Stroke Prevention and Management
The main primary preventive approaches for stroke are the promotion and maintenance of healthy lifestyle and blood pressure control. A healthy lifestyle includes not smoking (and smoking cessation for smokers), no binge drinking, being physically active, and a healthy diet characterized by adequate fruit and vegetable intake, reduced dietary trans fat intake, and reduced sodium intake.
High blood pressure prevention and control
Reducing blood pressure has been demonstrated to reduce the risk of stroke effectively. In a meta-analysis of 11 clinical trials on blood pressure reduction and stroke among Asian populations, a 10mmHg reduction in systolic blood pressure was associated with a 30% reduction in risk of stroke, regardless of the anti-hypertensive agents used (renin–angiotensin blockers, calcium-channel blockers, or diuretics).
Tobacco control was ranked number one among the top five priority interventions for non-communicable diseases (NCDs), according to a group of experts. According to a micro-simulation model based on Indian data, smoke-free legislation and tobacco taxation in combination could avert 25% (95% CI: 17%–34%) of myocardial infarctions and strokes if the effects of the interventions are additive.
Reduction of sodium intake has been ranked as the second most cost-effective intervention, after tobacco control, for addressing the NCD crisis. Achievement of actual and sustained reduction in sodium intake remains a challenge for both researchers and policymakers, due to the notorious difficulty of changing lifelong dietary habits. More emphasis is needed on programs that discourage younger generations from establishing a high-sodium dietary pattern earlier in life.
Secondary Prevention of stroke
Secondary prevention of stroke is of particular importance due to high risk of recurrent stroke which occurs in approximately one third of stroke survivors in 5 years. Evidence-based guidelines for secondary prevention stresses the benefits of healthy lifestyle, such as healthful diet, appropriate physical activity, and non-smoking, similar to those described for primary prevention. Additional measures are discussed below.
Blood pressure control
Control of high blood pressure remains themost important strategy for secondary prevention of stroke. Existing evidence shows that lowering blood pressure with lifestyle changes and antihypertensive medicines protect against stroke recurrence. No comprehensive data are available on how well blood pressure treatment has been achieved among stroke patients in LMICs; however, it is intuitively logical that the situation is worse in LMICs, compared to HICs, because of the higher prevalence of stroke, more limited access to high-quality healthcare, and lower affordability of medicine in these countries, especially in rural areas.
Surgery for Carotid Stenosis
Surgical interventions for symptomatic or asymptomatic carotid stenosis may be one option for certain patients for secondary prevention. The less invasive carotid artery stenting was not inferior to traditional carotid endarterectomy. However, the cost of stenting is much higher than endarterectomy. More evidence is needed to determine whether and under which circumstances surgical interventions for carotid stenosis are useful.
Self-management and family support
Community-based self-management intervention is a promising strategy to address public health problems of chronic conditions worldwide by emphasizing patient responsibility and acting in concert with community healthcare providers. Self-management in stroke involves conscious effort by patients themselves to deal with stroke-induced impairments, threat of stroke recurrence, and challenges of long-term recovery. Patients require a combination of information provision, support, and education about behavior change, tailored to the beliefs, attitudes and cognitions of those who have had a stroke, their social circle, and healthcare providers.