Preventie van vasculaire complicaties na een TIA of beroerte: Bloeddruk- en cholesterolverlagende therapie

In patients who have recently had a TIA or stroke, the risk of new serious cardiovascular disease is decreased by the pharmacological reduction of the serum cholesterol level and blood pressure; this has been convincingly demonstrated by randomised clinical trials. There is sufficient evidence that cholesterol-lowering treatment is effective in patients with a TIA or cerebral infarction who have a total cholesterol ≥ 3.5 mmol/l. The results from a trial in patients with only a TIA or a minor stroke will have to answer the question whether cholesterol-lowering treatment will be effective in patients > 80 years, and whether higher dosages of simvastatin will be more effective in these patients. Antihypertensive therapy is effective in preventing recurrent stroke and myocardial infarction in patients with a recent stroke or TIA. It is obvious that the treatment should be started with a diuretic and that a second agent should be added if necessary. On epidemiological grounds, vigorous treatment is also justified in patients with a normal or mildly elevated blood pressure; caution and a custom-tailored approach are essential, however, in each individual patient.