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(Stroke. 2007;38:1726.)
© 2007 American Heart Association, Inc.

Editorials

Making the Most of Secondary Prevention

Peter M. Rothwell, MD, PhD, FRCP

From the University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.

Correspondence to Peter M. Rothwell, MD, PhD, FRCP, Professor of Neurology, University Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Rd, Oxford OX2 6HA, UK. E-mail peter.rothwell@clinical-neurology.oxford.ac.uk

See related article, pages 1881–1885.

Key Words: prevention • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Recurrent strokes are more likely to be fatal than first strokes, and survivors are more likely to be left with major disability. In this issue of Stroke, Hackman and Spence’s report¹ of their interesting modeling study of the potential effectiveness of combining multiple medications/interventions in the secondary prevention of stroke is therefore to be welcomed. They suggest that at least 80% of recurrent cerebrovascular events might be prevented by a comprehensive, multifactorial approach. Indeed, relative reductions in risk of 90% are estimated for more intensive treatment and nearly 95% if carotid endarterectomy is included in the package. The philosophy is similar to that of the "polypill" in primary prevention although a more individualized approach is, of course, required in secondary prevention.

There are, however, a number of uncertainties. Firstly, there is, of course, the assumption that all of the interventions will have independent effects. The authors refer to some trials of 2 interventions in which the effects did appear to be independent, but it is a "leap of faith" to assume that the same will apply to 5 or 6 treatments given in combination. It is certainly possible, but no amount of modeling can give us a definite answer. Ischemic stroke has numerous etiologies, many of which are probably as yet unknown and might not be easily preventable. To what extent there will be a hard core of etiologies that will not respond to current preventive treatments is unknown.

Secondly, there is the issue of prevention versus delay. Most . . . [Full Text of this Article]

Related Article:

Combining Multiple Approaches for the Secondary Prevention of Vascular Events After Stroke: A Quantitative Modeling Study

Daniel G. Hackam and J. David Spence
Stroke 2007 38: 1881-1885. [Abstract] [Full Text] [PDF]

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