Acidente vascular cerebral isquémico – Prevenção: Aspectos actuais – É preciso agir

Autores

  • Francisco Silva Assistente Graduado de Medicina Interna Serviço de Medicina 2 do Hospital de Egas Moniz, Lisboa

Palavras-chave:

Acidente Vascular Cerebral, prevenção, factores de risco, hipertensão arterial, lipidos, antiagregação plaquetária, estatinas, Inibidores da ECA

Resumo

O Acidente Vascular Cerebral (AVC) é a patologia com maior mortalidade e morbilidade em
Portugal. A Medicina moderna tem contribuído
para um aumento da população idosa e, consequentemente, aumento do número de doentes
com AVC. A trombólise, recentemente aprovada na Europa, apenas beneficia um número muito
restrito de doentes. Assim, consideramos que a única forma de tentar diminuir a incidência
desta doença consiste no controlo dos factores de risco. Neste artigo salienta-se a importância
da terapêutica preventiva, abordam-se os factores de risco mais frequentemente relacionados
com o AVC, com especial ênfase para aqueles que podem ser controlados, nomeadamente a hipertensão arterial e a dislipidemia, entre outros. Abordam-se os novos estudos que clarificam o papel das estatinas e dos inibidores
do enzima conversor da angiotensina na prevenção primária e secundária do AVC. Chama-se a atenção para a empatia necessária entre médico-doente para uma melhor aderência às
medidas preventivas propostas. Salienta-se a importância de campanhas globais de informação como medida fundamental na diminuição da incidência do AVC.

Downloads

Não há dados estatísticos.

Referências

Pearson TA, Blair SN, Daniels SR, Eckel RH et al. AHA Guidelines for Primary Prevention of Cardiovascular disease and Stroke:2002 Update.

Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or other Atherosclerotic Vascular Diseases.

Circulation 2002;106:388-391.

Goldstein LB, Adams R, Becker K et al. Primary Prevention of Ischemic Stroke. A Statement for Healthcare Professionals From the Stroke

Council of the American Heart Association 2001;103:163-182.

Hayden M, Pignon M, Philips C, Mulrow Cynthia. Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the

Evidence for U.S. Preventive Services Task Force. Ann Intern Med 2002;136:161-172.

Aspirin for the Primary Prevention of Cardiovascular Events: Recomendation and Rational. U.S Preventive Task Force. Ann Intern Med

;136:157-160.

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:603-613.

Writing Group for the Womens`s Health Iniciative Investigators. Risk and Benefits of Estrogen Plus Progestin in Heath Postmenopausal

Women. JAMA 2002;288:321-333.

Barnett HJM, Meldrum HE. Ach Neurol 2000; 57:40-45.

World Health Report 2002. http//who.int/mediacentre/releases/pr83/en/print/html

MacMahon S, Peto R, Cutler J et al. Blood pressure, stroke, and coronary heart disease, part 1: prolonged differences in blood pressure:

prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765-774.

The Risc Group. Lancet 1990;335:827-830.

Neal B, MacMahon. J Hypertension 1995;13;1869-1873.

Gueyffier F, Bulpitt C, Boissel JP, Schron E, Ekbom T, Fagardr R, for the INDANA Group. Antihypertensive drugs in very old people:

a subgroup meta-analysis of randomized controlled trials. Lancet 1999;353:793-796.

MacMahon S et al. J Hypertension 1994;12(10):S11-S14.

Domenic A. Sica. J Clin Hypertens 2002; 4(2):126-129.

The Seventh report of the Joint National Commitee on Prevention, Detection, Avaluation, and Treatment of High Blood Pressure: the JNC

report. JAMA 2003;289:2560-2572.

Kottke TE, Stroebel RJ, Hoffman RS. JNC 7-It`s more than high blood pressure. JAMA 2003; 289 (19):2573-2575.

Yusuf S, Sleight P, Pogue J et al. Effects of na angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in hight-risk

patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-153.

Bosch J, Yusuf Salim, Pogue Janice et al. Use of ramipril in preventing stroke: double blind randomised trial. BMJ 2002 Mar 23;324:699-702.

Svensson P, de Faire U, Sleight P et al. Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Hypertension. 2001;38:E28-E32.

PROGRESS Collaborative Group. Randomized trial of a perindoprilbased blood-pressure-lowering regimen among 6105 individuals with

previous stroke or transient ischaemic attack. Lancet 2001;358:1033-1041.

Staessen JA. Lancet 2001;358:1026-1027.

Losartan Intervention For End-point reduction in hypertension) (Dahlof B, Devereus RB, Kjeldsen SE, Julius S, Beevers G, Faire U et al., for

the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study

(LIFE): a randomized trial against atenolol. Lancet 2002;359:995-1003.

