Stroke Epidemiology and Risk Factor Management.
Stroke Epidemiology and Risk Factor Management.
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DOI：
10.1212/con.0000000000000416
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发表时间：
2017-02-01
期刊：
影响因子：
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通讯作者：
Bushnell, Cheryl
中科院分区：
文献类型：
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作者：
Guzik, Amy;Bushnell, Cheryl
综述目的：在过去的十年中，中风死亡率有所下降，目前中风是美国第五大死亡原因。此外，新发和复发性卒中的发病率正在下降，这可能是因为增加了特定预防药物的使用，如他汀类药物和抗高血压药物。尽管在发病率和死亡率方面有这些积极的趋势，但许多中风仍然是可以预防的。主要可改变的风险因素是高血压、糖尿病、吸烟和高脂血症，以及生活方式因素，如肥胖、饮食/营养不良和缺乏体育活动。本文回顾了目前的建议，为管理这些可修改的风险factors.Recent发现：它已被证明，一些血压药物可能会增加血压的变异性，并最终增加中风的风险。卒中预防通常包括抗血小板治疗（除非存在抗凝适应症），因此对支持使用这些药物的最新证据进行了综述。此外，新出现的风险因素，如阻塞性睡眠呼吸暂停，电子香烟，脂蛋白（a）升高，进行了讨论。概要：总体而言，二级预防中风包括多因素的方法。本文结合了指南和已发表的研究的证据，并在整篇文章中使用了一个说明性的案例研究，以提供中风风险因素二级预防管理的例子。
PURPOSE OF REVIEW: Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity. This article reviews the current recommendations for the management of each of these modifiable risk factors.RECENT FINDINGS: It has been documented that some blood pressure medications may increase variability of blood pressure and ultimately increase the risk for stroke. Stroke prevention typically includes antiplatelet therapy (unless an indication for anticoagulation exists), so the most recent evidence supporting use of these drugs is reviewed. In addition, emerging risk factors, such as obstructive sleep apnea, electronic cigarettes, and elevated lipoprotein (a), are discussed.SUMMARY: Overall, secondary stroke prevention includes a multifactorial approach. This article incorporates evidence from guidelines and published studies and uses an illustrative case study throughout the article to provide examples of secondary prevention management of stroke risk factors.