{"product_id":"stroke-prevention-a-lifetime-of-lessons-a-patients-guide-to-treating-arteries-not-just-risk-factors","title":"Stroke Prevention: A Lifetime of Lessons — A Patient's Guide to Treating Arteries, Not Just Risk Factors","description":"\u003cp\u003eDr. J. David Spence's 2020 Feinberg Award Lecture, summarized in this supplement, describes a fundamental shift in stroke prevention: instead of merely treating individual risk factors like high blood pressure or high cholesterol, doctors should focus on \u003cstrong\u003etreating the arteries themselves\u003c\/strong\u003e. The lecture presents a personalized medicine approach that uses blood tests to tailor blood pressure medications to each patient's specific physiology, combined with aggressive lifestyle interventions and imaging to show patients their own plaque buildup. Real-world data from a large network of clinics in Argentina demonstrates the power of this strategy, with annual cardiovascular event rates dropping from \u003cstrong\u003e5.85% to 2.35%\u003c\/strong\u003e after the approach was implemented.\u003c\/p\u003e\n\n\u003ch1\u003eStroke Prevention: A Lifetime of Lessons — A Patient's Guide to Treating Arteries, Not Just Risk Factors\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eWhy Stroke Prevention Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#philosophy\"\u003eA New Philosophy: Treating Arteries Instead of Just Risk Factors\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#blood-pressure\"\u003ePersonalized Blood Pressure Treatment: The Renin\/Aldosterone Approach\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#lifestyle\"\u003eLifestyle Changes: The Foundation of Artery Health\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#medications\"\u003eMedical Therapies: Medications That Protect Your Arteries\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#brain-blood-pressure\"\u003eBlood Pressure in the Brain: Why Small Vessels Matter\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#argentina\"\u003eReal-World Success: The Argentina Experience\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eWhat This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003ePractical Recommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eTreating arteries directly, rather than just risk factor numbers, is a more personalized stroke prevention approach.\u003c\/li\u003e\n\u003cli\u003eMeasuring renin and aldosterone helps select the right blood pressure medication for resistant hypertension.\u003c\/li\u003e\n\u003cli\u003eShowing patients their own artery plaque can motivate lifestyle change and plaque regression is achievable.\u003c\/li\u003e\n\u003cli\u003eIn an Argentine clinic network, annual cardiovascular events fell from 5.85% to 2.35% after implementing this approach.\u003c\/li\u003e\n\u003cli\u003eLifestyle changes include Mediterranean diet, exercise, smoking cessation, and avoiding drugs like decongestants that raise blood pressure.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eWhy Stroke Prevention Matters\u003c\/h2\u003e\n\n\u003cp\u003eStroke remains one of the leading causes of death and disability worldwide. Yet the startling truth is that most strokes are preventable. Dr. Spence's lifetime of research, honored with the Feinberg Award in 2020, shows that prevention is far more powerful than treatment after a stroke occurs.\u003c\/p\u003e\n\n\u003cp\u003eThe traditional approach to stroke prevention has been to identify risk factors—things like high blood pressure, high cholesterol, diabetes, and smoking—and treat each one with the appropriate medication. This \"treat the numbers\" strategy has saved countless lives, but it has an important gap: two people with identical blood pressure readings, identical cholesterol levels, and identical lifestyle habits can have dramatically different outcomes.\u003c\/p\u003e\n\n\u003cp\u003eWhy? Because risk factors are only part of the story. What really matters is what is happening inside the arteries themselves.\u003c\/p\u003e\n\n\u003ch2 id=\"philosophy\"\u003eA New Philosophy: Treating Arteries Instead of Just Risk Factors\u003c\/h2\u003e\n\n\u003cp\u003eDr. Spence's lecture introduces a powerful concept: rather than focusing exclusively on risk factor numbers, doctors should focus on the \u003cstrong\u003ehealth of the arteries\u003c\/strong\u003e themselves. The approach is built on several key pillars, summarized in the supplement as \"Treating arteries instead of treating risk factors.\"\u003c\/p\u003e\n\n\u003cp\u003eThe first and perhaps most innovative element involves patient education through imaging. The strategy recommends that all patients be \u003cstrong\u003eshown images of their own arterial plaque\u003c\/strong\u003e (the fatty buildup inside artery walls that causes blockages). Doctors should compare the patient's plaque burden with that of healthy people of the same age and sex, describing the specific risks associated with that degree of buildup and what happens if it progresses. Crucially, they should also explain that \u003cstrong\u003eplaque regression is possible\u003c\/strong\u003e—asking patients to take an active role in their own vascular health.