Can you improve your odds? Absolutely! The process of using information from the first stroke to help prevent another is called "secondary stroke prevention." The idea is that if there is something that can and should be done to reduce one's risk, now is the time to do it. There is no point in waiting for yet another attack to occur before getting started. A blue-ribbon panel from the American Stroke Association and American Heart Association reviewed the state of knowledge concerning secondary stroke prevention for patients with ischemic strokes and published their results in a March 2006 issue of the journal "Circulation." They found that use of blood-pressure-lowering medications has a powerful effect in reducing the risk of a second stroke -- ranging from 24-43% in better studies -- and this benefit might even extend to patients who have normal blood pressure to start with. If you have diabetes, then it is especially important to control high blood pressure. Using a medication from the groups of drugs known as "angiotensin converting enzyme inhibitors" (ACEIs) and "angiotensin receptor blockers" (ARBs) will not only help control blood pressure, but will additionally help protect the kidneys. If you have diabetes, then it is also important to consider use of cholesterol-lowering medication, especially from the class of drugs known as "statins." Statins can additionally benefit people without diabetes and even those without elevated cholesterol levels. Of course, in diabetes it is also important to keep the blood-sugar levels as close to normal as is humanly possible.

If your hospital studies showed that a carotid artery is 70-99% narrowed (severe stenosis) and your recent stroke was downstream from this blood vessel, then you are much less likely to have another stroke if you have a surgical clean-out (endarterectomy) by an experienced surgeon whose complication rate is less than 6%. If you have severe narrowing, but because of some medical or surgical problem the surgery is considered too risky, then insertion of a stent into the narrowed artery can serve as a substitute for endarterectomy.

The above recommendations are based on studies in people with atherosclerosis (hardening of the arteries) which is the most common cause of strokes and, for that matter, heart attacks. But not every stroke is caused by atherosclerosis. That's why medical testing is important in stroke patients -- so that treatment can be tailored to individual circumstances.

If your stroke was due to atherosclerosis, then studies support the use of an "anti-platelet" drug. Platelets are the building blocks from which blood clots are made, and anti-platelet drugs interfere with the ability of the platelets to clump together to form a clot. Antiplatelet drugs of first choice include aspirin by itself, aspirin in combination with extended-release dipyridamole (Aggrenox), and clopidogrel (Plavix).

(C) 2006 by Gary Cordingley