At present, cerebrovascular disease has become a major disease that endangers the health and life of middle-aged and elderly people in China, and its morbidity, mortality and disability rates are high. The prevention of morbidity is the primary prevention, also called fundamental prevention or etiological prevention. The method is to avoid and control the various risk factors of cerebrovascular disease.
First, to know your blood pressure
Hypertension is the most important risk factor for cerebral hemorrhage and cerebral infarction. After controlling other risk factors, the relative risk of stroke increases by 49% for every 10 mmHg increase in systolic blood pressure and by 46% for every 5 mmHg increase in diastolic blood pressure. Therefore, it is recommended that people ≥ 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 to 3 months) to adjust the dose of medication.
Second, to understand the presence of heart disease
The risk of stroke is more than 2 times higher in people with heart disease than in those without heart disease. Adults (≥40 years old) should have regular checkups for early detection of heart disease; patients diagnosed with heart disease should be actively treated by a specialist;
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 should be appropriate; or oral aspirin 50-300 mg/d, or other antiplatelet aggregation drugs. Patients at high risk of coronary artery disease should also take small doses of aspirin 50-150mg/d, or other anti-platelet aggregation drugs.
Third, to understand the presence of diabetes mellitus
Patients with type II diabetes mellitus have a 2-fold increased risk of stroke. People with risk factors for cardiovascular disease should have their blood glucose tested regularly, and glycated hemoglobin (HbA1c) and glycated plasma albumin should be measured if necessary. Diabetic patients should first control their diet and strengthen physical exercise, and those whose blood sugar control is still unsatisfactory in 2 to 3 months should be treated with oral hypoglycemic drugs or insulin.
Fourth, to understand the presence of dyslipidemia
A large number of studies have confirmed that elevated serum total cholesterol (TC), low-density lipoprotein (LDL) and reduced high-density lipoprotein (HDL) are closely related to cardiovascular disease. People with dyslipidemia should first change their unhealthy lifestyles and have their blood lipids reviewed regularly. Those whose lifestyle changes are ineffective are treated with medication. Patients with a 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.
V. Quit smoking
Frequent smoking mainly affects the systemic vascular and blood system, such as accelerating atherosclerosis, increasing fibrinogen level, promoting platelet aggregation, and lowering HDL level. Long-term passive smoking can also increase the risk of stroke. Smoking is harmful but not beneficial.
Six, moderate alcohol consumption
Evidence from population studies has shown that alcohol intake has a direct dose-related effect on hemorrhagic stroke. However, the relevance for ischemic stroke is still controversial. Therefore, small amounts of alcohol are not advocated for non-drinkers to prevent cardiovascular disease; pregnant women should avoid alcohol. Previous drinkers must be moderate and not alcoholic; the daily alcohol content should not exceed 20-30g for men and 15-20g for women.
VII. Treatment of carotid artery stenosis
Some foreign studies found that 7% to 10% of men and 5% to 7% of women aged 65 years or older had carotid artery stenosis greater than 50%. Therefore, surgical treatment or endovascular intervention is generally not recommended for patients with asymptomatic carotid stenosis, and antiplatelet agents such as aspirin or statins are preferred. For patients with severe carotid artery stenosis (>70%), carotid endarterectomy or endovascular intervention can be considered where available.
VIII. Weight loss
A prospective study of 10 populations in China showed that the relative risk of ischemic stroke in obese people was 2.2. Several large studies in recent years have shown that abdominal obesity is more closely related to stroke than increased body mass index (BMI) or homogeneous obesity. Obesity can cause hypertension, hyperglycemia hyperlipidemia and atherosclerosis. Overweight and obese people can reduce the risk of stroke by adopting a healthy lifestyle and increasing physical activity to reduce weight. Promote a healthy lifestyle and good dietary habits.
IX. Reasonable lifestyle
Salt limitation and potassium supplementation, low-fat diet with daily intake of fresh fruits and vegetables and soy products can eliminate the influence of risk factors for hypertension disease. Stable emotion, mental relaxation and proper exercise also have positive effects on the prevention of cerebrovascular disease.
X. Control other risk factors
Hyperhomocysteinemia; metabolic syndrome; oral contraceptives; procoagulant risk factors.