Prevention of cerebrovascular diseases

1. Big picture

Prevention of cerebrovascular disease means reducing the risk of ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage, subarachnoid hemorrhage, vascular dementia, and recurrent vascular events.

For the exam, the most important distinction is:

Primary prevention = prevent the first stroke.
Secondary prevention = prevent another stroke after TIA or stroke.

The key clinical idea is simple:

Most strokes are preventable because the main risk factors are treatable: hypertension, smoking, diabetes, dyslipidemia, atrial fibrillation, carotid stenosis, obesity, physical inactivity, and alcohol/drug use.

The highest-yield risk factor is:

Hypertension.

It increases the risk of both ischemic stroke and intracerebral hemorrhage, and its treatment is the single most important preventive intervention.

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