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Should I start all my ischaemic stroke and TIA patients on a statin, an ACE inhibitor, a diuretic, and aspirin today?

Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK

Correspondence to:
Correspondence to:
Professor Sandercock;
pags@skull.dcn.ed.ac.uk

Received 7 May 2003

Accepted for publication 1 July 2003

Keywords: antihypertensive treatment; cholesterol reduction; stroke; transient ischaemic attack

Abbreviations: ASCOT, Anglo-Scandinavian cardiac outcomes trial; AVASIS, aspirin versus anticoagulants in symptomatic intracranial stenosis; ESPRIT, European/Australian stroke prevention in reversible ischaemia trial; GALA, general anaesthetic versus local anaesthetic for carotid endarterectomy; PROGRESS, perindopril protection against recurrent stroke study; PROSPER, pravastatin in elderly individuals at risk of vascular disease; SPORTIF, stroke prevention by oral thrombin inhibition IV; TIA, transient ischaemic attack; WARCEF, warfarin-aspirin reduced cardiac ejection fraction study; WASID, warfarin-aspirin symptomatic intracranial disease study

The first 150 words of the full text of this article appear below.

Stroke is eminently preventable.^1,2 A combination of individual and population based interventions could lower the global incidence of vascular events by as much as 50%.² However, the public health and legislative changes required to achieve substantial primary prevention of vascular disease (for example, by reducing the salt content of processed food) is really the territory of public health systems and governments² and is beyond the scope of this article. In this short review I shall therefore deal with stroke prevention from the perspective of the hospital clinician and hence focus on secondary prevention. In the 1980s, the only treatment offered to many patients with transient ischaemic attack (TIA) or minor ischaemic strokes was aspirin. There is now a much wider range of evidence based interventions available for reducing the risk of recurrent stroke and other serious vascular events.¹ In brief, I will identify who is at high . . . [Full text of this article]

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