Stroke Prevention in Older Adults: Recent Advances.

Abstract

The risks of stroke and dementia increase steeply with age, and both are preventable. At present, the best way to preserve cognitive function is to prevent stroke. Therapeutic nihilism based on age is common and unwarranted. We address recent advances in stroke prevention that could contribute greatly to prevention of stroke and dementia at a time when the aging of the population threatens to markedly increase the incidence of both. Issues discussed: (1) old patients benefit even more from lipid-lowering therapy than do younger patients; (2) patients with stiff arteries are at risk from a target systolic blood pressure <120 mm Hg; (3) the interaction of the intestinal microbiome, age, and renal function has important dietary implications for older adults; (4) anticoagulation with direct-acting oral anticoagulants should be prescribed more to old patients with atrial fibrillation; (5) B vitamins to lower homocysteine prevent stroke; and (6) most old patients in whom intervention is warranted for carotid stenosis would benefit more from endarterectomy than from stenting. An 80-year-old person has much to lose from a stroke and should not have effective therapy withheld on account of age. Lipid-lowering therapy, a more plant-based diet, appropriate anticoagulation or antiplatelet therapy, appropriate blood pressure control, B vitamins to lower homocysteine, and judicious intervention for carotid stenosis could do much to reduce the growing burden of stroke and dementia.

• Authors: J David Spence, M Reza Azarpazhooh, Susanna C Larsson, Chrysi Bogiatzi, Graeme J Hankey
• Journal: Stroke (Stroke) Vol. 51 Issue 12 Pg. 3770-3777 (12 2020) ISSN: 1524-4628 [Electronic] United States
• PMID: 33121384 (Publication Type: Journal Article, Review)

Chemical References

• Anticoagulants
• Antihypertensive Agents
• Factor Xa Inhibitors
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Hypolipidemic Agents
• Platelet Aggregation Inhibitors
• Homocysteine
• Vitamin B Complex
• Ezetimibe

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Carotid Stenosis (surgery)
• Dementia (prevention & control)
• Diet
• Diet, Vegetarian
• Endarterectomy, Carotid
• Ezetimibe (therapeutic use)
• Factor Xa Inhibitors (therapeutic use)
• Gastrointestinal Microbiome
• Homocysteine (blood)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Hypolipidemic Agents (therapeutic use)
• Patient Care Planning
• Patient Selection
• Platelet Aggregation Inhibitors (therapeutic use)
• Renal Insufficiency
• Stents
• Stroke (etiology, prevention & control)
• Vascular Stiffness
• Vitamin B Complex (therapeutic use)