PubMed Central, TABLE 2a: Ther Adv Cardiovasc Dis. 2008 August; 2(4... http://www.ncbi.nlm.nih.
gov/pmc/articles/PMC2729177/table/T2/
From: Ther Adv Cardiovasc Dis. Author manuscript; available in PMC 2009 August 19.
Published in final edited form as:
Ther Adv Cardiovasc Dis. 2008 August; 2(4): 287–303.
doi: 10.1177/1753944708093847
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TABLE 2a
Effects of treatment of risk factors in primary prevention of stroke
Risk
Risk factor Evidence Management/Comments
Reduction
Screening every 2 years.
Individualized management and choice of
12 agent.
Hypertension , Class I A 35 – 44%
Life style modification.
Goal BP <140/90mm Hg for usual care and
‡
<130/80 for compelling indications.
Pre-Hypertension1 No data --- Life style modification
Data lacking
Reduction of microvascular complications,
to support
Glycemic but not macrovascular.
effect on ---
control3 Emphasis on aggressive management of other
stroke
risk factors in patients with diabetes.
reduction
Diabetes
Goal BP < 130/80 mmHg.
Hypertension
124 Class I A 20-44% ACEI/ARB are preferred agents in patients
control , ,
with diabetes and microalbuminuria.
Hyperlipidemia2, Class I A 24-48%
LDL Goal < 100
5 LDL <70 for high-risk patients.
Diet, exercise and medications reduce
Pre-Diabetes3 No data --- incidence of diabetes, but the effects on
vascular outcomes are not known.
Anticoagulation also recommended for
valvular heart disease.
20%aspirin
Atrial fibrillation2 Class I A Goal INR 2.0-3.0.
68%warfarin
Low risk patients — aspirin or warfarin
High risk patient — warfarin
If coronary artery disease or high risk
Class I A hypertensive, even with normal LDL levels
treat with lifestyle measures and a statin.
Hyperlipidemia2 30% If coronary artery disease and low HDL
levels treat with weight loss, increased
Class IIa B
physical activity, smoking cessation, and
consider adding niacin or gemfibrozil.
50% at 1 year, Counseling.
2
Smoking cessation Class I B baseline by 5 Nicotine replacement.
years Oral smoking-cessation medications.
Abdominal obesity associated with an odds
2 * ratio for stroke 1.75-2.37. Weight loss affects
Obesity Class I A ---
other vascular risk factor (diabetes, HTN) but
has not been shown to affect stroke directly.
Evidence class and level as defined by the AHA: Class I Evidence and/or general agreement that treatment is useful and effective;
Class II Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of treatment; Class IIa Weight of evidence or
opinion in favor of treatment; Class IIb Usefulness/efficacy less well established by evidence or opinion; Class III Evidence and/or
general agreement that treatment is not useful/effective and may be harmful. Level A Data from multiple randomized clinical trials; Level
B Data from a single randomized trial or nonrandomized studies; Level C Expert opinion or case studies.
1 of 2 04-Feb-12 3:31 PM
PubMed Central, TABLE 2a: Ther Adv Cardiovasc Dis. 2008 August; 2(4... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729177/table/T2/
‡
Compelling indications = Diabetes, chronic kidney disease, myocardial infarction, congestive heart failure.
1
(Chobanian, Bakris et al. 2003).
2
(Goldstein, Adams et al. 2006).
3
(Ryden, Standl et al. 2007).
4
(UKPDS-Group-Investigators 1998b).
5
(The Expert Panel on Detection 2002).
*
For weight reduction and hypertension control.
2 of 2 04-Feb-12 3:31 PM
