Neurology Department, Lariboisière Hospital AP-HP, Paris Diderot University, Paris 75010, France.
Front Med. 2012 Mar;6(1):22-34. doi: 10.1007/s11684-012-0178-6. Epub 2012 Mar 31.
Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.
中风是个人、家庭和社会的灾难。它是全球第三大致死原因，第一大致残原因，第二大致痴呆原因，其费用高得惊人。由于人口老龄化和许多血管危险因素发病率的增加，中风的负担可能会增加。预防中风包括——与所有其他疾病一样——一种旨在降低社会层面风险的“大众方法”，以及一种旨在降低特定个体风险的个体化方法。大众方法主要基于识别和治疗血管危险因素，如果可能的话，还包括实施保护因素。这些措施是一级预防的基础，但大多数措施现在已被证明在二级预防中也有效。个体化方法结合了血管危险因素的改变和针对中风特定亚型的各种治疗方法，例如抗血小板药物预防大脑中动脉和小动脉疾病中的脑梗死，颈动脉内膜切除术或支架置入术治疗颈动脉狭窄，以及口服抗凝剂预防心脏栓塞。人们越来越意识到，由于社会经济因素，中风预防中存在巨大的证据与实践差距。最近的方法包括降低血压的低成本干预方案和廉价的“多效药丸”，将阿司匹林和几种降低血压和胆固醇的药物结合在一片药丸中。然而，多效药丸的摄入不应导致放弃仍然是中风预防主要支柱的健康生活方式措施。
