Ezekowitz Justin A, Straus Sharon E, Majumdar Sumit R, McAlister Finlay A
University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta.
Am Fam Physician. 2003 Dec 15;68(12):2379-86.
Stroke is a leading cause of morbidity and mortality in North America. Primary prevention of stroke includes lifestyle modifications and measures to control blood pressure, cholesterol levels, diabetes mellitus, and atrial fibrillation. Lowering blood pressure in patients with hypertension prevents both hemorrhagic and ischemic stroke (relative risk reduction, 35 to 45 percent). Observational studies suggest that higher cholesterol levels are associated with an increased risk of ischemic stroke, and treatment with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) may reduce the risk of fatal and nonfatal stroke by 25 percent. Although high-quality evidence linking tighter glucose control with stroke reduction is lacking, good glucose control and aggressive treatment of hypertension and hyperlipidemia in patients with diabetes mellitus are recommended. The risk of stroke in patients with atrial fibrillation and the role of anticoagulation depend on factors such as age and the presence of comorbid conditions. Controversy exists about the roles of angiotensin-converting enzyme inhibitors and aspirin in the primary prevention of stroke.
中风是北美地区发病和死亡的主要原因。中风的一级预防包括生活方式的改变以及控制血压、胆固醇水平、糖尿病和心房颤动的措施。高血压患者降低血压可预防出血性和缺血性中风（相对风险降低35%至45%）。观察性研究表明，较高的胆固醇水平与缺血性中风风险增加有关，使用他汀类药物（3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂）治疗可使致命和非致命性中风的风险降低25%。尽管缺乏将更严格的血糖控制与中风风险降低联系起来的高质量证据，但仍建议对糖尿病患者进行良好的血糖控制以及积极治疗高血压和高脂血症。心房颤动患者的中风风险以及抗凝的作用取决于年龄和合并症等因素。关于血管紧张素转换酶抑制剂和阿司匹林在中风一级预防中的作用存在争议。
