Secondary Prevention: Stoppin... Video Transcript

Participants

, Dara Jamieson MD, Paul J. Moniz , Ralph L. Sacco MS, MD

Summary

If you've suffered a stroke, one of your greatest concerns should be preventing a second stroke. Currently, 40 percent of stroke survivors have a second stroke within five years. And a repeat stroke is frequently more devastating than the first. But there are things you can do to keep a second attack at bay. Join our panel of experts for a discussion of prevention issues specific to stroke survivors.

Webcast Transcript

PAUL J. MONIZ: I'm Paul Moniz. Thank you for joining us on this webcast. Do you know someone in the United States has a stroke every minute? If you or someone you're close to is in that category, you need to know two things. Your likelihood of having another stroke within five years is within 35%. But if you modify your lifestyle, you can reduce your chances of suffering another stroke.

Here to answer questions about secondary prevention are two specialists in the field. Dr. Ralph Sacco is an Associate Chairman of Neurology at Columbia University. Thanks for joining us. Dr. Dara Jamieson is a neurology at Pennsylvania Hospital. Thank you.

Dr. Sacco, let's begin with you. When people talk about secondary prevention, what are we really talking about here?

RALPH L. SACCO, MD: The key is somebody who has now had a stroke, or a TIA, preventing an event — preventing a recurrence. Most of the time we talk about secondary or tertiary prevention. We're really talking about how to prevent a recurrent stroke. It's clear that if you've survived your stroke, you're at risk for a recurrence. If you have a recurrence, it's going to make a major impact. It will increase the chance of dying. It will clearly add more disability to your life. It's important for us to be thinking about ways to reduce the chance — in the survivors of stroke — the chance of a recurrent stroke.

PAUL J. MONIZ: You mentioned TIA. For those viewers who are just joining us, again could you explain what that is.

RALPH L. SACCO, MD: TIA is a warning sign, a transient ischemic attack — it's a brain attack. It may be a warning sign of a stroke. In TIA patients who are at high risk for stroke, we want to prevent a stroke and this fits into prevention as well.

PAUL J. MONIZ: Dr. Jamieson, as time goes on someone's chances of having another stroke actually increases. Can you give us the numbers? The breakdown?

DARA JAMIESON, MD: Certainly the risk accumulates over time. After you've had a TIA or after you've had one stroke, your risk of actually having another episode is highest right near that — in the next hours to days to weeks. But the risk continues to accumulate so that by one year, you may have a 5-10% chance of having another stroke. Or by five years, you may have a 30-35% chance of having another stroke. The process of prevention continues for many years, both in terms of lifestyle and in terms of medication.

PAUL J. MONIZ: So this is something that people have to be really serious about for the rest of their lives once it happens.

DARA JAMIESON, MD: Often a stroke is a wake-up call. I remember a woman I saw in the office today who at 65 really didn't think she needed to go see doctors. But when she had her stroke, it was discovered that her blood pressure was too high, her glucose was too high, her cholesterol was too high and all of a sudden she needed specialists to help her with these risk factors and intervention to help prevent another stroke from occurring.

PAUL J. MONIZ: Dr. Sacco, are second strokes always more serious?

RALPH L. SACCO, MD: Sometimes. The key is that when you have one stroke, and you survived it, if you have another one, the next one may leave you with a lot more disability. For example, if you have right-sided weakness and then go on to have a stroke on the other side of the brain, you may have your right and left side impaired. Clearly if you're going to have another brain injury, another stroke, it's going to disable you further. There are ways that we can think of to try to reduce that risk.

PAUL J.