Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Eur Heart J. 2011 Mar;32(5):545-52. doi: 10.1093/eurheartj/ehq472. Epub 2011 Feb 1.
Stroke contributes significantly to morbidity, mortality, and disability worldwide. Despite the successes accomplished in the acute treatment and rehabilitation of stroke, the global burden of this disease can only be tackled with co-ordinated approaches for primary prevention. Stroke is a heterogeneous disease and the contribution of individual risk factors to its occurrence estimated by population attributable risk differs from coronary heart disease. Here, we review evidence to demonstrate the prominent role of elevated blood pressure (BP) and heart disease on risk of stroke, while the influence of lipids on stroke is less clear; we also demonstrate that stroke is an important complication of heart failure. Current approaches to primary preventive action emphasize the need to target the absolute risk of cardiovascular diseases rather than individual risk factors. Lifestyle interventions serve as a basis for primary prevention of cardiovascular diseases. It is estimated that 70% of strokes are potentially preventable by lifestyle modification but prospective evidence is needed to support these hypotheses derived from epidemiological studies. Different strategies for drug interventions in primary prevention are discussed, including the polypill strategy. Additional measures are needed for the primary prevention of stroke which focus on BP, chronic heart failure, and possibly lipids.
中风在全球范围内导致了大量的发病率、死亡率和残疾。尽管在中风的急性治疗和康复方面取得了成功，但只有通过协调一致的一级预防措施，才能应对这种疾病的全球负担。中风是一种异质性疾病，人群归因风险估计的个体危险因素对其发生的贡献与冠心病不同。在这里，我们回顾了证据，以证明血压升高和心脏病对中风风险的显著作用，而血脂对中风的影响则不那么明确；我们还证明中风是心力衰竭的一个重要并发症。目前一级预防措施的方法强调需要针对心血管疾病的绝对风险，而不是针对个体危险因素。生活方式干预是心血管疾病一级预防的基础。据估计，70%的中风可以通过生活方式的改变来预防，但需要前瞻性的证据来支持这些从流行病学研究中得出的假设。讨论了一级预防中药物干预的不同策略，包括多药联合方案。还需要采取额外的措施来预防中风，重点是血压、慢性心力衰竭和可能的血脂。
