Prevention of stroke in men and women

Stroke( ONMC) is a fairly common acute cerebrovascular disease, leading at best to disability of the patient, at worst - to a lethal outcome. To protect yourself from its consequences, it is important to know the measures of preventive care.

The state of the brain with a sudden disorder of its functions, resulting from the deterioration of its blood supply, is called acute cerebral vascular stroke, or stroke.

• This occurs when violation of patency and integrity of the arteries feeding the brain, if they contain deposits of atherosclerotic plaques, due to arterial hypertension, diabetes mellitus or their combinations;
• This diagnosis is valid in the case when such a condition lasts more than 24 hours and in the future can be fatal;
• The concept of stroke can still be described as an acute violation of the blood supply to the brain( cerebral infarction), and this is always a complication of human diseases that occur acutely or chronically;
• Is the main cause of disability and incapacity of the population. And, in recent years, young people who are able to work have become more likely to be exposed to it. Only 20% of them after the restoration return to work without limiting their professional capabilities. In 60% of people after a stroke, a mild neurological deficit persists. At the same time, 20% of people need further external help and care when doing their household skills;
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• Mortality after the expiration of a month after a previous acute vascular accident depends on its nature, so, with ischemic stroke, the mortality is 8-15%, 42-46% with subarachnoid hemorrhages, 48-42% with intracerebral hematomas.

We can not lose hope of a favorable outcome of the disease, which can occur within one month, with the reverse development of all neurological symptoms or the preservation of mild disorders. It depends on the severity of the symptoms, behavior and mood of patients and their relatives. Therefore, it is so important to follow the measures of primary and secondary prevention. They are selected separately for each person and are based on non-drug and medicament methods, the conduct of which should favorably affect the level of morbidity and the frequency of deaths from acute brain disasters.

Measures of primary prevention of acute vascular disorders

The primary measure of stroke prevention is control of blood pressure and maintenance of it within the limits of acceptablevalues.

They are aimed at preventing the first acute brain episode. To do this, you need to know the factors that predispose to this, and try to limit their adverse effects. Speaking of this, it is implied that the probability of development of acute vascular catastrophes in a person is higher, the more there are factors predisposing to them. The task of the district doctor of the polyclinic is to identify early individuals with such "prerequisites" and carry out their subsequent correction. For example, it is recommended to maintain blood pressure at a comfortable level for a person( not more than 140/90 mm Hg) and not allow it to rise to critical figures( 200-220 / 100-120 mm Hg), monitor changes in indicatorstotal cholesterol, lipids, blood sugar, waist circumference in men( not more than 102 cm) and women( not more than 88 cm).

Possible causes of risk

Most of the causes of the risk of developing cerebral infarctions, according to experts, considering the possible impact on their change and degree of study, are divided into:

Well-researched:

• Eliminated: arterial hypertension;exposure to cigarette smoke;excess of body weight;diabetes;long-term stress;cardiac pathology( arrhythmias, recent acute myocardial infarction);narrowing of the carotid artery;deficiency of hormones in postmenopause;unbalanced diet;lack of physical activity.
• Unrecoverable: gender differences, age characteristics, race, heredity, ethnic and geographical factors.

Insufficiently studied:

1. Exchange disorders of the ratio of fats, excess of insulin and decrease in digestibility by the body tissues of blood sugar;
2. Cardiac pathology: cardiomyopathy, sagging of the bicuspid valve flaps, unopened ovarian opening of the interatrial septum;
3. Violation of the bleeding stop system, dissolution of blood clots;
4. Conditions without any manifestations, atherosclerotic plaque of the aortic arch, cerebral infarction without clear clinical symptoms, but detected by MRI;
5. Also include migraine headaches, respiratory arrest syndrome in sleep, alcohol consumption in large quantities.

Parameters that can not be affected:

1. Heredity. The presence of a stroke in the parents does not exclude the high degree of its development in children;
2. Race. The incidence of acute vascular events varies widely in certain ethnic groups, for example between blacks and white Americans, between Europeans and people in South-East Asia. This is due to the peculiarities of life, the nature of nutrition, the socio-economic conditions, the availability of medical care;
3. Age characteristics. The incidence of stroke increases in every decade of life, but the highest percentage is found after the age of sixty. Simultaneously, there is a clear desire to rejuvenate acute vascular brain conditions( in persons younger than 50 years);
4. Sex differences. The predominance of a violation of the blood supply to the brain in representatives of the male population was 1.25 times unlike that of the female population. Despite this, the share of mortality is higher among females due to longer life expectancy.