\u003c\/p\u003e\n\n\u003cp\u003eThis visual feedback loop appears to be remarkably effective. Patients who see their own plaque may be far more motivated to take medications consistently, quit smoking, and adopt healthier diets than those who are simply told \"your cholesterol is 240.\"\u003c\/p\u003e\n\n\u003ch2 id=\"blood-pressure\"\u003ePersonalized Blood Pressure Treatment: The Renin\/Aldosterone Approach\u003c\/h2\u003e\n\n\u003cp\u003eHigh blood pressure (hypertension) is the single most important modifiable risk factor for stroke. Yet standard treatment often follows a \"one-size-fits-all\" pattern, where patients receive whatever medication happens to be on the formulary. Dr. Spence argues for a more scientific approach: \u003cstrong\u003ephysiologically individualized therapy\u003c\/strong\u003e based on measuring two key substances in the blood—\u003cem\u003erenin\u003c\/em\u003e and \u003cem\u003ealdosterone\u003c\/em\u003e.\u003c\/p\u003e\n\n\u003cp\u003eRenin is an enzyme produced by the kidneys, while aldosterone is a hormone produced by the adrenal glands (small glands on top of the kidneys). Together, they form a system that regulates blood pressure by controlling salt and water balance in the body. When doctors measure these levels in a patient with resistant hypertension (high blood pressure that doesn't respond to standard treatment), they can identify which of three distinct conditions is driving the problem:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePrimary Aldosteronism\u003c\/strong\u003e: Renin levels are \u003cstrong\u003elow\u003c\/strong\u003e, but aldosterone levels are \u003cstrong\u003ehigh\u003c\/strong\u003e. This means the adrenal glands are producing too much aldosterone, causing the kidneys to retain too much salt and water. The primary treatment is an \u003cstrong\u003ealdosterone antagonist\u003c\/strong\u003e such as \u003cstrong\u003espironolactone\u003c\/strong\u003e or \u003cstrong\u003eeplerenone\u003c\/strong\u003e (for men, eplerenone may be preferred if spironolactone causes side effects). In rare cases, surgery to remove the adrenal gland (adrenalectomy) may be considered.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLiddle's Syndrome and Variants \/ Inappropriate Aldosterone Secretion\u003c\/strong\u003e: Both renin and aldosterone levels are \u003cstrong\u003elow\u003c\/strong\u003e. This condition is often caused by mutations affecting a sodium channel in the kidneys (the renal sodium channel). The kidneys retain salt even without aldosterone stimulation. The primary treatment is \u003cstrong\u003eamiloride\u003c\/strong\u003e, a medication that directly blocks this sodium channel.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRenal\/Renovascular Hypertension\u003c\/strong\u003e: Both renin and aldosterone levels are \u003cstrong\u003ehigh\u003c\/strong\u003e. This usually means that the kidneys themselves are not getting enough blood flow (often due to narrowing of the arteries supplying the kidneys). The kidney releases excess renin to try to raise blood pressure and improve flow. The primary treatment is an \u003cstrong\u003eangiotensin receptor blocker (ARB)\u003c\/strong\u003e or a \u003cstrong\u003erenin inhibitor\u003c\/strong\u003e. In rare cases, surgically reopening a narrowed kidney artery (revascularization) may help.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThis classification, originally developed for treating uncontrolled hypertension in African patients (published in the \u003cem\u003eAmerican Journal of Hypertension\u003c\/em\u003e in 2017 by Akintunde and colleagues), transforms blood pressure treatment from guesswork into precision medicine. A simple blood test can save patients months or even years of ineffective treatment.\u003c\/p\u003e\n\n\u003cp\u003eThe supplement also notes a simple but often overlooked tip: switching from non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to \u003cstrong\u003esulindac\u003c\/strong\u003e, which has less effect on blood pressure control. A 1986 study in \u003cem\u003eThe Lancet\u003c\/em\u003e by Wong and colleagues showed that certain pain medications can interfere with blood pressure medications—a lesson many patients never hear.\u003c\/p\u003e\n\n\u003ch2 id=\"lifestyle\"\u003eLifestyle Changes: The Foundation of Artery Health\u003c\/h2\u003e\n\n\u003cp\u003eThe second major component of \"Treating Arteries\" is lifestyle modification, and the supplement outlines a detailed, practical plan:\u003c\/p\u003e\n\n\u003ch3\u003eSmoking Cessation\u003c\/h3\u003e\n\u003cp\u003eSmoking damages the lining of arteries, accelerates plaque buildup, and dramatically increases stroke risk. The recommended approach goes beyond simple advice: it includes \u003cstrong\u003ecounseling, liberal use of nicotine replacement therapy\u003c\/strong\u003e (patches, gum, lozenges), and medications such as \u003cstrong\u003evarenicline or bupropion\u003c\/strong\u003e—with bupropion preferred if the patient has a history of depression, since it can also address mood symptoms.