Brain Neurorehabil.  2014 Sep;7(2):86-92. 10.12786/bn.2014.7.2.86.

Secondary Prevention as Integral Part of Stroke Rehabilitation

• Yoo SD

• KMID: 1797640
• DOI: http://doi.org/10.12786/bn.2014.7.2.86

Abstract

Stroke is the second leading cause of death, and the leading cause of acquired disability in adults. Survivors of stroke are at risk of a recurrent event, which is often more disabling than first-ever stroke. Recurrent strokes continue to account for 25~30% of all strokes. That represents the needs of successful secondary prevention. Appropriate secondary prevention of recurrent stroke needs rapid diagnosis and treatment and prompt identification of the underlying cardiovascular cause. Some epidemiological data suggest that a substantial proportion of strokes can be attributed to unhealthy lifestyle behaviors. This review summarizes the evidence for optimum secondary prevention of recurrent ischemic stroke as integral part of physical medicine and rehabilitation.

Keyword

stroke; secondary prevention; physical medicine and rehabilitation

MeSH Terms

Adult
Cause of Death
Diagnosis
Humans
Life Style
Physical and Rehabilitation Medicine
Rehabilitation*
Secondary Prevention*
Stroke*
Survivors

Reference

1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095–2128.

2. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2197–2223.

3. Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, et al. Oxford Vascular Study. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004; 363:1925–1933.

4. Chandratheva A, Mehta Z, Geraghty OC, Marquardt L, Rothwell PM. Oxford Vascular Study. Population-based study of risk and predictors of stroke in the first few hours after a TIA. Neurology. 2009; 72:1941–1947.

5. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007; 6:1063–1072.

6. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al. CHANCE investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013; 369:11–19.

7. Giles MF, Rothwell PM. Systematic review and pooled analysis of published and unpublished validations of the ABCD and ABCD2 transient ischemic attack risk scores. Stroke. 2010; 41:667–673.

8. Chandratheva A, Geraghty OC, Luengo-Fernandez R, Rothwell PM. Oxford Vascular Study. ABCD2 score predicts severity rather than risk of early recurrent events after transient ischemic attack. Stroke. 2010; 41:851–856.

9. Arsava EM, Furie KL, Schwamm LH, Sorensen AG, Ay H. Prediction of early stroke risk in transient symptoms with infarction: relevance to the new tissue-based definition. Stroke. 2011; 42:2186–2190.

10. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004; 363:915–924.

11. Rerkasem K, Rothwell PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2011; 4:CD001081.

12. Bonati LH, Fraedrich G. Carotid Stenting Trialists' Collaboration. Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosis-a pooled analysis of EVA-3S, SPACE, and ICSS. Eur J Vasc Endovasc Surg. 2011; 41:153–158.

13. Bonati LH, Lyrer P, Ederle J, Featherstone R, Brown MM. Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2012; 9:CD000515.

14. Bekelis K, Bakhoum SF, Desai A, Mackenzie TA, Goodney P, Labropoulos N. A risk factor-based predictive model of outcomes in carotid endarterectomy: the National Surgical Quality Improvement Program 2005-2010. Stroke. 2013; 44:1085–1090.

15. Stromberg S, Gelin J, Osterberg T, Bergstrom GM, Karlstrom L, Osterberg K. Swedish Vascular Registry (Swedvasc) Steering Committee. Very urgent carotid endarterectomy confers increased procedural risk. Stroke. 2012; 43:1331–1335.

16. Lal BK, Beach KW, Roubin GS, Lutsep HL, Moore WS, Malas MB, et al. CREST Investigators. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012; 11:755–763.

17. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011; 42:1489–1494.

18. Purroy F, Jiménez Caballero PE, Gorospe A, Torres MJ, Alvarez-Sabin J, Santamarina E, et al. Stroke Project of the Spanish Cerebrovascular Diseases Study Group. Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study. J Neurol Neurosurg Psychiatry. 2013; 84:596–603.

19. Ois A, Cuadrado-Godia E, Rodriguez-Campello A. Relevance of stroke subtype in vascular risk prediction. Neurology. 2013; 81:575–580.

20. Charidimou A, Kakar P, Fox Z, Werring DJ. Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts. Stroke. 2013; 44:995–1001.

21. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010; 137:263–272.

22. Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011; 342:d124.

23. Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, et al. Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature. Hypertens Res. 2009; 32:1032–1040.

24. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009; 338:b1665.

25. Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, Pearce LA, et al. SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013; 382:507–515.

26. Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009; 8:453–463.

27. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Cholesterol Treatment Trialists' (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376:1670–1681.

28. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376:112–123.

29. Kim J, Gall SL, Dewey HM, Macdonell RAL, Sturm JW, Thrift AG. Baseline smoking status and the long-term risk of death or nonfatal vascular event in people with stroke: a 10-year survival analysis. Stroke. 2012; 43:3173–3378.

30. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network metaanalysis. Cochrane Database Syst Rev. 2013; 5:CD009329.

31. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013; 346:f1325.

32. Hankey GJ. Nutrition and the risk of stroke. Lancet Neurol. 2012; 11:66–81.

33. Whitlock RP, Hanif H, Danter M. Nonpharmacologic approaches to stroke prevention in atrial fibrillation. Can J Cardiol. 2013; 29:S79–S86.

34. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996; 61:755–759.

35. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med. 1995; 123:817–822.

36. Leung DY, Black IW, Cranney GB, Hopkins AP, Walsh WF. Prognostic implications of left atrial spontaneous echo contrast in non-valvular atrial fibrillation. J Am Coll Cardiol. 1994; 24:755–762.

37. Madden JL. Resection of the left auricular appendix; a prophylaxis for recurrent arterial emboli. J Am Med Assoc. 1949; 140:769–772.

38. Freixa X, Arzamendi D, Tzikas A, Noble S, Basmadjian A, Garceau P, et al. Cardiac procedures to prevent stroke: patent foramen ovale closure/left atrial appendage occlusion. Can J Cardiol. 2014; 30:87–95.

39. Lee JY, Song JK, Song JM, Kang DH, Yun SC, Kang DW, et al. Association between anatomic features of atrial septal abnormalities obtained by omni-plane transesophageal echocardiography and stroke recurrence in cryptogenic stroke patients with patent foramen ovale. Am J Cardiol. 2010; 106:129–134.

40. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011; 343:d4169.

41. Hankey GJ. Secondary stroke prevention. Lancet Neurol. 2014; 13:178–194.