BACKGROUND: Atherosclerotic intracranial arterial stenosis is an important cau se of stroke. Warfarin is commonly used in preference to aspirin for this disord er, but these therapies have not been compared in a randomized trial. METHODS: W e randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial arte ry to receive warfarin (target international normalized ratio, 2.0 to 3.0) or as pirin (1300 mg per day) in a double-blind, multicenter clinical trial. The prim ary end point was ischemic stroke, brain hemorrhage, or death from vascular caus es other than stroke. RESULTS: After 569 patients had undergone randomization, e nrollment was stopped because of concerns about the safety of the patients who h ad been assigned to receive warfarin. During a mean follow-up period of 1.8 yea rs, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative t o warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major h emorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 per cent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or su dden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 pe rcent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascula r causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin gr oup (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent o f the patients in the aspirin group and 21.8 percent of those in the warfarin gr oup (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83). CONCLUSIONS: Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be use d in preference to warfarin for patients with intracranial arterial stenosis.

Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis

Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The "American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update" is a summary document (updated yearly) regarding CVD risk factors. This "ASPC Top Ten CVD Risk Factors 2021 Update" summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the "ASPC Top Ten CVD Risk Factors 2021 Update" to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.

/pdf/ten-things-to-know-about-ten-cardiovascular-disease-risk-1y5o1sikh9.pdf

Ten things to know about ten cardiovascular disease risk factors

Hypertension, among the common conditions encountered in primary care, is known to have a causal link with cardiovascular disease. With new thresholds for diagnosing hypertension, its prevalence is expected to increase. Currently, a high percentage of patients have suboptimal or inadequately controlled blood pressure, thus placing them at risk for cardiovascular disease. Among the best strategies for improved outcomes are inclusion of the patient in decision-making as well as provision of individualized treatment plans.

Prevention of Hypertension Related to Cardiovascular Disease

Chungkookjang, a soy food, fermented with Bacillus amyloliquefaciens protects gerbils against ishcmeic stroke injury, and post-stroke hyperglycemia

Coronavirus disease 2019 (COVID-19), a contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world. Apart from respiratory complications, an increasing number of patients with ischemic stroke have been reporting. This systematic review and meta-analysis aims to explore the characteristics of ischemic stroke after SARS-CoV-2 infection, and provides valuable reference materials for subsequent clinical treatment. PubMed, Web of Science, and Ovid-Embase databases were searched up to 24th March 2021. We utilized the search strategy of medical subject headings combined with entry terms to search all related literatures. All studies identified with the electronic and manual searches were listed by citation, title, authors, and abstract. Only studies involving patients with COVID-19-related stroke were eligible. The references of included studies were also manually screened. The meta-analysis was conducted following the PRISMA and MOOSE reporting guidelines. Bias risk was assessed using the Newcastle–Ottawa Scale (NOS). Ten articles, including 26,691 participants and 280 patients with ischemic stroke and COVID-19, were selected. The pooled prevalence of ischemic stroke in COVID-19 was 2% (95% CI 1–2%; p < 0.01). The pooled proportions of hypertension, hyperlipidemia and diabetes in COVID-19-related ischemic stroke was 66% (95% CI 51–81%; p < 0.01), 48% (95% CI 19–76%; p < 0.01) and 40% (95% CI 29–51%; p < 0.01), respectively. Notably, the pooled proportions of female was 36% (95% CI 21–50%; p < 0.01) in patients with COVID-19 and stroke. In addition, in TOAST classification, cryptogenic stroke subtype was associated with a high trend, and its pooled proportion was 35% (95% CI 12–59%; p < 0.01). Ischemic stroke caused by COVID-19 has its own unique clinical features. Although common high-risk factors can also be observed, its importance may have changed. The major inflammatory storm of COVID-19 is more likely to occur in male patients. The increase in the proportion of cryptogenic stroke has also made stroke related to COVID-19 complicated.

/pdf/ischemic-stroke-associated-with-covid-19-a-systematic-review-3co0es4fap.pdf

Ischemic stroke associated with COVID-19: a systematic review and meta-analysis.

Recurrent strokes make up almost 25% of the nearly 800,000 strokes that occur annually in the United States Risk factors for ischemic stroke include hypertension, diabetes mellitus, hyperlipidemia, sleep apnea, and obesity Lifestyle modifications, including tobacco cessation, decreased alcohol use, and increased physical activity, are also important in the management of patients with a history of stroke or transient ischemic attack Antiplatelet therapy is recommended to reduce the risk of recurrent ischemic stroke The selection of antiplatelet therapy should be based on timing, safety, effectiveness, cost, patient characteristics, and patient preference Aspirin is recommended as initial treatment to prevent recurrent ischemic stroke Clopidogrel is recommended as an alternative monotherapy and in patients allergic to aspirin The combination of clopidogrel and aspirin is not recommended for long-term use (more than two to three years) because of increased bleeding risk Aspirin/dipyridamole is at least as effective as aspirin alone, but it is not as well tolerated Warfarin should not be used for prevention of recurrent ischemic stroke

Recurrent Ischemic Stroke: Strategies for Prevention.

Hypertension is one of the most common conditions encountered in primary care. Nonpharmacologic strategies have been shown to help lower blood pressure. Lifestyle modifications are recommended for all patients with hypertension. The American Heart Association/American College of Cardiology lifestyle management guideline recommends a diet emphasizing vegetables, fruits, and whole grains; limiting sodium intake to less than 2,400 mg per day; and exercising three or four times per week for an average of 40 minutes per session. Other nonpharmacologic strategies include weight loss, tobacco cessation, decreased alcohol consumption, biofeedback, and self-measured blood pressure monitoring. For patients with obstructive sleep apnea, the use of continuous positive airway pressure has been shown to improve blood pressure. Dietary supplements such as garlic, cocoa, vitamin C, coenzyme Q10, omega-3 fatty acids, and magnesium have been suggested for lowering blood pressure, but evidence is lacking.

Miriam Garcellano

Papers

Recurrent Ischemic Stroke: Strategies for Prevention.

Nonpharmacologic management of hypertension: what works?