Stroke Prevention Flashcards
What cause of stroke is responsible for 50% of mortality
Intracerebral haemorrhage
What does primary prevention focus on
Avoidance of the disease
Lifestyle interventions
Targeting individuals at risk (especially genetics)
What does secondary prevention focus on
Early detection and screening
Treatment of subclinical disease
What does tertiary prevention focus on
Reducing the severity of disease
Reducing the effects of the disease
Reducing the recurrence
What are the barriers to prevention measures
Socioeconomic status
Education
Social deprivation
Perceived discrimination from healthcare system
Inadequate continuity of care
Perceived lack of benefit
What is the largest risk factor for stroke
Hypertension
What is hypertension
Elevated BP (force of blood pushing against artery walls is too high)
Meaning heart has to work harder to pump blood
More than 50% of hypertensive patients had additional cardiovascular risk factors such as
Diabetes
Lipid disorders
Overweight/ obesity
Hyperuricemia
Metabolic syndrome
What is HMOD
Hypertension mediated organ damage
Structural/ functional alteration of the arterial vasculature to the organs it supplies caused by elevated BP
Affects heart, brain, kidneys and eyes
How many % of UK adults have hypertension
28%
For every 7.5mmHg drop in BP stroke risk reduces by
50%
What drugs are used to treat hypertension
ACEi
ARBS
CCB or thiazide like diuretic
Diabetes increases risk stroke by _____
2 to 4 times
Those who suffered a stroke at a younger age what percent were diabetics
76%
People with diabetes how many times more likely to develop vascular dementia
2-3
How is diabetes managed
Lifestyle counselling
Nutrition
Education
Medications such as SGLT-2 inhibitors or GLP-1 agonists
What is atrial fibrillation
In atrial fibrillation the atria of the heart beat irregularly due to extra electrical signals
- ventricles are unaffected?
What describes the pattern of incidence of atrial fibrillation
Increases with age
10% of adults aged over 85 have AFIB
What is the risk of stroke in a person with AF with no rheumatic heart disease compared to rheumatic heart disease
AF with no rheumatic disease = risk x5 higher
AF with rheumatic heart disease = X17 higher
What % of stroke is associated with AF
16%
What’s the best anticoagulant in preventing stroke in patients with AFib
Warfarin ( vitamin K antagonist)
What % of stroke patients have ipsilaeral ICA stenosis
15%
What is a carotid endarterectomy CEA
Surgical procedure in which the plaque is removed from the artery
Less beneficial for asymptomatic disease as risk of stroke is lower
However age also matters. Elderly still more at risk
What is the alternative to CEA for patients with high surgical risk
Carotid angioplasty and stenting CAS
What is the RRR for CEA
65 % relative risk reduction in stroke post CEA for recent symptomatic disease
Agents that can lower lipids
Statins
Ezetimibe
PCSK-9 inhibitors
Bempedoic acid
What kinds of anti-platelet therapies are used in management of non-cardio emboli ischaemic stroke and TIA
Aspirin
Clopidogrel
Dipyridamole
Ticagrelor
Examples of platelet aggregation inhibitors
Aspirin
Clopidogrel
Ticagrelor