\u003c\/p\u003e\n\n\u003ch3\u003eMediterranean Diet\u003c\/h3\u003e\n\u003cp\u003ePatients should be counseled on the Mediterranean diet—rich in fruits, vegetables, whole grains, fish, and healthy fats like olive oil. The supplement notes that patients should receive a booklet with advice, recipes, and links to helpful websites, with reinforcement at every follow-up visit. One-time advice is rarely enough; repetition is essential.\u003c\/p\u003e\n\n\u003ch3\u003eWeight Management and Exercise\u003c\/h3\u003e\n\u003cp\u003eObesity is addressed with counseling on caloric restriction, referral to a dietician, and—for refractory patients with severe obesity plus diabetes or insulin resistance—referral for \u003cstrong\u003ebariatric surgery\u003c\/strong\u003e. Exercise recommendations are for \u003cstrong\u003emoderate activity at least 30 minutes a day\u003c\/strong\u003e, with advice tailored to each patient's disabilities. For someone with limited mobility, even chair-based exercises can help.\u003c\/p\u003e\n\n\u003ch3\u003eBlood Pressure-Friendly Habits\u003c\/h3\u003e\n\u003cp\u003eSimple dietary changes can have a big impact on blood pressure: \u003cstrong\u003ereducing salt intake, limiting alcohol consumption, avoiding licorice\u003c\/strong\u003e (which contains a compound that raises blood pressure), and avoiding decongestants, which can also elevate blood pressure.\u003c\/p\u003e\n\n\u003ch2 id=\"medications\"\u003eMedical Therapies: Medications That Protect Your Arteries\u003c\/h2\u003e\n\n\u003cp\u003eThe medical therapy component of \"Treating Arteries\" is just as detailed as the lifestyle component, with strategies designed to halt plaque progression and ideally achieve plaque regression:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLipid lowering (statins)\u003c\/strong\u003e: Treatment begins with statins, with doses increased according to how the patient's plaque responds on imaging. If plaque continues to progress, the dose is raised to the highest tolerated level. \u003cstrong\u003eCoenzyme Q10 (CoQ10)\u003c\/strong\u003e is used to minimize muscle pain (myopathic symptoms) that can cause patients to stop taking their statins. If statins alone aren't enough, \u003cstrong\u003eezetimibe\u003c\/strong\u003e is added. For patients with low HDL (good cholesterol) and high triglycerides, \u003cstrong\u003efibrates\u003c\/strong\u003e are added. If accessible, newer \u003cstrong\u003ePCSK9 inhibitor\u003c\/strong\u003e medications—which dramatically lower cholesterol—are recommended.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAntiplatelet therapy\u003c\/strong\u003e: \u003cstrong\u003eLow-dose aspirin\u003c\/strong\u003e is used to prevent blood clots, with the addition of \u003cstrong\u003eclopidogrel\u003c\/strong\u003e in patients with severe narrowing (stenosis) of the arteries or other high-risk indicators.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAnticoagulation\u003c\/strong\u003e: For patients with \u003cstrong\u003eatrial fibrillation\u003c\/strong\u003e (an irregular heart rhythm that increases stroke risk fivefold) or other cardiac sources of stroke, blood thinners (anticoagulants) are essential.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eInsulin resistance and prediabetes\u003c\/strong\u003e: The medication \u003cstrong\u003epioglitazone\u003c\/strong\u003e is recommended, based on a post-hoc analysis of the IRIS randomized clinical trial published in \u003cem\u003eJAMA Neurology\u003c\/em\u003e in 2019 by Spence and colleagues. This study showed benefits of pioglitazone in patients who had experienced a stroke and were living with prediabetes. Lifestyle reinforcement remains crucial.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDiabetes\u003c\/strong\u003e: Patients with full diabetes are referred to a diabetes clinic, with ongoing reinforcement of lifestyle changes.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"brain-blood-pressure\"\u003eBlood Pressure in the Brain: Why Small Vessels Matter\u003c\/h2\u003e\n\n\u003cp\u003eThe supplement also addresses a lesser-known but critical mechanism in stroke: blood pressure gradients within the brain's small arteries. Using computer simulations (published by Blanco, Muller, and Spence in \u003cem\u003eStroke and Vascular Neurology\u003c\/em\u003e in 2017), researchers compared blood pressure patterns in people with normal blood pressure (normotensive) and those with hypertension.