The struggle with disposable characteristics is of greatest importance for prevention. Therefore, the doctor aims to bring powerful arguments to convince the patient to change these life principles for the benefit of his health.

Exception of smoking tobacco

Smoking promotes the formation of atherosclerotic plaques and blood thickening. The risk of stroke among smokers increases twofold.

Tobacco smoking increases the probability of developing brain incidents by a factor of 2 and is directly related to the number of cigarettes smoked and the duration of smoking. This is due to the ability of the addiction to affect the processes of blood clotting and the formation of plaques of atherosclerosis, so it is better to completely abandon it.

With the cessation of smoking, the pressure, pulse, temperature of hands and feet normalizes. The balance of oxygen and carbon dioxide is restored. The body begins to self-purification. Differences in blood pressure are reduced, which gives the first preconditions to note the occurrence of a heart attack to a minimum. Improved taste and olfactory sensations.

After a month of abstinence, blood circulation and respiratory functions normalize, and in two - it becomes easier to carry out walking tours. After three months - dyspnea disappears, coughing and arrhythmia. The mucous membrane of the lung can now independently cope with infections from the outside. For 5-10 years after quitting smoking, the risk of a heart attack is reduced to the level of a non-smoker.

Do not also condemn your body to passive inhalation of cigarette smoke, as this also adversely affects the expansion of blood vessels.

Avoiding alcohol abuse

It is recommended to stop drinking alcohol in large quantities. This will lead to a gradual reduction in the risk of stroke in former alcoholics. Exceeding the permissible doses of alcohol consumption can lead to hemorrhage into the brain substance, negatively affect the work of the heart and liver, the exchange of fats and favors the development of arteriosclerosis of blood vessels, increased blood pressure and cholesterol level. For men, the optimal amount of alcohol is less than 24 mg / day, for women - 12 mg / day.

Active motor mode

It is necessary to maintain daily activity, avoid static poses. Regular physical exercises prevent the likely risk of cardio- and cerebrovascular diseases. Adequate exercise forces the heart to work more efficiently, regulates blood pressure, coagulability of blood, helps to get out of stress, helps the body to utilize insulin, has a favorable effect on body weight and can raise the level of "good" lipoproteins with increased density( low density - source of plaque formation) and total cholesterol. The optimal mode of distribution of activity per day is selected separately for each patient, taking into account his age, features of the state and physical readiness. Thus, persons with asymptomatic cardiac pathology associated with insufficient blood flow to the myocardium( IHD) should be engaged in walking, cycling, swimming, skiing and jogging. Do less than three times a week for 45-50 minutes, not excluding warm-up and rest periods. The intensity of exercise is controlled by the pulse rate( not more than 60-75% of the maximum).

Normalization of body weight

Support of healthy weight. Obesity is the first step towards mortality from atherosclerosis and ischemic heart disease and the formation of hypertension, diabetes and lipid and cholesterol metabolism. The distribution of subcutaneous fat also matters. People with fat deposits at the waist( abdominal obesity) are more likely to develop coronary heart disease than those who have fat on their hips. At the reception, the doctor must necessarily measure the waist volume to diagnose abdominal obesity. In male subjects, the waist circumference should not exceed 102 cm, for women - 88 cm. Recently, people tend to tend to excessive body weight, especially at the age of up to 50 years, and this increases the incidence of cardiovascular pathology in 2-3 times. Body weight is assessed using a special index, which normally should be 18.5-24.9 kg / m2.It is important to constantly adjust this parameter, comparing it with the cholesterol content( not higher than 5.2 mmol / l) and the lipid spectrum of the blood plasma. Exceeding their targets in conjunction with other cardiovascular risk factors for stroke is a direct indication for taking statins( simvastatin, fluvastatin, atorvastatin, rosuvastatin).The question of rational appointment is considered by the attending physician separately for each case.

Blood glucose under the control of

People suffering from diabetes mellitus to reduce the risk of vascular complications, it is important to keep the blood sugar within acceptable limits.

