Stroke Prevention

Question 1

What cause of stroke is responsible for 50% of mortality

Answer 1

Intracerebral haemorrhage

Question 2

What does primary prevention focus on

Answer 2

Avoidance of the disease

Lifestyle interventions

Targeting individuals at risk (especially genetics)

Question 3

What does secondary prevention focus on

Answer 3

Early detection and screening

Treatment of subclinical disease

Question 4

What does tertiary prevention focus on

Answer 4

Reducing the severity of disease

Reducing the effects of the disease

Reducing the recurrence

Question 5

What are the barriers to prevention measures

Answer 5

Socioeconomic status

Education

Social deprivation

Perceived discrimination from healthcare system

Inadequate continuity of care

Perceived lack of benefit

Question 6

What is the largest risk factor for stroke

Answer 6

Hypertension

Question 7

What is hypertension

Answer 7

Elevated BP (force of blood pushing against artery walls is too high)

Meaning heart has to work harder to pump blood

Question 8

More than 50% of hypertensive patients had additional cardiovascular risk factors such as

Answer 8

Diabetes
Lipid disorders
Overweight/ obesity
Hyperuricemia
Metabolic syndrome

Question 9

What is HMOD

Answer 9

Hypertension mediated organ damage

Structural/ functional alteration of the arterial vasculature to the organs it supplies caused by elevated BP

Affects heart, brain, kidneys and eyes

Question 10

How many % of UK adults have hypertension

Answer 10

28%

Question 11

For every 7.5mmHg drop in BP stroke risk reduces by

Answer 11

50%

Question 12

What drugs are used to treat hypertension

Answer 12

ACEi
ARBS
CCB or thiazide like diuretic

Question 13

Diabetes increases risk stroke by _____

Answer 13

2 to 4 times

Question 14

Those who suffered a stroke at a younger age what percent were diabetics

Answer 14

76%

Question 15

People with diabetes how many times more likely to develop vascular dementia

Answer 15

2-3

Question 16

How is diabetes managed

Answer 16

Lifestyle counselling
Nutrition
Education
Medications such as SGLT-2 inhibitors or GLP-1 agonists

Question 17

What is atrial fibrillation

Answer 17

In atrial fibrillation the atria of the heart beat irregularly due to extra electrical signals

• ventricles are unaffected?

Question 18

What describes the pattern of incidence of atrial fibrillation

Answer 18

Increases with age

10% of adults aged over 85 have AFIB

Question 19

What is the risk of stroke in a person with AF with no rheumatic heart disease compared to rheumatic heart disease

Answer 19

AF with no rheumatic disease = risk x5 higher

AF with rheumatic heart disease = X17 higher

Question 20

What % of stroke is associated with AF

Answer 20

16%

Question 21

What’s the best anticoagulant in preventing stroke in patients with AFib

Answer 21

Warfarin ( vitamin K antagonist)

Question 22

What % of stroke patients have ipsilaeral ICA stenosis

Answer 22

15%

Question 23

What is a carotid endarterectomy CEA

Answer 23

Surgical procedure in which the plaque is removed from the artery

Less beneficial for asymptomatic disease as risk of stroke is lower

However age also matters. Elderly still more at risk

Question 24

What is the alternative to CEA for patients with high surgical risk

Answer 24

Carotid angioplasty and stenting CAS

Question 25

What is the RRR for CEA

Answer 25

65 % relative risk reduction in stroke post CEA for recent symptomatic disease

Question 26

Agents that can lower lipids

Answer 26

Statins
Ezetimibe
PCSK-9 inhibitors
Bempedoic acid

Question 27

What kinds of anti-platelet therapies are used in management of non-cardio emboli ischaemic stroke and TIA

Answer 27

Aspirin
Clopidogrel
Dipyridamole
Ticagrelor

Question 28

Examples of platelet aggregation inhibitors

Answer 28

Aspirin
Clopidogrel
Ticagrelor