Clinical review

In Russia, diseases of the circulatory system occupy leading positions in the structure of mortality, and stroke occupies the 2nd place, "skipping ahead" only myocardial infarction. The consequences of ischemic stroke (AI) are catastrophic – only 13-16% of patients recover completely and can return to their previous lifestyle, while the majority acquire permanent disability or die. However, there are methods of secondary prevention with which most strokes can be prevented.

Key words: ischemic stroke, secondary prevention, acetylsalicylic acid, cardiovascular mortality.

1. Kernan WN, Ovbiagele B, Black HR et al.; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (7): 2160–236. 2. PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl) 1995; 108 (9): 710–7. 3. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358 (9287): 1033–41. 4. Stone NJ, Robinson JG, Lichtenstein AH et al.; 2013 ACC/AHA Cholesterol Guideline Panel. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med 2014; 160 (5): 339–43. 5. Amarenco P, Bogousslavsky J, Callahan A III et al.; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355 (6): 549–59. 6. Karam JG, Loney-Hutchinson L, McFarlane SI. High-dose atorvastatin after stroke or transient ischemic attack: The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. J Cardiometab Syndr 2008; 3 (1): 68–9. 7. Joseph JP, Afonso M, Berdaï D et al. Benefits and risks for primary prevention with statins in the elderly. Presse Med 2015; 44 (12 pt 1): 1219–25. 8. Epstein LJ, Kristo D, Strollo PJJr et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5 (3): 263–76. 9. Putaala J, Kurkinen M, Tarvos V et al. Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke. Neurology 2009; 72 (21): 1823–9. 10. Mendis S, Abegunde D, Yusuf S et al. WHO study on prevention of recurrences of myocardial infarction and stroke (WHO-PREMISE). Bull World Health Organ 2005; 83 (11): 820–9. 11. Kaplan RC, Tirschwell DL, Longstreth WTJr et al. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology 2005; 65 (6): 835–42. 12. Mostofsky E, Burger MR, Schlaug G et al. Alcohol and acute ischemic stroke onset: the stroke onset study. Stroke 2010; 41 (9): 1845–9. 13. Левин О.С., Бриль Е.В. Первичная и вторичная профилактика инсульта. Современная терапия в психиатрии и неврологии. 2016; 1: 4–7. 14. Millard MA, Hernandez-Vila EA. What Do the Guidelines Really Say About Aspirin? Texas Heart Institute J 2018; 45 (4): 228–9. 15. Arnett et al. ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. 2019. 16. Антитромботическая терапия у больных со стабильными проявлениями атеротромбоза. Российские рекомендации. Кардиоваск. терапия и профилактика. 2009; 8 (Прил. 6): 20. 17. Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54 (12): 1044–54. 18. The Dutch TIA Trial Study Group. A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 1991; 325 (18): 1261–6 19. The Canadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med 1978; 299 (2): 53–9. 20. Johnson ES, Lanes SF, Wentworth CE III et al. A metaregression analysis of the dose-response effect of aspirin on stroke. Arch Intern Med 1999; 159 (11): 1248–53. 21. The SALT Collaborative Group. Swedish Aspirin Low-Dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 1991; 338 (8779): 1345–9. 22. Drepper MD, Spahr L, Frossard JL. Clopidogrel and proton pump inhibitors – where do we stand in 2012? World J Gastroenterol 2012; 18 (18): 2161–71. 23. Diener HC, Bogousslavsky J, Brass LM et al.; MATCH Investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364 (9431): 331–7. 24. Lavie CJ, Howden CW, Scheiman J, Tursi J. Upper Gastrointestinal Toxicity Associated With Long-Term Aspirin Therapy: Consequences and Prevention. Curr Probl Cardiol 2017; 42: 146–64. 25. Namio Uemura, Kentaro Sugano, Hideyuki Hiraishi et al. Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study. J Gastroenterol 2014; 49: 814–24. 26. Van Hecken A, Juliano ML, Depre M et al. Effects of enteric-coated, low-dose aspirin on parameters of platelet function. Aliment Pharmacol Ther 2002; 16: 1683–8.