In order to decrease stroke incidence and mortality, promotion of correct life styles at the whole population are recommended. Cessation of cigarette smoking is recommended for all smokers independent of age and amount of smoking. Moderate physical activity, i.e. minutes walking per day is recommended because it is associated with 45% reduction of stroke incidence, especially in men. The reduction of dietary salt especially in hypertensive elderly people is necessary because it can reduce hypertension1.The treatment of hypertension either systolic or diastolic is recommended independent of age and severity of hypertension. Accordng to WHO guidelines the optimal systolic and diastolic arterial pressures, for young
adults and for diabetics of any age, are <130 mmHg and <85 mmHg and for elderly people are <140 mmHg and <90 mmHg respectively. Individuals with recent ischemic events have a much higher risk of stroke than general population. Because of this, TIA or stroke patients with relatively normal blood pressure may benefit substantially from blood pressure eduction after stroke. Angiotensin Converting Enzyme Inhibitors reduce the rate of recurrent stroke, MI and vascular death by one-quarter, even in normotensive patients. The reduction in vascular events is larger than might be expected from just lowering the blood pressure. Statins are used for patients with TIA and stroke with hypercholesterolemia if diet correction is not effective in reducing blood cholesterol. Statins not only reduce cholesterol levels but
also are effective in reducing coronary artery events and ischemic stroke even in patients with normal levels of cholesterol. Using statins slows progression of carotid artery atherosclerotic plaques. The beneficial effects of statins on nearly all aspects of atherosclerotic disease are not entirely explained by reduction in serum lipid levels. Basic researches indicates
some other important saltatory effects of statins including; normalization of the vascular endothelium, improvement of endothelial cell function, anti-inflammatory effects, depletion and stabilization of the lipid core content of the plaques, strengthening fibrous cap of plaque, decrease in formation of platelet-fibrin thrombi, decreased deposition of white clot on endothelial surfaces and reduction in the thrombogenicity of plaque elements.
Statins have antiplatelet and antioxidant effect. Daily statin intake appears to be associated with a better functional outcome following an acute stroke. The use of statins significantly reduces stroke risk in patients with ischemic heart disease or hypertension or diabetes. Some studies have demonstrated that low cholesterol is a risk factor for ICH. Diagnosis and management of diabetes mellitus is recommended for its contribution in reducing stroke
risk. Young women who have an ischemic stroke when taking oral contraceptives should stop it and use an alternative form of contraception.