Optimizing vascular risk reduction in the stroke patient with atherothrombotic disease

ABSTRACT

With mounting evidence underscoring the multifactorial pathogenesis of atherothrombotic cerebrovascular disease, it is becoming increasingly obvious that an early and aggressive multimodal treatment of the underlying atherosclerotic disease process is the most effective approach towards preventing recurrent vascular events in the majority of ischemic stroke patients. Knowledge of the evidence behind this strategy and the effective means for implementing it could be useful to the healthcare practitioner caring for stroke and transient ischemic attack [TIA] patients. This review presents the evidence behind the broadening therapeutic options for recurrent vascular event prevention in ischemic stroke patients whose underlying stroke pathophysiologic mechanism is presumed to be due to atherosclerosis. The paper identifies modifiable vascular risk factors associated with recurrent stroke, as well as the clinical trial data on which the latest clinical practice guidelines on recurrent stroke prevention have been based. Therapies discussed include antithrombotics, statins, antihypertensives, revascularization procedures and lifestyle modification [smoking cessation, exercise and diet education]. Finally, successful hospital-based quality improvement programs for initiating and maintaining these evidence-based recurrent stroke prevention treatments are also described. A timely, systematic, evidence-based multimodal preventive approach to atherothrombotic disease in ischemic stroke and TIA patients that transcends the continuum of care will enhance treatment rates and improve clinical outcomes: