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This Article Figures Only Full Text Full Text (PDF) Data Supplement All Versions of this Article: 01.WNL.0000171745.13592.cbv1 65/1/17    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elkind, M. S.V. Search for Related Content PubMed PubMed Citation Articles by Elkind, M. S.V. Related Collections Stroke prevention All Cerebrovascular disease/Stroke Infarction

Implications of stroke prevention trials

Treatment of global risk

From the Department of Neurology and Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, and Columbia University Medical Center of New York–Presbyterian Hospital, New York, NY.

Address correspondence and reprint requests to Dr. Mitchell S.V. Elkind, Neurological Institute, Columbia University, 710 W. 168 St., New York, NY 10032; e-mail: mse13{at}columbia.edu

Clinical trials have demonstrated that risk of cardiovascular events may be reduced in patients with stroke, using blood pressure (BP) reduction and statin therapy, independently of the presence of specific risk factors. These results suggest an alternative approach to secondary stroke prevention, focused more on global risk than on detection and modification of individual categorical risk factors such as hypertension, dyslipidemia, and diabetes mellitus. A risk-based approach is warranted because stroke patients are at high risk of several cardiovascular events, not just stroke, and because physiologic risk factors such as BP demonstrate a continuous, or log-linear, relationship with cardiovascular risk. Essential to the implementation of such an approach is the development of adequate risk stratification models for stroke patients. Based on limited available evidence, however, it appears that most patients who experience an ischemic stroke or TIA are at high long-term absolute risk of a subsequent cardiovascular event and should be treated with all available risk-reduction strategies.

Supported by NINDS K23 42912 and the Kathleen Scott Research Fellowship of the American Heart Association.

Dr. Elkind receives research support for studies of inflammatory markers in prognosis after stroke from Bristol Myers Squibb–Sanofi Pharmaceutical Partnership and diaDexus, Inc., as well as personal compensation for consulting and lecturing on stroke prevention from Bristol Myers Squibb–Sanofi Pharmaceutical Partnership. Dr. Elkind also receives personal compensation for lecturing on stroke prevention from Boehringer–Ingelheim, Inc.

Received January 3, 2005. Accepted in final form April 5, 2005.

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