Stress Management

Stroke

Management of Primary Stroke Risk Factors

1. Risk Factor: Hypertension

Goal:
Systolic blood pressure < 140 mm Hg
Diastolic blood pressure < 90 mm Hg

Interventions:
Blood pressure screening, Lifestyle modification, Antihypertensive medications

2. Risk Factor: Diabetes

Goal:
Tight glucose control, especially when coinciding with hypertension

Interventions:
Diet and lifestyle modification, Oral hypoglycemics, Insulin

3. Risk Factor: Asymptomatic carotid stenosis

Goal:
Significant reduction of carotid stenosis

Interventions:
For stenosis > 60% 
Endarterectomy in selected cases. Surgery has to be performed by a surgeon with < 3% combined complication rate.

4. Risk Factor: Smoking

Goal:
Smoking cessation

Interventions:
Lifestyle modification and drug treatment

5. Risk Factor: Atrial fibrillation

Goal:
Decrease in cardiac thromboembolism rate

Interventions:
For patients < 75 years without other risk factors for stroke - Aspirin
For patients with risk factors for stroke and/ or > 75 years - Warfarin

6. Risk Factor: Lipids

Goal:
Total cholesterol < 200 mg/ dl, 
Low-density lipoprotein (LDL)< 160 mg/dl
High density lipoprotein (HDL) - greater than or equal to 35 mg/dl

Interventions:
Lifestyle modification, Step II diet, drug therapy

7. Risk Factor: Lack of Physical activity

Goal:
At least 30 minutes moderate physical activity daily

Interventions:
Lifestyle modification

8. Risk Factor: Poor diet

Goal:
At least five servings of fruits and vegetables every day

Interventions:
Lifestyle and diet modification

9. Risk Factor: Alcohol

Goal:
No more than two drinks a day for men
One drink per day for nonpregnant women
No drinking if you are pregnant

Interventions:
Lifestyle modification

10. Risk Factor: Drug abuse

Goal:
Complete cessation of drug use

Interventions:
Lifestyle modification, rehabilitation programs, treatment

Source: Eugene D. Kaplan, MD, and Ralph L. Sacco, MD, MSc: "Use of Antiplatelet Therapy for Stroke Prevention," Clinical Geriatrics, Vol. 10, Number 2, February 2002

Caution: If you suspect a stroke, seek emergency medical treatment immediately. Time is of essence.

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