Medications to reduce risk
While lifestyle changes are crucial, they may not be enough on their own to protect our brains and prevent strokes1. For stroke survivors, the effects of stroke can make it challenging for someone to maintain long-term lifestyle changes, in these circumstances, medication can be important for ongoing prevention1. Those who do not follow their medication programme have a significantly higher risk of experiencing another stroke within one year, even if they make lifestyle changes2.
Guidelines advise starting prevention medication at the time of stroke diagnosis. For example, after an ischemic stroke, antiplatelets that prevent blood clots are recommended for prevention of another ischemic stroke or TIA to reduce the risk of stroke and other vascular events by 22%3,4. Managing conditions such as high blood pressure, high cholesterol, diabetes and atrial fibrillation (AF) with medication is crucial for stroke survivors3. It is essential that we follow the medications prescribed. For example:
- Managing high blood pressure, which affects 50-80% of stroke survivors, can lower the risk of another stroke by 25-30% if properly controlled4,5. However, even where 80-90% of survivors receive treatment, less than 40% reach the recommended blood pressure level6,7.
- Up to 24% of stroke survivors are diagnosed with AF after their initial stroke8. Treating AF with anticoagulants can reduce the risk of secondary stroke by 60 to 70%9. Although anticoagulation therapy is accepted as gold standard for reducing the risk of stroke, major challenges are underuse, underdosing and people not following their treatment programme10
For more detailed information on managing stroke risk through medication and surgery, please refer to the section on medical interventions.
Read about medical interventions
Read about surgical interventions
References
- Ryan R Bailey. Lifestyle Modification for Secondary Stroke Prevention. American Journal of Lifestyle Medicine. 2018. 12(2):140–47. https://doi.org/10.1177/1559827616633683
- See‐Hwee Yeo, Matthias Paul Han Sim Toh, Sze Haur Lee, Raymond Chee Seong Seet, Lai Yin Wong, Wai‐Ping Yau. Impact of Medication Nonadherence on Stroke Recurrence and Mortality in Patients after First‐Ever Ischemic Stroke: Insights from Registry Data in Singapore. Pharmacoepidemiology and Drug Safety. 2020. 29(5):538–49. https://doi.org/10.1002/pds.4981
- Jesse Dawson, Yannick Béjot, Louisa M Christensen, Gian Marco De Marchis, Martin Dichgans, Guri Hagberg, Mirjam R Heldner, et al. European Stroke Organisation (ESO) Guideline on Pharmacological Interventions for Long-Term Secondary Prevention after Ischaemic Stroke or Transient Ischaemic Attack. European Stroke Journal. 2022. 7(3). https://doi.org/10.1177/23969873221100032
- NICE. Secondary Prevention Following Stroke and TIA. 2022. https://cks.nice.org.uk/topics/stroke-tia/management/secondary-prevention-following-stroke-tia/
- Kazuo Kitagawa. Blood Pressure Management for Secondary Stroke Prevention. Hypertension Research. 2022. 45(6):936–43. https://doi.org/10.1038/s41440-022-00908-1
- PU Heuschmann, J Kircher, T Nowe, et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 2015. 22(10):1354-62. https://doi.org/10.1177/2047487314546825
- JP Sheppard, K Fletcher, RJ McManus, et al. Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study. Br J Gen Pract 64(618): e38-46). 2014. https://doi.org/10.3399/bjgp14X676447
- Luciano A Sposato, Seemant Chaturvedi, Cheng-Yang Hsieh, Carlos A. Morillo, Hooman Kamel. Atrial Fibrillation Detected after Stroke and Transient Ischemic Attack: A Novel Clinical Concept Challenging Current Views. Stroke. 2022. 53(3). https://doi.org/10.1161/strokeaha.121.034777
- Hans-Christoph Diener, Graeme J Hankey, J Donald Easton, Gregory Y H Lip, Robert G Hart, Valeria Caso. Non-Vitamin K Oral Anticoagulants for Secondary Stroke Prevention in Patients with Atrial Fibrillation. European Heart Journal Supplements. 2020. 22 (Supplement_I): I13–21. https://doi.org/10.1093/eurheartj/suaa104
- Svetlana V Garkina, Tatiana V Vavilova, Dmitry S Lebedev, Evgeny N Mikhaylov. Compliance and Adherence to Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation in the Era of Direct Oral Anticoagulants. Journal of Geriatric Cardiology. 2016. 13(9):807–10. https://doi.org/10.11909/j.issn.1671-5411.2016.09.010