta-blockers and calcium antagonists are superior to diuretics in the prevention of recurrent cerebrovascular disease.
2. Glycemic control in cerebrovascular patients
The annual standardized incidence rate of cardiovascular and cerebrovascular patients with metabolic syndrome in the cohort population of 11 provinces and cities was significantly higher than that of the group without metabolic syndrome. Metabolic syndrome is the most important predictor of the development of cardiovascular and cerebrovascular disease (especially cerebrovascular disease). In diabetic patients with cerebrovascular disease, glycemic control at near normal levels is recommended to reduce microvascular comorbidities and possibly macrovascular comorbidities.
Glycemic control index in cerebrovascular patients: glycated hemoglobin 7%, fasting glucose 126 mg/dl (6.99 mmol/L). Patients with diabetes should be given more stringent control of blood pressure and lipids. Although all types of antihypertensive drugs are indicated for the control of hypertension, most patients require more than 1 agent. Because angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are beneficial to prevent renal damage, they are recommended as the drugs of choice for diabetic patients.
Third, the application of anti-platelet aggregation drugs
As early as the 1970s, the clinical application of small doses of aspirin (50-200 mg/day) began to promote the use of anti-platelet aggregation as a first and second stage prophylactic treatment. Aspirin 300 mg/day was administered at the time of acute ischemic stroke. Newer trials have suggested that aspirin plus pansentine is more effective than monotherapy and that clopidogrel is more effective than aspirin. The European Stroke Prevention Study-2, the CAPPIE study, the Chinese Acute Stroke Trial, and other large domestic and international studies have confirmed the importance of aspirin’s standardized application for secondary prevention of cerebrovascular disease.