In this issue of JAMA, the articles by Tran
and Anand1 and Spagnoli and colleagues2 contribute useful information about prevention of
ischemic stroke. Tran and Anand rightly consider that atherosclerosis is a
patchy disease for which platelet anti-aggregants, in addition to reduction
of modifiable risk factors, are recommended and have chosen transient ischemic
attack (TIA) and cerebral infarction as the indices for the successful intervention.
The authors consider aspirin alone and in combination with clopidogrel, ticlopidine,
and dipyridamole and conclude that clopidogrel alone or with aspirin is the
most efficacious method for primary and secondary prevention of TIA and recurrent
ischemic stroke. However, they concentrate only on antiplatelet therapy and
do not specifically address the important effects of diet, lipids, exercise,
smoking, and other modifiable risk factors.
Toole JF, Sane DC, Bettermann K. Stroke PreventionOptimizing the Response to a Common Threat. JAMA. 2004;292(15):1885–1887. doi:10.1001/jama.292.15.1885
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