Primärprävention des Schlaganfalls – Was ist neu?

Zusammenfassung

Trotz der Fortschritte im Bereich der Akutbehandlung und Sekundärprävention des Schlaganfalls, stellt dieser weiterhin die wichtigste Ursache für dauernde Behinderung und die zweithäufigste Todesursache weltweit dar. Die wesentlichen Risikofaktoren für den Schlaganfall sind gut bekannt und können in nichtveränderbare (z. B. Alter, Geschlecht, genetische Prädisposition) und modifizierbare (z. B. Hypertonus, Nikotin, Diabetes) unterteilt werden. Die INTERSTROKE-Studie zeigte, dass 5 Faktoren (anamestischer Hypertonus oder Blutdruck >160/90 mm Hg, Rauchen, Taille-Hüft-Quotient, Ernährung und Bewegungsmangel) insgesamt 83,4% des Schlaganfallrisikos erklären. In der vorliegenden Übersichtsarbeit werden aktuelle Entwicklungen der Primärprävention des Schlaganfalls dargestellt. Dazu gehören die Bedeutung der Blutdruckvariabilität, neue Daten zu Statinen und Antithrombotika, die Therapie der asymptomatischen Karotistenose sowie der Stellenwert nichtmedikamentöser Maßnahmen im Rahmen einer „Lifestyle“-Modifikation.

Abstract

In spite of the improvements in acute stroke therapy as well as effective secondary prevention measures, stroke remains the most important disease for permanent disability and is the second most frequent cause of death worldwide. The risk factors for stroke are well known and have been subdivided into non-modifiable (e. g., age, sex, genetic predisposition) and modifiable (e. g., hypertension, smoking, diabetes). The INTERSTROKE study shows that 5 risk factors (history of hypertension or blood pressure >160/90 mm Hg, smoking, waste-to-hip ratio, physical inactivity and diet-risk score account for 83.4% of the stroke risk in the population. This review focusses on recent developments of primary stroke prevention including the importance of blood pressure variability, new data concerning statins and antithrombotics, the therapy for an asymptomatic carotid stenosis as well as the role of non-medical measures in the framework of lifestyle changes.

Schlüsselwörter

Schlaganfall - Risikofaktoren - Primärprävention - Hypertonus - Vorhofflimmern

Keywords

stroke - risk factors - primary prevention - hypertension - atrial fibrillation

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