Hansson L, Lithell H, on behalf of the SCOPE Study Investigators. The Study on COgnition and Prognosis in Elderly Hypertensives (SCOPE).

Abstracts of Hypertension Prague 2002 - Joint 19th Scientific Meeting of the International Society of Hypertension and 12th European

Meeting on Hypertension, Prague, Czech Republic. Abstract 0162. 2002: 23-27.

Hankey GJ. Angiotensin-Converting Enzyme Inhibitors for Stroke Prevention. Is There HOPE for PROGRESS After LIFE? Stroke

;34:354-356.

Lonn EM, Yusuf S, Jha P, Montague TH, Teo KK, Pitt B. Emerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular

protection. Crculation 1994;90:2056-2069.

Cohn JN, ACE inhibition and vascular remodeling of resistence vessels: vascular compliance and cardiovascular implications. Heart Dis

;2:S2-S6.

Blood Pressure Lowering Treatment Trialists` Collaboration. Effect of ACE inhibitors, calcium antagonists, and other blood pressure-lowering drugs: results of prospectively designed overviews of randomized trials. Lancet 2000;355:1955-1964.

Staaessen JA, Wang JI-G, Thijs L. Cardiovascular protection and blood pressure reduction: a meta-analysis: The Lancet 2001;358:1305-

Hansson L, Lindhom LH, Niskanen L et al. Effect of angiotensinconverting-enzyne inhibition compared with conventional therapy on

cardiovascular morbidity and mortality inhypertension: the Captopril Prevention Project (CAPPP) randomized trial. Lancet 1999;353:611-

Blood Pressure Lowering Trialist`s Collaboration. Effect of ACE inhibitors, calcium antagonists, and other blood pressure-lowering

drugs: results of prospectively designed overviews of randomized trials. Lancet 2000;355:1955-1964.

Friday G, Alter M, Lai S-M. Control of Hypertension and Risk of Stroke Recorrence Stroke 2002;33:2652-2657.

Yusuf S, Sleight P, Pogue J et al. Effects of na angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in hight-risk

patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-153.

Bosch J, Yusuf Salim, Pogue Janice et al. Use of ramipril in preventing stroke: double blind randomised trial. BMJ 2002 ;324:699-702.

Wahlgren NG, McMahon DG, De Kayser J et al. Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischemic stroke. Cerebrovasc Dis 1994;4:204-210.

Wahlgren NG, Vorstrup S, Andersen AR et al. Angiotensin-converting enzyme inhibition and regional crebral blood flow in acute stroke. J

Cardiovasc Pharmacol 1989;14:722-729.

Dyker AG, Grosset DG, Lees KR. Perindopril reduces blood pressure but not cerebral blood flow in patients with recent crebral ischemic

stroke. Stroke 1997;28:580-583.

Walters MR, Bolster A, Dyker AJ et al. Effects of perindorpil on cerebral and renal perfusion in stroke patients in carotid disease. Stroke

;32:473-478.

Gorelick – Lancet Neurology 2002;1:149-156.

Quisilbash N, Lewington S, Duffy S et al. Cholesterol, diastolic blood pressure and stroke: 13000 strokes in 450000 people in 45 prospective

cohorts: Prospective Studies Collaboration. Lancet 1995;346:1647-1653.

Iso H, Jacobs DR. Jr, Wentworth D et al. Serum cholesterol levels and sixt-year mortality from stroke in 350,977 men screened for the Multiple Risk Factor Intervention Trial. N Engl J Med 1989;320:904-910.

Benfante R, Yano K, Hwang LJ et al.Elevated serum cholesterol is a risk factor for both cornary heat disease and thromboembolic

stroke in Hawaiin Japanese men: implications of shared risk. Stroke 1994;25:814-820.

Bucher HC, Griffith LE, Guyatt GH. Effect of HMG-CoA reductase inhibitors on stroke: a meta-analysis of randomized controlled studies.

Ann Intern Med 1998;128:89-95.

Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the

Scandinavian Simvastatin Survival Study (4s). Lancet 1994;344:1383-1389.

Pedersen TR, Kjekshus J, Pyorala K et al. Effects of simvastatina on ischemic signs and symtoms in the Scandinavian Simvastatin Survival

Study (4S). Am J Cardiol 1999;81:333-335.

The LIPID Study Group. Prevention of Carvdiovascular events and death with pravastatin in patients in coronary heart disease and a

broad range of initial cholesterol levels. N Engl J Med 1998;339:1349-1357.

Plehn JF, Davis BR, Sacks FM et al. Reduction of Stroke Incidence after Myocardial Infarction With Pravastatin. The Cholesterol and Recorrent Events Study. Circulation 1999;99:216-223.

