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[Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure].
Ned Tijdschr Geneeskd 2006; 150(39):2127-30NT

Abstract

The most important risk factor for stroke is blood pressure: lowering the diastolic pressure by 5-6 mmHg or the systolic pressure by 10 mmHg will reduce the number of strokes in the general population (primary prevention) by 30-40% over 4-5 years. This effect is enhanced by the concurrent use of diuretics. The association between stroke and serum cholesterol was unclear until trials on preventing cardiovascular disease showed the introduction of statins to be clearly beneficial on strokes. In the recent 'Stroke prevention by aggressive reduction in cholesterol levels' (SPARCL) trial, high-dose statin therapy was shown to reduce the risk of fatal and non-fatal stroke in patients with a history of ischaemic stroke or transient ischaemic attack (TIA), but without manifest coronary disease (secondary prevention). A difference in LDL-cholesterol of 1.4 mmol/l was associated with a significant absolute 5-year risk reduction of fatal and non-fatal stroke of 2.2%, whereas the risk of major cardiovascular events was reduced by 3.5%. It is already known that stroke or TIA should be regarded as a 'coronary heart disease risk equivalent' for which secondary prevention guidelines apply. However, high-dose statin therapy should be given only after careful selection of the stroke patient at very high risk because of its high cost, adverse effects and a possible increase in haemorrhagic stroke.

Authors+Show Affiliations

Universitair Medisch Centrum St Radboud, afd. Algemeen Interne Geneeskunde en Vasculaire Geneeskunde, 463, Postbus 9101, 6500 HB Nijmegen. a.stalenhoef@aig.umcn.nl

Pub Type(s)

English Abstract
Journal Article

Language

dut

PubMed ID

17059084

Citation

Stalenhoef, A F H.. "[Secondary Prevention of Recurrent Stroke By Lowering Cholesterol Levels and Blood Pressure]." Nederlands Tijdschrift Voor Geneeskunde, vol. 150, no. 39, 2006, pp. 2127-30.
Stalenhoef AF. [Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure]. Ned Tijdschr Geneeskd. 2006;150(39):2127-30.
Stalenhoef, A. F. (2006). [Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure]. Nederlands Tijdschrift Voor Geneeskunde, 150(39), pp. 2127-30.
Stalenhoef AF. [Secondary Prevention of Recurrent Stroke By Lowering Cholesterol Levels and Blood Pressure]. Ned Tijdschr Geneeskd. 2006 Sep 30;150(39):2127-30. PubMed PMID: 17059084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure]. A1 - Stalenhoef,A F H, PY - 2006/10/25/pubmed PY - 2006/12/9/medline PY - 2006/10/25/entrez SP - 2127 EP - 30 JF - Nederlands tijdschrift voor geneeskunde JO - Ned Tijdschr Geneeskd VL - 150 IS - 39 N2 - The most important risk factor for stroke is blood pressure: lowering the diastolic pressure by 5-6 mmHg or the systolic pressure by 10 mmHg will reduce the number of strokes in the general population (primary prevention) by 30-40% over 4-5 years. This effect is enhanced by the concurrent use of diuretics. The association between stroke and serum cholesterol was unclear until trials on preventing cardiovascular disease showed the introduction of statins to be clearly beneficial on strokes. In the recent 'Stroke prevention by aggressive reduction in cholesterol levels' (SPARCL) trial, high-dose statin therapy was shown to reduce the risk of fatal and non-fatal stroke in patients with a history of ischaemic stroke or transient ischaemic attack (TIA), but without manifest coronary disease (secondary prevention). A difference in LDL-cholesterol of 1.4 mmol/l was associated with a significant absolute 5-year risk reduction of fatal and non-fatal stroke of 2.2%, whereas the risk of major cardiovascular events was reduced by 3.5%. It is already known that stroke or TIA should be regarded as a 'coronary heart disease risk equivalent' for which secondary prevention guidelines apply. However, high-dose statin therapy should be given only after careful selection of the stroke patient at very high risk because of its high cost, adverse effects and a possible increase in haemorrhagic stroke. SN - 0028-2162 UR - https://www.unboundmedicine.com/medline/citation/17059084/[Secondary_prevention_of_recurrent_stroke_by_lowering_cholesterol_levels_and_blood_pressure]_ L2 - https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html DB - PRIME DP - Unbound Medicine ER -