Anderson C S
Department of Medicine, Flinders Medical Centre, Bedford Park, Australia.
J Hypertens Suppl. 1996 Dec;14(6):S25-8.
Epidemiological studies suggest that significant reductions in the incidence of stroke, as with coronary heart disease, can be expected by reducing the prevalence or shifting the distribution of risk factors across the entire population. Thus, identifying risk factors and intervening to control or modify them remains the most important means of further reducing the incidence and case fatality of stroke in developed countries, and controlling the emerging epidemic of cardiovascular disease in developing countries. All people should be encouraged to stop smoking, reduce weight, and increase physical activity and the consumption of fruit and vegetables.
The high-risk strategy involves the identification and management of people at high risk of developing stroke. Therapies of proven benefit in the prevention of stroke among certain individuals are blood pressure lowering therapy, antiplatelet therapy, anticoagulation therapy and carotid endarterectomy. Evidence is mounting that aggressive treatment of hypercholestrolaemia and hyperglycaemia is also effective in reducing the risk of stroke, but the role of aspirin and carotid endarterectomy in the primary prevention of stroke remains uncertain. This article will review strategies for the prevention of stroke, except blood pressure lowering therapy, which is discussed elsewhere, and address some of the questions about which individuals have the most to gain from various interventions.
流行病学研究表明，与冠心病一样，通过降低危险因素在整个人口中的流行率或改变其分布，有望显著降低中风的发病率。因此，识别危险因素并进行干预以控制或改变这些因素，仍然是发达国家进一步降低中风发病率和病死率、以及发展中国家控制心血管疾病新流行的最重要手段。应鼓励所有人戒烟、减重、增加体育活动以及增加水果和蔬菜的摄入量。
高危策略涉及识别和管理有中风风险的高危人群。在某些个体中已证实对预防中风有益的治疗方法包括降压治疗、抗血小板治疗、抗凝治疗和颈动脉内膜切除术。越来越多的证据表明，积极治疗高胆固醇血症和高血糖症在降低中风风险方面也有效，但阿司匹林和颈动脉内膜切除术在中风一级预防中的作用仍不确定。本文将综述中风预防策略，但降压治疗在其他地方讨论，同时探讨一些关于哪些个体能从各种干预措施中获益最多的问题。