Schwartz GG, Olsson AG, Ezekowitz MD et al. Effects of atorvastatin on recurrent ischemic events and acute coronary syndromes. The

MIRACL study: a randomized controlled trial. JAMA 2001;285:1711-1718.

Schwartz GG, Olsson AG et al. Effects of atorvastatin on stroke in patients with unstable angina or non-Q-wave myocardial infarction: a

myocardial ischemia reduction with aggressive cholesterol lowering (MIRACL) sbstudy. Circulation 2002;106:1690-1695.

Sever PS, Dahlof B, Pouler NR et al. Rational, design, methodds ans baseline demography of participants of the Anglo-Sacandinavian Cardiac Outcomes Trial. ASCOT investigators. J Hypertens 2001;19:1139-1147.

Sever PS, Dahlof B, Pouler NR et al. Prevention of Coronary and Stoke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOTT-LLA):

a multicentre randomized controlled trial. THE LANCET 2003; 361:1149-1158.

The Heart Protection Study Collaborative Group. MRC/BHF Heart protection study of cholesterol lowering with simvastatin in 20536

high-risk individuals: randomized placebo-controlled trial. Lancet 2002;360:7-22.

Stroke Prevention by Aggressive Reduction in Cholesterol Levels – SPARCL. Stroke. Major ongoing clinical trials 2002;33:1736.

Yano K, Reed DM, Maclean CI. Serum Cholesterol and hemorrhagic stroke in fhe Honolulu Heart Program. Stroke 1989;20:1460-1465.

Iso H, Jacobs DR. Jr, Wentworth D et al. Serum cholesterol levels and sixt-year mortality from stroke in 350,977 men screened for the Multiple Risk Factor Intervention Trial. N Engl J Med 1989;320:904-910.

Suh II, Jee SH, Kim HC et al. Elevated serum cholesterol and heamorragic stroke in men. Korean Medical Insurance Corporation Study.

Lancet 2001;351:922-925.

Shepherd J, Blauw GJ, Murphy MB et al. Pravastatin in elderly individualsat risc of vascular disease (PROSPER): a randomized controlled

trial.- Lancet 2002;360:1623-1630.

Albers G W, Amarenco P, Easton AD, Sacco RL and Teal PT. Anti-thrombotic and Thrombolytic Therapy for Ischemic Stroke. CHEST

;119:300S-320S.

Antithrombotic Trialists` Collaboration. Collaborative meta-analysis of randomizaed trials of antiplatelet therapy for prevention of death,

myocardial infarction, and stroke in high risk patients. BMJ 2002; 321:71-86.

Matias-Guiu J, Ferro JM, Alvarez-Sabin J, Torres F, Jimenez MD et al. for the TACIP Investigators. Stroke 2003;34:840-848.

Helgason CM, Bolin KM, Hoff JÁ et al. Development of aspirin resistance in persons with previous ischemic stroke. Stroke 1994;25:2331-

Newby LK. A randomized comparison of sibrafiban, an oral glycoprotein (GP) IIb/IIIa receptor antagonist, with and without aspirin versus

aspirin after acute coronary syndromes: results of the 2nd SYNPHONY trial. J Am Coll Cardiol 2000;36:319-320.

Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL et al. A comparison of warfarin and aspirin for the prevention of recorrent ischemic

stroke. N Engl J Med 2001;345:1444-1451.

Philip B. Gorelick, MD, MPH; DeJuran Richardson, PhD; Michael Kelly, MD; Sean Ruland, DO; Elena Hung, MS; Yvonne Harris, MPA,

CCRA; Steven Kittner, MD, MPH; Sue Leurgans, PhD; for the African American Antiplatelet Stroke Prevention Study (AAASPS) Investigators. JAMA 2003;289:2947-2957.

European Stroke Prevention Study 2. Efficacy and safety data. J Neurol Sci 1997;15:S1-S77.

Yusuf S, Zhao F, Mehata SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute

coronary syndrome s without ST-segment elevation. N Engl J Med 2001;345:494-502.

Major Ongoing Stroke Trials. Stroke 2003;34:41.

Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood

Cholesterol in Adults (Adult Treatment Panel III). Circulation. 2002;106:3143

Ficheiros Adicionais

Publicado

30-06-2004

Como Citar

1.
Silva F. Acidente vascular cerebral isquémico – Prevenção: Aspectos actuais – É preciso agir. RPMI [Internet]. 30 de Junho de 2004 [citado 20 de Abril de 2024];11(2):99-108. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1748

Edição

Secção

Artigos de Revisão

Artigos mais lidos do(s) mesmo(s) autor(es)