Blood glucose monitoring. Non-insulin-dependent diabetes mellitus( 2 types) is a powerful risk factor for heart and brain vessels and creates preconditions for the development of acute conditions. In men of the male population, this happens 2-3 times more often, for women it is 3-7 times. With this form of diabetes, the sensitivity of body tissues to insulin decreases, and as a result, its increased accumulation. Glucose is not distributed properly in the cells and its amount in the blood rises, this insulin is released even more. Excess insulin leads to excessive formation of fat, which in turn provokes the development of atherosclerotic plaques on the walls of the arteries. Diabetes damages mostly small vessels of the eyes, kidneys, limbs, but is also closely related to diseases in which large vessels are affected( in this case, cerebral vessels).Weight control, proper nutrition, adequate exercise and taking drugs that reduce sugar, in the form of tablets or in the form of subcutaneous injections of insulin lead to better digestibility of sugar from the blood and prevent the onset of diabetes or its complications.

Healthy diet

Rational nutrition and dieting is of great importance for the prevention of acute disorders. In the diet, fruits, vegetables, vegetable oils with restriction of animal fats, cholesterol-rich( fatty meat, fat, butter, sour cream, egg yolk, sausage, sausages, fatty kinds of cheese) must be present in sufficient quantities. The diet aims to minimize the concentration of cholesterol and lipids with low density in the blood plasma, but at the same time to preserve its diversity and usefulness to cover all the energy costs of the body, increase the level of potassium due to the products containing it and reduce salt intake - a provocateur of high blood pressure. It is important in proper nutrition to give preference to foods that contain fiber. It is found in cauliflower, broccoli;peas, beans;pears, apples, peaches;raspberries, strawberries, blueberries. Focus on complex carbohydrates of cereals, vegetables and fruits. The daily amount of sugar should not exceed 50 g. Products that have antioxidant properties, that is, containing vitamins C, A, E, beta-carotene, can play an important role. For example, a rich source of vitamin A is the fish of the northern seas( mackerel, sardines, tuna, herring, halibut);vitamin C( citrus fruits, sweet peppers, tomatoes, beets, cabbage, potatoes, zucchini, green peas);vitamin E - vegetable oils( cottonseed, sunflower, corn), hazelnuts, sunflower seeds;beta-carotene - fruits and vegetables of green and orange color( carrots, melon, pumpkin, bananas, persimmons, peaches), leaves of spinach, sorrel, parsley.

Blood Pressure Adjustment

The doctor also recommends mandatory monitoring of blood pressure and its support within the limits of proper values. Overestimated blood pressure figures for some are a surprise, so for a primary prevention of stroke should be as early as possible to identify this increase and begin its treatment. High figures of pressure indicate the presence of hypertension in a person, and without the necessary drug therapy this can lead to complications, in particular, to a crisis( BP = 200-220 / 100-120 mm Hg).Hypertension is one of the possible factors in the development of coronary heart disease( CHD) and the main cause of development of acute vascular pathology. It is necessary to regularly monitor the indices of blood pressure: for patients with AH, SD, IHD, chronic kidney and thyroid gland diseases at least every 4-6 months. Continuous measurement of pressure during the day is carried out. Such a study provides more complete information on changes in blood pressure in the morning and at night;assesses the effect of treatment and the uniform distribution of the effect of the drug throughout the day, shows the condition of the heart and blood vessels. BP indices should not be more than 140/85 mm Hg, and if they are exceeded, antihypertensive measures are prescribed to all adult patients, regardless of age. It is better to start them with the appointment of one drug and only if it is ineffective go to combinations. The drugs should be administered gradually, slowly increasing the dose, especially for the elderly and with a strong narrowing( more than 70%) of the carotid arteries. In the first stages, treatment may include thiazide diuretics( hypothiazide);ACE inhibitors( ACE inhibitors) - lisinopril, enalapril, captopril, perindopril;calcium channel blockers( BCC) - nimodipine, nifedipine, amlodipine;beta-blockers( in people younger than 60 years) - bisoprolol, propranolol, carvedilol or aldosterone receptor blockers( sartans) - losartan, valsartan. In patients with diabetes mellitus or chronic kidney disease( CKD), the choice mostly falls on the ACEI or ARB( in case of intolerance to the ACE inhibitor), and the drugs with a diuretic are contraindicated because of their ability to progress to diabetes.

