Abstract: Ten risk factors are associated with 90% of the risk of stroke. Healthy lifestyle must be thecornerstone of all physician recommendations for stroke prevention. Recent clinical trials havedemonstrated that there are numerous opportunities to improve stroke prevention strategies. Forpatients with diabetes mellitus and for those with previous strokes or transient ischemic attacks, ithas become evident that aggressive low-density lipoprotein lowering with statins will decrease therisk for total and fatal strokes. Optimal anticoagulation and antiplatelet therapy for primary andsecondary stroke prevention in atrial fibrillation is being carefully defined; Dabigatran has beenapproved by Food and Drug Administration(FDA) for secondary prevention in selected patients,and the guideline has been updated. The study findings offer conflicting views on future role ofcarotid angioplasty and stenting(CAS), and CAS is more risky than carotid endarterectomy(CEA);completion of long-term follow-up is needed to establish the efficacy of CAS compared withCEA; CEA should remain the treatment of the first choice for patients suitable for surgery. As tohypertension and stroke prevention, the results of recent studies might set the foundation for a majorchange in the clinical practice.

Key words: Stroke; Prevention; Guidebooks; American Heart Association; American Stroke Association

摘要： 90%的卒中风险与10大危险因素有关。健康生活方式作为卒中预防的基石是所有医生都必须推荐的。最近的临床试验已证实，卒中预防策略的改善存在许多机会。很显然，对于糖尿病以及既往卒中或短暂性脑缺血发作患者，采用他汀类药物积极降低低密度脂蛋白，可减少总的卒中和致死性卒中的风险。对于心房颤动患者的卒中一级和二级预防，正在谨慎制定最佳抗凝和抗血小板治疗措施；达比加群已获美国食品和药品管理局（Food and Drug Administration，FDA）批准用于部分患者的二级预防，指南已做了更新。关于颈动脉成形和支架术（carotid angioplasty and stenting，CAS）未来的作用仍有争议，CAS较颈动脉内膜切除术（carotid endarterectomy，CEA）风险更大；为确定CAS与CEA比较的疗效，还需完成长期随访；对于适合于手术者CEA应仍然是首选。关于高血压与卒中预防，最新研究有可能成为临床实践发生较大改变的基础。

关键词: 卒中; 预防; 指南; 美国心脏病协会; 美国卒中协会