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The Journal of the American Board of Family Practice 18:528-540 (2005)
© 2005 American Board of Family Practice

Clinical Review

Long-Term Therapy to Prevent Stroke

Howard S. Kirshner, MD, José Biller, MD and Alfred S. Callahan, III, MD

From the Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (HSK); Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (JB); and Neurologic Consultants P.C., Nashville, TN (ASC)

Correspondence: Corresponding author: Howard S. Kirshner, MD, Department of Neurology, Vanderbilt University School of Medicine, 2100 Pierce Avenue, Nashville, TN 37212 (e-mail: Howard.Kirshner{at}vanderbilt.edu)

Cerebrovascular disease is the third leading cause of mortality and the leading cause of long-term neurological disability in the United States. Most strokes are of ischemic origin and, other than cardioembolic or small vessel strokes, are caused by the development of platelet-fibrin thrombi on an atherosclerotic plaque. This underlying disease mechanism shares important features with coronary artery disease and peripheral artery disease, highlighting the systemic nature of atherothrombosis and the elevated cross risk in stroke patients for ischemic events in other vascular beds. It has been estimated that up to 80% of ischemic strokes could be prevented with application of currently available treatments for blood pressure, cholesterol, and antithrombotic therapies. Stroke is not, like cancer, waiting for a scientific breakthrough; stroke preventive treatments are well understood and widely available. It is only the application of these treatments to patients, many of whom do not visit physicians, that is lacking. Clearly, better education of the public and active participation of primary care physicians is essential to get the message out to all those at risk.


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Copyright © 2005 by the American Board of Family Medicine.