Secondary Prevention of Stroke — New Trials

THE WORD "STROKE" is derived from the Old English word "stricken" and is now the accepted medical term for the results of a cerebro-vascular accident which includes loss of motor sensory and higher cerebral functions. The World Health Organisation definition is "sudden onset of signs of disturbance of cerebral function, lasting more than 24 hours or leading to death which are of presumed vascular origin". A transient ischaemic attack (TIA) or "small stroke" is similar but the cerebral signs and symptoms have resolved within 24 hours. In the UK about 10 per cent of strokes are due to intracerebral bleeding and 90 per cent due to thromboemoblism. With the increasing number of people in our ageing population the number ofnew stroke victims has increased as has the medical, social and financial costs. Each year in the UK well over 120,000 people suffer a first ever stroke, about 40,000 have recurrence of a previous stroke and there are about 500,000 people alive who are trying to cope with the long term consequences. 1 Stroke disease remains the third commonest cause ofdeath in the United Kingdom (after myocardial infarction and cancer). About half the patients presenting with a new stroke will die within 28 days, onequarter will require long term care and only a quarter will recover sufficiently to return to their own homes and only a small number return to productive work.' Care of stroke patients ranks as one of the most important costs to the National Health Service accounting for upwards of 13 per cent of occupied acute hospital beds, with an average length ofstay ofover 28 days. The estimated cost of this is about £1.5 billion pounds.' Risk factors for stroke have become better defined and screening for these is now accepted as an important function of general practice in terms of primary stroke prevention and also hospital practice as part of secondary stroke prevention. Important risk factors include: (a) race; (b) family history; (c) previous history of cerebrovascular disease; (d) elevated blood pressure; (e) increasing age, especially in females; (f) diabetes mellitus; (g) atrial fibrillation; (h) smoking; (i) cholesterol level.