\u003c\/p\u003e\n\n\u003cp\u003eThe simulations measured pulsatile pressure—the wave of pressure that travels through the arteries with each heartbeat—at various points in the brain's blood supply, including:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMedium-sized arteries\u003c\/strong\u003e: the internal carotid artery (ICA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and basilar artery (BA)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSmall-sized arteries\u003c\/strong\u003e: the lenticulostriate arteries (LsA), distal medial striate arteries (DMSA), prefrontal arteries (PfA), and posterior parietal branches (PPB)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe findings help explain why high blood pressure is so damaging to the brain's small vessels. The pressure waves that reach these delicate arteries are influenced by the stiffness of larger arteries above them. In hypertension, the larger arteries lose their cushioning effect, sending higher-pressure pulses deep into the brain where they can damage the small vessel walls. This is thought to be a key mechanism behind \u003cstrong\u003ecerebral small vessel disease\u003c\/strong\u003e, which is a major cause of both strokes and dementia.\u003c\/p\u003e\n\n\u003ch2 id=\"argentina\"\u003eReal-World Success: The Argentina Experience\u003c\/h2\u003e\n\n\u003cp\u003ePerhaps the most encouraging evidence in the supplement comes from an unpublished real-world implementation of the \"Treating Arteries\" approach. Beginning in 2012, Blossom DMO—a healthcare organization operating \u003cstrong\u003eseven large health maintenance organizations across Argentina\u003c\/strong\u003e—implemented the \"Treating Arteries\" protocol in its vascular prevention clinics.\u003c\/p\u003e\n\n\u003cp\u003eThe results, presented by Dr. Luis Armando in August 2016 at a seminar at the University of Oxford, are striking:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe number of participants aged over 65 increased from \u003cstrong\u003e1,675 in 2011 to 2,000 in 2015\u003c\/strong\u003e\n\u003c\/li\u003e\n  \u003cli\u003eThe annual rate of cardiovascular events dropped from \u003cstrong\u003e5.85% to 2.35%\u003c\/strong\u003e over that period\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCardiovascular events in the study included a composite of \u003cstrong\u003eMajor Coronary Events\u003c\/strong\u003e (heart attacks with or without ST-segment elevation and unstable angina), \u003cstrong\u003eStroke\u003c\/strong\u003e, \u003cstrong\u003eCoronary Revascularization\u003c\/strong\u003e (procedures like stents or bypass surgery), and \u003cstrong\u003ePeripheral Vascular Events\u003c\/strong\u003e (vascular amputation, peripheral revascularization, or new-onset claudication—leg pain caused by blocked arteries).\u003c\/p\u003e\n\n\u003cp\u003eThis \u003cstrong\u003e60% reduction in cardiovascular event rates\u003c\/strong\u003e—achieved in a real-world setting across multiple clinics, not in a controlled research environment—suggests that the \"Treating Arteries\" approach is not just theoretically sound but practical and effective on a large scale.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eFor patients living with high blood pressure, high cholesterol, diabetes, or a history of stroke, these lessons carry several profound messages.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFirst, you are not a number.\u003c\/strong\u003e Two patients with the same blood pressure reading may need completely different medications. If your blood pressure hasn't responded to treatment, ask your doctor about renin and aldosterone testing. This simple blood test could identify the underlying cause and lead to far more effective treatment.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSecond, seeing is believing.\u003c\/strong\u003e If your doctor offers to show you images of your own arteries, take a good look. Understanding your personal plaque burden can be one of the most powerful motivators for lifestyle change. And remember: plaque regression—not just slowing its growth—is achievable.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThird, the drugstore matters.\u003c\/strong\u003e Over-the-counter medications you use for pain or colds could be raising your blood pressure and interfering with your prescription medications. If you have high blood pressure, talk to your doctor about which pain relievers are safe for you.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFourth, statins are just the beginning.\u003c\/strong\u003e Modern cholesterol treatment is personalized and increasingly powerful. If one medication isn't enough, there are now multiple options—ezetimibe, fibrates, PCSK9 inhibitors—that can be added to get your cholesterol to target and stop plaque in its tracks.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations\u003c\/h2\u003e\n\n\u003cp\u003eIt is important to understand the limitations of the evidence presented in this supplement. The lecture is a synthesis of Dr. Spence's career work, drawing on multiple clinical trials and observational data rather than a single new trial. The renin\/aldosterone phenotyping approach was studied in an African population and may not apply identically to all ethnic groups, though the underlying physiology suggests broad relevance.