Therapy for cardio-vascular diseases

Timely treatment of heart diseases. For example, atrial fibrillation( atrial fibrillation) is the most common disorder of the heart rhythm. The cerebral stroke associated with atrial fibrillation( cardioembolic variant) is characterized by poor recovery of impaired functions and high mortality. Patients over the age of 65 from atrial fibrillation( AF) after an acute cardiac infarction and cardiac valve replacement in order to avoid ONMC and other conditions associated with the formation of thrombi, the use of aspirin in a dose of 75-150 mg / day or drugs,preventing blood clotting and the formation of blood clots( oral anticoagulants), for example, warfarin.

Estrogen replacement therapy

Hormonotherapy. The incidence of acute vascular pathology in men is higher than that of women. This is due not only to the peculiarities of the lifestyle, but also to the difference in the hormonal profile. In the postmenopausal period, the protective action of estrogens on the cardiac and vascular system is reduced in women, and therefore the number of circulatory system diseases increases, and by the age of 65-70 their frequency is the same in both sexes. Estrogen deficiency in postmenopause changes glucose-insulin metabolism and forms the resistance of tissues to insulin, increases blood coagulability. To date, there is insufficient information about the advisability of prescribing estrogen replacement therapy, since their role in primary prevention of acute cerebral infarctions has not been fully clarified, therefore this type of therapy is not recommended for women over 50 years old who have the prerequisites for a stroke( AH, IHD, migraine,violation of lipid metabolism).

Confronting the stress and depressive factors

Stress increases the likelihood of developing vascular diseases, including stroke, by 7 times. It is important to learn how to counteract stress, to calmly treat unpleasant events.

It is necessary to resist stress and depression, as they contribute to the risk of the possible development of coronary heart disease, the pathology of the cardio-vascular system 7 times. The body's response to emotional shock is accompanied by the development of adrenaline, norepinephrine, cortisol - hormones that increase blood pressure, pulse, sugar, damaging the vascular wall and act as triggers of spontaneous narrowing of the lumen of blood vessels, in particular the brain and myocardium( cardiac muscle).Long-term stress and depression can influence the formation of plaques of atherosclerosis, blood thickening, thus predisposing to the formation of blood clots - thrombi, and can lead to a transient increase in cholesterol. However, it is important to take into account the fact that people with a depressed mood background tend to apathy and show less interest in their health, so it is important to start a psychotherapeutic treatment in time. For these purposes, the following drugs are used: fluoxetine, escitalopram, sertraline, paroxetine, duloxetine, venlafaxine.

Features of secondary prevention of acute vascular episodes

Preventive measures, whose aim is to prevent a recurrence of a stroke after the first acute violation has already occurred, are designated as secondary. These programs are developed in a hospital in the first day of the disease and are also aimed at correcting possible causes of development.

Repeat ONMK occurs in 25-30% of cases. The highest probability of recurrence is high in the first few weeks from its development, and repeated transient ischemic attack - during the first three days.

Transient ischemic attack - is a disease with transient impairment of cerebral circulation, which is based on the complete disappearance of neurologic symptoms during the day. If this does not happen, then it's legal to diagnose a stroke.

The complex of secondary prevention measures, like the primary one, includes changing the way of life - rejecting bad habits( smoking, alcohol), salt-free diet, maintaining optimal body weight, and treating diabetes. Do not forget about the increase in physical activity, but it should be done gradually until the level of activity that was before the occurrence of a brain accident.

Medical methods of secondary prevention

Medication prophylaxis methods include the therapy of blood pressure lowering, prevention of blood clots, taking statins, correction of carbohydrate metabolism disorders. Of particular importance are the surgical techniques, which are aimed at restoring the patency of cerebral blood flow when the lumen of the arteries is blocked by a plaque.

If, for some reason, these methods were not performed at a stationary stage, then they are performed by a neurologist in a clinic with a cardiologist, endocrinologist, and therapist in the clinic.

