Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
复制标题
DOI：
10.1161/str.0b013e3181fcb238
复制
发表时间：
2011-02-01
期刊：
影响因子：
8.3
通讯作者：
Pearson, Thomas A.
中科院分区：
文献类型：
--
作者：
Goldstein, Larry B.;Bushnell, Chair Cheryl D.;Pearson, Thomas A.
背景与目的——本指南概述了已确定的和新出现的卒中危险因素的证据，为降低首次卒中风险提供基于证据的建议。
方法——写作组成员由委员会主席根据他们之前在相关主题领域的工作进行提名，并经美国心脏协会（AHA）卒中委员会科学声明监督委员会和AHA文稿监督委员会批准。写作组利用系统文献综述（涵盖自2006年上次综述发表至2009年4月的时间段）、参考先前发表的指南、个人文献以及专家意见来总结现有证据，指出当前知识的差距，并在适当的时候，使用美国心脏协会的标准准则制定建议（表1和表2）。写作组的所有成员都有机会对建议进行评论，并批准了本文件的最终版本。该指南在由美国心脏协会科学咨询与协调委员会审议和批准之前，经过了卒中委员会领导层和美国心脏协会科学声明监督委员会的广泛同行评审。
结果——对评估一个人首次卒中风险的方案进行了评估。首次卒中的危险因素或风险标志物根据可改变的可能性（不可改变、可改变或潜在可改变）以及证据强度（有充分文献记载或文献记载不充分）进行分类。不可改变的危险因素包括年龄、性别、低出生体重、种族/民族和遗传倾向。有充分文献记载且可改变的危险因素包括高血压、吸烟暴露、糖尿病、心房颤动和某些其他心脏疾病、血脂异常、颈动脉狭窄、镰状细胞病、绝经后激素治疗、不良饮食、缺乏身体活动以及肥胖和体脂分布。文献记载不充分或潜在可改变的危险因素包括代谢综合征、过量饮酒、药物滥用、口服避孕药的使用、睡眠呼吸障碍、偏头痛、高同型半胱氨酸血症、脂蛋白（a）升高、高凝状态、炎症和感染。对阿司匹林用于一级卒中预防的数据进行了综述。
结论——大量证据确定了多种增加首次卒中风险的特定因素，并提供了降低该风险的策略。（《卒中》2011年；42卷：517 - 584页）
Background and Purpose-This guideline provides an overview of the evidence on established and emerging risk factors for stroke to provide evidence-based recommendations for the reduction of risk of a first stroke.Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council Scientific Statement Oversight Committee and the AHA Manuscript Oversight Committee. The writing group used systematic literature reviews (covering the time since the last review was published in 2006 up to April 2009), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations using standard AHA criteria (Tables 1 and 2). All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive peer review by the Stroke Council leadership and the AHA scientific statements oversight committees before consideration and approval by the AHA Science Advisory and Coordinating Committee.Results-Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic predisposition. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, migraine, hyperhomocysteinemia, elevated lipoprotein(a), hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed.Conclusion-Extensive evidence identifies a variety of specific factors that increase the risk of a first stroke and that provide strategies for reducing that risk. (Stroke. 2011;42:517-584.)