Guidelines for Management of Ischaemic Stroke 2008 - ESO

ESO-Guidelines for Management of Ischaemic Stroke 2008
Statin withdrawal at the acute stage of stroke may be associated with an increased
risk of death or dependency [294].
Cigarette smoking
There are no specific data in secondary prevention. See primary prevention.
Diet
Overweight
There are no specific data in secondary prevention. See primary prevention. Weight
loss may be beneficial after stroke as it lowers blood pressure [245].
Vitamins
Beta carotene increased the risk of cardiovascular death in a meta-analysis of
primary and secondary prevention trials (RR 1.10; 95% CI 1.03-1.17) [295]. Vitamin
E supplementation does not prevent vascular events [296]. Fat soluble antioxidant
supplements may increase mortality [297].
Vitamins which lower homocysteine (folate, B12, B6) do not appear to reduce stroke
recurrence and may increase vascular events [298-301], but further trials are ongoing
[302].
Sleep-disordered breathing
Sleep-disordered breathing represents both a risk factor and a consequence of
stroke and is linked with poorer long-term outcome and increased long-term stroke
mortality [303]. More than 50% of stroke patients have sleep-disordered breathing,
mostly in the form of obstructive sleep apnoea (OSA). This can improve
spontaneously after stroke, but may need treatment. Continuous positive airway
pressure is the treatment of choice for OSA. Oxygen and other forms of ventilation
may be helpful in other (e.g. central) forms of SDB.
Patent foramen ovale
Case reports and case control studies indicate an association between the presence
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