缺血性卒中二级预防PPT.ppt

* * * * * * * None of the Recommendations for Behavior Change are supported by randomized clinical trials, therefore the level of evidence is reported as “C” in all cases. Smoking: Avoid environmental smoke (Class IIa, Level C), Counseling, nicotine products, and oral smoking cessation medications have been found to be effective for smokers (Class IIa, Level B) Alcohol: Light to moderate levels of less than or equal to 2 drinks per day for men and 1 drink per day for nonpregnant women may be considered. Class IIb, Level C) Obesity: A BMI of 18.5 to 24.9 kg/m2 and a waist circumference of 35 in for women and 40 in for men. Clinicians should encourage weight management through an appropriate balance of caloric intake, physical activity, and behavioral counseling. (Class IIb, Level C) Physical activity:For those with ischemic stroke or TIA who are capable of engaging in physical activity, at least 30 minutes of moderate-intensity physical exercise most days may be considered to reduce risk factors and comorbid conditions that increase the likelihood of recurrence of stroke. For those with disability after ischemic stroke, a supervised therapeutic exercise regimen is recommended. (Class IIb, Level C) * All rates shown are for patients referred to the study clinic. 90 d CVA risk 10.3% to 2.1% (p0.0001) NNT=12; 80% RRR for those treated in the EXPRESS clinic. NNT to prevent the combined outcome of CVA, MI and death also 12. For all patients presenting with suspected TIA in the county irrespective of treatment site, recurrent CVA declined from 9.9% to 4.2% (NNT 18) also statistically significant, but on subgroup analysis most of that improvement stemmed from the impact of those referred to the EXPPRESS clinic. Phase II patients at 30 days were significantly more likely to be on ASA/Clopidogrel, on a statin, on BP meds, have a lower BP and to have had CEA 7d and 30d after the event. The overall rate of CEA was not different between groups. No evidence of gradual im