Preventing ischemic stroke in the older adult
Geoffrey S.F. Ling, MD, PhD
Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD
Shari M. Ling, MD
Clinical Research Branch, National Institute of Aging, National Institutes of Health, Baltimore, MD
Correspondence: Geoffrey S.F. Ling, MD, PhD, Department of Neurology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814; email@example.com
Dr. Geoffrey Ling serves on the speakers’ bureaus of the Sanofi-Aventis and Bristol-Myers Squibb corporations.
Dr. Shari Ling reported that she has no financial interests or affiliations that pose a potential conflict of interest with this article.
Stroke is a deadly and disabling disease that preferentially afflicts older adults. It shares common risk factors with myocardial infarction (MI), such as hypertension, diabetes, and hyperlipidemia. Blood pressure control, cholesterol reduction with statins, and glucose control reduce the risk for both stroke and MI. Additionally, management of atrial fibrillation with warfarin reduces stroke risk. Beyond risk factor reduction, antiplatelet therapy is an effective option for lowering the likelihood of stroke in at-risk patients. Among antiplatelet agents, aspirin has been shown effective for secondary stroke prevention as well as primary and secondary MI prevention; clopidogrel for secondary stroke and MI prevention; and both ticlodipine and dipyridamole for secondary stroke prevention. Combining antiplatelet agents is rational. Carotid endarterectomy should be considered for stroke prevention in patients with ischemic symptoms; for patients with asymptomatic stenosis, potential benefit must be balanced against surgical risk.
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