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F1000Res. 2017 Jun 28;6:1017. doi: 10.12688/f1000research.11597.1. eCollection 2017.

Recent advances in preventing stroke recurrence.

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1
Robarts Research Institute, Western University, London, ON, Canada.

Abstract

Recent advances in secondary stroke prevention include new evidence in hypertension, nutrition, anticoagulation, antiplatelet therapy, intracranial stenosis, percutaneous closure of patent foramen ovale, and lipid-lowering therapy. Individualized therapy for hypertension based on phenotyping with plasma renin and aldosterone markedly improves blood pressure control in patients with resistant hypertension. A Mediterranean diet can reduce the risk of stroke by nearly half. The diagnosis and treatment of metabolic vitamin B12 deficiency, and B vitamins to lower homocysteine, can reduce the risk of stroke by approximately 30%. There are problems with clopidogrel that can be overcome by using ticagrelor, and new anticoagulant drugs markedly improve anticoagulation for stroke prevention, particularly in atrial fibrillation. There are pharmacokinetic problems with dabigatran that deserve attention. Intensive medical therapy is better than stenting for intracranial stenosis, and new therapies directed at proprotein convertase subtilisin-kexin type 9 (PCSK9) will revolutionize lipid-lowering therapy. In the past, it was estimated that rational therapy could reduce recurrent stroke by about 80%. With recent advances, we should be able to do even better.

KEYWORDS:

B12 deficiency; LDL cholesterol; anticoagulation; antiplatelet; diet; hypertension; intracranial stenosis; stroke recurrence

Conflict of interest statement

Competing interests: The author declares that he has no competing interests.No competing interests were disclosed.No competing interests were disclosed.

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