Preventing Stroke

Abstract

Stroke, the third leading cause of death in the United States, is also the chief cause of neurological disability in the elderly. Lifetime risk of stroke at age 65 years is estimated to be 1 in 5 in women and 1 in 6 in men in the Framingham Study population.1 Despite improvements in management of the acute stroke and in rehabilitation poststroke, it is clear that prevention holds the key to decreasing the toll of cerebrovascular disease. In recent years, it has become increasingly clear that clinically inapparent strokes detected on magnetic resonance scan of the brain, so-called “silent” strokes, exert a discernible impact on brain function.2 Measurable reduction in cognitive performance that leads to vascular cognitive impairment, depressed mood, and impaired gait are consequences of these “silent” strokes.3 In addition, persons harboring these infarcts and a large burden of white-matter hyperintensities are predisposed to develop clinically apparent cerebral infarctions. Further, the presence of elevated levels of stroke risk factors exerts a measurable effect on brain structure and function, which results in reduced total cerebral volume and an increased presence and volume of white-matter hyperintensities on magnetic resonance scan of the brain, as well as reduced cognitive performance, particularly on tests of executive function.4 Article p 2157 In this issue of Circulation , Markus et al report on the results of the difficult task of …