Secondary Prevention Strategies for Ischemic Stroke

Ischemic stroke carries a high risk of recurrence, closely linked to the underlying pathology of atherosclerosis. The secondary prevention of ischemic stroke primarily involves the management of risk factors. Among these, hypertension plays a significant role. It is crucial to maintain blood pressure within an ideal range. For patients around 60 years old or younger, the recommended target is below 140/90 mmHg, with an optimal goal of 130/80 mmHg. For elderly patients, particularly those aged 80 to 90, strict adherence to the 140/90 mmHg target is not always necessary, and slight elevations may be acceptable depending on individual health conditions.

Managing Other Key Risk Factors

Diabetes management is equally important, as maintaining stable and ideal blood glucose levels significantly reduces the likelihood of recurrent stroke. Cholesterol levels must also be carefully controlled, especially low-density lipoprotein (LDL) cholesterol. It is generally recommended to keep LDL levels at the lower end of the normal range. For certain high-risk patients, targeting LDL levels below 50% of the standard normal value is often advised.

Healthy lifestyle modifications are essential components of secondary prevention. Patients are encouraged to quit smoking, limit alcohol consumption, adopt a balanced diet, and achieve a healthy weight through regular physical activity. Emotional well-being also plays a role in long-term recovery, and maintaining a positive, stable mindset can support overall cardiovascular health.

Medications for Stroke Prevention

Drug Therapy for Atherosclerosis Patients

For patients whose strokes were caused by atherosclerosis, especially those with vascular stenosis or plaque buildup, physicians often recommend statins to protect the inner lining of blood vessels. Anti-thrombotic medications may also be prescribed to reduce the risk of blood clots. If the patient has a healthy gastrointestinal system, anti-platelet drugs such as aspirin or clopidogrel are typically advised. However, for individuals with a history of peptic ulcers or gastrointestinal bleeding, these medications should be used with caution or avoided altogether.

Effective secondary prevention emphasizes the "two Es"—using effective medications at effective doses. It is critical not to discontinue prescribed treatments without medical supervision. Stopping medication abruptly is strongly discouraged, as it can increase the risk of stroke recurrence and lead to more severe outcomes.

Understanding Primary and Secondary Prevention

Stroke prevention is divided into two categories: primary and secondary. Primary prevention focuses on individuals who are at risk but have not yet experienced a stroke. In contrast, secondary prevention targets those who have already had a stroke. The main objectives of secondary prevention are to improve clinical symptoms, reduce mortality and disability rates, and prevent future stroke events. By following a comprehensive and consistent prevention plan, patients can significantly improve their long-term prognosis and quality of life.