\u003c\/p\u003e\n\n\u003cp\u003eThe Argentina data, while impressive, comes from an observational implementation without a comparison group or randomized controls. The decline in cardiovascular events could theoretically reflect broader improvements in healthcare during the same period, though the magnitude of change suggests the program played a major role. Additionally, detailed information about how consistently the protocol was applied at each of the seven organizations is not available in the supplement.\u003c\/p\u003e\n\n\u003cp\u003eThe blood pressure gradient research relies on computer simulations rather than direct measurements in humans, though the models are based on validated physiological parameters. Finally, some of the specific recommendations—such as the use of CoQ10 to reduce statin-related muscle symptoms—reflect clinical experience and expert opinion that may not be supported by large randomized trials.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003ePractical Recommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on the lessons from Dr. Spence's lecture, here are practical steps patients can discuss with their healthcare providers:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about renin\/aldosterone testing\u003c\/strong\u003e if your blood pressure remains elevated (above 130\/80 mmHg) despite taking two or more blood pressure medications.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRequest vascular imaging\u003c\/strong\u003e (such as carotid ultrasound) to assess plaque burden, and ask to see and discuss your results during the visit. If feasible, ask about follow-up imaging to track plaque progression or regression over time.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eReview your medication list\u003c\/strong\u003e, including over-the-counter drugs and supplements, with a pharmacist or physician at least once a year. Pay special attention to pain relievers and decongestants.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBe persistent with statins\u003c\/strong\u003e. If you experience muscle pain, don't simply stop your statin—ask your doctor about CoQ10 supplementation or switching to a different statin. Many patients can find a statin regimen they can tolerate.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEat Mediterranean-style\u003c\/strong\u003e: more vegetables, fruits, beans, nuts, fish, and olive oil; less red meat, processed food, and refined sugar. Ask for printed resources, and revisit your diet goals at each appointment.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMove for at least 30 minutes daily\u003c\/strong\u003e at moderate intensity—a brisk walk, swimming, or cycling. If you have physical limitations, ask your doctor for exercises tailored to your situation.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you smoke, treat cessation like a medical emergency\u003c\/strong\u003e. Ask for nicotine replacement therapy and medications (varenicline or bupropion) at your next appointment. Every year of continued smoking significantly increases stroke risk.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow your heart rhythm\u003c\/strong\u003e. If you have atrial fibrillation (even the intermittent kind), anticoagulation therapy can reduce your stroke risk by nearly two-thirds. Ask your doctor if you should be screened.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have prediabetes\u003c\/strong\u003e (a condition affecting over 80 million Americans), ask your doctor whether pioglitazone might be appropriate for you, particularly if you have already experienced a transient ischemic attack (TIA or \"mini-stroke\") or stroke.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe lessons from Dr. Spence's lifetime of work are clear: stroke prevention is most effective when it is \u003cstrong\u003epersonalized, proactive, and focused on the arteries themselves\u003c\/strong\u003e. While the science is sophisticated, the message for patients is beautifully simple: knowledge is power. Understand your own risk, participate actively in your treatment decisions, and never stop working to improve the health of your arteries.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhy do two people with the same blood pressure and cholesterol have different stroke outcomes?\u003c\/h3\u003e\n\u003cp\u003eRisk factor numbers are only part of the story. What really matters is what is happening inside the arteries themselves. The same blood pressure or cholesterol reading can reflect different arterial health in different people. Doctors can now focus on treating the arteries directly, using imaging to see plaque buildup and personalized treatments based on each patient's physiology.\u003c\/p\u003e\n\u003ch3\u003eWhat is the renin\/aldosterone blood test for high blood pressure?\u003c\/h3\u003e\n\u003cp\u003eIt measures two substances that regulate salt and water balance in the body. Based on the levels, doctors can identify which of three conditions is driving resistant hypertension: primary aldosteronism, Liddle syndrome or variants, or renal\/renovascular hypertension. The test helps choose the most appropriate medication, such as spironolactone, amiloride, or an ARB, instead of using a one-size-fits-all approach.