Risk factors of cerebrovascular diseases
(1) Non-intervention factors
1, the incidence, morbidity and mortality of cerebrovascular diseases are positively correlated with age. After the age of 55, the incidence of stroke increased significantly, and the incidence of stroke increased by 1 times with each increase of 10 years.
2. Gender? The incidence of stroke in men is higher than that in women.
3. Genetic factors? A history of stroke in both parents will increase the risk of stroke in children. (about 2~4 times)
(2) Intervenable factors
1, hypertension? It is the most important and independent risk factor of cerebrovascular disease. The increase of systolic blood pressure and diastolic blood pressure is positively correlated with the risk of stroke, and has a linear relationship. Studies have shown that the relative risk of stroke is about four times that of normal blood pressure when systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 95mmHg.
2. Smoking? It can affect the blood vessels and blood system of the whole body, such as accelerating arteriosclerosis, increasing plasma fibrinogen level, promoting platelet aggregation and reducing high density lipoprotein level. Nicotine can also stimulate sympathetic nerve, promote vasoconstriction and raise blood pressure. Smoking can increase the risk of ischemic stroke by 2 times and hemorrhagic stroke by 2~4 times.
3. Diabetes? It is an independent risk factor for ischemic stroke, but not for hemorrhagic stroke. Diabetes increases the risk of ischemic stroke by 3.6 times.
4. Atrial fibrillation? The risk of ischemic stroke increases significantly and increases with age. Statistics show that the risk of stroke increases by 3-4 times.
5. Other heart diseases? Such as myocardial infarction, heart valve repair, dilated cardiomyopathy, perioperative period of heart disease, cardiac catheter and endovascular treatment, pacemaker and radiofrequency ablation will all increase the incidence of embolic stroke.
6. Hyperlipidemia? Studies have shown that every increase in blood cholesterol 1 increases the risk of ischemic stroke by 25%. There are few studies on low density lipoprotein and ischemic stroke, and there is no consistent conclusion. However, every increase in HDL 1mmol/L reduces the risk of ischemic stroke by 47%.
7. Asymptomatic carotid stenosis? The incidence of asymptomatic carotid artery stenosis stroke is1%-3.4% per year; Long-term follow-up study showed that asymptomatic carotid stenosis (50%-99%) was 9.3% in 10 and 16.6% in 15.
8. Sickle cell anemia? Among homozygous patients with genetic abnormalities, the cumulative incidence of cerebral stroke before the age of 20 is above 1 1%, and most of them occur in childhood.
9. Postmenopausal estrogen replacement therapy? Studies have shown that estrogen plus progesterone replacement therapy will significantly increase the risk of ischemic stroke.
10, diet and nutrition? Increasing the daily intake of vegetables and fruits can reduce the relative risk of stroke. There is no significant correlation between the daily intake of vitamin C, vitamin E and carotenoids and the risk of stroke. Low sodium and high potassium intake can reduce the risk of stroke, which may be related to lowering blood pressure.
1 1, exercise and exercise? The results of systematic review published in 2003 show that high-intensity active exercise can reduce the risk of stroke and death by 27% compared with low-intensity active exercise; Moderate intensity active exercise can reduce the risk of stroke and death by 20% compared with passive exercise; High-intensity and moderate-intensity active exercise (compared with low-intensity active exercise) is equally effective in preventing ischemic stroke and hemorrhagic stroke.
12, obesity and body fat distribution? Obese patients are prone to hypertension, diabetes and hyperlipidemia, thus increasing the risk of stroke.
13, others? Include metabolic syndrome, alcoholism, oral contraceptives and drug abuse, sleep apnea, migraine, hyperhomocysteinemia, hyperlipoproteinemia, increase of lipoprotein-associated phospholipase A2, hypercoagulable state, inflammation, infection, abnormal hemodynamics, increased blood viscosity, increased fibrinogen and hypercoagulability.
Prevention of cerebrovascular diseases
(A) the primary prevention of cerebrovascular diseases
It refers to the prevention of stroke in individuals with stroke tendency and no history of stroke, that is, to prevent or delay the occurrence of cerebrovascular diseases by changing unhealthy lifestyles at an early stage and actively controlling various controllable risk factors. Carry out comprehensive preventive measures (such as health education and control of risk factors), and carry out graded intervention according to the number of risk factors, whether risk factors cause corresponding complications and the severity of risk factors. Mainly includes:
1. The prevention and treatment measures of hypertension include limiting salt intake, reducing dietary fat content, losing weight, proper physical exercise, reducing alcohol consumption and long-term adherence to antihypertensive drugs. Blood pressure should be controlled below 140/90mmHg, and for patients with hypertension complicated with diabetes or nephropathy, blood pressure should be controlled below 130/80mmHg.
2. Smoking? Smokers should quit smoking by using nicotine substitutes and oral smoking cessation drugs. Promote smoking in public places and reduce passive smoking.
3. hyperlipidemia? For those who have no cardiovascular events, but have elevated blood total cholesterol or hyperlipidemia with elevated non-high density lipoprotein, lipid-lowering treatment should be actively carried out; Patients with hypertension and diabetes who have normal blood lipids but have cardiovascular events or high risk should receive statin therapy and lifestyle changes.
4. Diabetes? The ideal level is that fasting blood glucose should be less than 5.6 mmol/L. According to the situation, blood glucose can be controlled by controlling diet, taking hypoglycemic drugs or using insulin.
5. Atrial fibrillation? Warfarin should be used for anticoagulation when there are stroke risk factors such as hypertension and left ventricular dysfunction. For patients over 75 years old who have no other risk factors for stroke, warfarin anticoagulation is still recommended.
6. Others? For those with risk factors of cerebrovascular diseases such as myocardial infarction, carotid stenosis, alcoholism, hyperhomocysteinemia and obesity, corresponding measures should be taken to intervene and deal with them.
(2) Secondary prevention of cerebrovascular diseases
It refers to finding the cause of stroke for patients who have had one or more strokes and correcting it to reduce the recurrence of stroke.
1、? Etiological prevention? Etiological prevention of intervenible risk factors is basically the same as primary prevention.
2、? Antiplatelet aggregation therapy? For patients with ischemic stroke, conventional antiplatelet therapy, aspirin 75~ 150mg/d, and clopidogrel 75mg/d can be used for patients with history of gastric ulcer and aspirin resistance or intolerance.
3、? Anticoagulation therapy? Warfarin should be used in patients with cardiogenic embolism induced by nonvalvular degenerative atrial fibrillation.
4、? Intervention of transient ischemic attack? Patients with recurrent TIA are at great risk of complete stroke, and the etiology of TIA should be actively sought and treated.