1. Therapy aimed at reducing blood pressure( or antihypertensive therapy).It is considered one of the most effective methods for preventing repeated acute brain events in patients with hypertension. It is based on a reduction in blood pressure to normal levels. To date, the normal level does not exceed 140/90 mm Hg, and in patients with diabetes mellitus and insufficient kidney function - no more than 130/80 mm.gt;Art. The greatest preference is given to combinations of drugs, as a result of this, a rapid reduction in blood pressure is achieved and the frequency of side effects decreases due to the minimal doses of the medicinal products that make up the composition. For example, the combination of perindopril with indapamide is reasonable.
2. Reduces the risk of formation of blood clots( blood clots).To do this, funds are used that can dilute blood( antiplatelet) and prevent the rapid formation of blood clots( anticoagulant).In the future, their lifelong application is required.

In the first two days after the stroke is prescribed acetylsalicylic acid( aspirin) in a dose of 75-150 mg / day.(or clopidogrel in the case of intolerance to the former).Continuous administration of heparin in the form of infusions( injections, droppers) to people who have multiple sources of blood clots and emboli( air bubbles).

Patients in the post-stroke period with the presence of cardiac pathology capable of leading to sudden disturbances in the blood supply of the brain( ciliary arrhythmia, myocardial infarction, open oval window, infective endocarditis) are prescribed warfarin.

1. Normalization of the lipid profile. Patients with ischemic heart disease, atherosclerotic damage to peripheral arteries, after a stroke, are treated with statins - atorvastatin, simvastatin. The necessary condition for this is a diet with restricted animal fats and an active lifestyle.
2. In cases where an acute cerebral infarction occurred in the background of type 2 diabetes, a more stringent control of pressure and fat is recommended. The drugs of choice for antihypertensive therapy in such patients are ACE inhibitors and calcium channel blockers. It is necessary to obtain a normal blood glucose level in this category of patients with a diet and appropriate preparations to avoid subsequent complications.
3. For pregnant women with acute or transient impairment of cerebral blood flow and with a predisposition to thrombus formation, one of the following tactics can be considered:

• to select different doses of heparin throughout the pregnancy, choosing the subcutaneous route of administration;
• administer portions of heparin until the 13th week of gestation, with a subsequent transition to warfarin until the middle of the third trimester, when heparin is administered again until delivery;
• in pregnant women with stroke can be shown the use of heparin or its fractions in the first trimester, with the subsequent transition to low doses of aspirin for the rest of the period until delivery, when the possible re-formation of thrombi and emboli is minimized;

1. For women who have reached postmenopausal age, with a stroke or TIA, hormone replacement therapy at this age is not advisable.

Methods of operative intervention on vessels

Stenting is an effective procedure that allows to restore the patency of an affected atherosclerosis vessel and to establish blood flow in the blood region of the brain that is supplied to them.

The most frequent cause of development of an acute vascular cerebral event is a change in the lumen of the artery due to an atherosclerotic process. Overlapping of the vessel is incomplete( stenosis) up to 70% of the volume or complete( occlusion) up to 90%.A high risk for the development of ONMI by type of ischemia is stenosis of more than 70% and the presence of neurological symptoms. This requires immediate consultation of an angiosurgeon and performing a surgical intervention - carotid endarterectomy( CEAE).It is conducted, as a rule, in specialized centers with a reduced rate of postoperative complications. For patients with symptomatic arterial stenoses of 50-70%, additional factors should be taken into account when deciding whether to perform an operation: male gender, age characteristics( more than 75 years), complete damage to the ischemic process of one hemisphere, and the severity of symptoms. If the narrowing of the vessel does not exceed 50% - CE is not shown. Antiplatelet drugs are recommended before and after surgery.

An alternative to CEAE is percutaneous transluminal angioplasty( stenting) and balloon dilatation - modern intravascular technologies. The mechanism on which the balloon dilatation method is based consists in the mechanical action on the atherosclerotic plaque, as a result of which it is crushed and disintegrates into separate fragments, with traumatic damage to the artery wall and the vascular patency being restored.

The method with fewer complications after angioplasty is stenting. The essence of it is to install a metal frame-grid( stent) in the affected arterial segment with the restoration of blood flow. In those times when CE is contraindicated due to a large number of complications, stenosis in a surgically inaccessible place, re-emergence of stenosis after endarterectomy or under the influence of radiation therapy, the choice falls on the method of stenting. Subsequently, people who underwent this procedure should receive a combination of clopidogrel 75 mg and aspirin 100 mg immediately before, during and for at least one month after the intervention.

How to avoid a stroke in the "About the most important" program:

Lecture of Dr. Sc. A. S. Kotova on "Prevention of stroke":