\u003c\/p\u003e\n\u003ch3\u003eHow can I see my own artery plaque and why does it help?\u003c\/h3\u003e\n\u003cp\u003eDoctors can show you images of your arterial plaque from tests like carotid ultrasound, comparing it to healthy people of your age and sex. Seeing your own plaque buildup can motivate you to take medications consistently, quit smoking, and adopt healthier habits. The article says plaque regression is possible, and patients who see their own plaque may be more motivated to make changes.\u003c\/p\u003e\n\u003ch3\u003eWhat lifestyle changes does the treating arteries approach recommend?\u003c\/h3\u003e\n\u003cp\u003eIt recommends smoking cessation with nicotine replacement or medications like varenicline or bupropion, a Mediterranean diet rich in fruits, vegetables, fish and olive oil, weight management and exercise for at least 30 minutes daily. It also advises reducing salt and alcohol, avoiding licorice and decongestants, and getting blood pressure-friendly habits. Repetition and reinforcement at every follow-up visit are considered essential.\u003c\/p\u003e\n\u003ch3\u003eWhat medications are used to protect arteries and stop plaque progression?\u003c\/h3\u003e\n\u003cp\u003eStatins are the starting point, with the dose increased if plaque progresses. CoQ10 may help with statin muscle pain. Ezetimibe and fibrates can be added, and PCSK9 inhibitors if accessible. Low-dose aspirin is used, plus clopidogrel for severe narrowing. Anticoagulants are given for atrial fibrillation. Pioglitazone is recommended for insulin resistance or prediabetes after a stroke.\u003c\/p\u003e\n\u003ch3\u003eDoes the treating arteries approach really reduce heart attacks and strokes?\u003c\/h3\u003e\n\u003cp\u003eIn a real-world implementation at seven health maintenance organizations in Argentina, starting in 2012, the annual rate of cardiovascular events dropped from 5.85% to 2.35% by 2015. This was an observational study without a comparison group, so the reduction might partly reflect broader healthcare improvements, but the magnitude suggests the program played a major role.\u003c\/p\u003e\n\u003ch3\u003eWhat should I ask my doctor about stroke prevention based on this article?\u003c\/h3\u003e\n\u003cp\u003eAsk about renin\/aldosterone testing if your blood pressure stays above 130\/80 despite two or more medications. Request vascular imaging to see your plaque burden and ask about follow-up imaging. Review all medications, including over-the-counter pain relievers and decongestants, with your pharmacist. If you smoke, ask about cessation aids. If you have prediabetes and had a TIA or stroke, ask about pioglitazone.\u003c\/p\u003e\n\u003ch3\u003eMy blood pressure stays high on two medications. Should I get a second opinion about renin and aldosterone testing before changing my stroke prevention plan?\u003c\/h3\u003e\n\u003cp\u003eYes, a second opinion can help if your blood pressure remains above 130\/80 despite two or more medications. The renin\/aldosterone blood test identifies which of three conditions drives resistant hypertension, guiding specific treatment like spironolactone, amiloride, or an ARB. This personalized approach, part of treating arteries rather than just risk factors, was linked to a 60% reduction in cardiovascular events in a real-world Argentine clinic network. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article:\u003c\/strong\u003e \"Stroke Prevention: a Lifetime of Lessons\" — The Feinberg Award Lecture 2020, supplemental material.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor:\u003c\/strong\u003e J. David Spence, M.D.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication Details:\u003c\/strong\u003e This supplement accompanies the Feinberg Award Lecture presented in 2020. It includes material reproduced by permission from the \u003cem\u003eAmerican Journal of Hypertension\u003c\/em\u003e (Akintunde et al., 2017), \u003cem\u003eJAMA Neurology\u003c\/em\u003e (Yang et al., 2015; Spence et al., 2019), \u003cem\u003eThe Lancet\u003c\/em\u003e (Wong et al., 1986), and \u003cem\u003eStroke and Vascular Neurology\u003c\/em\u003e (Blanco et al., 2017). The Argentina data was previously unpublished and reproduced by permission of Dr. Luis Armando, Blossom DMO, with acknowledgment of Dr. Hernan Perez, Dr. Hugo Villafañe, and Dr. Nestor Garcia.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eNote: This patient-friendly article is based on peer-reviewed research and lecture materials. It is intended for educational purposes and does not constitute medical advice. Always consult your healthcare provider before making changes to your medications or treatment plan.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47459139322012,"sku":null,"price":0.0,"currency_code":"EUR","in_stock":true}],"url":"https:\/\/diagnosticdetectives.de\/products\/stroke-prevention-a-lifetime-of-lessons-a-patients-guide-to-treating-arteries-not-just-risk-factors","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}