Stroke
Strokes are our main cause of disability, particularly in later life. Rehabilitation after stroke can help but the most valuable thing we can do is to prevent strokes happening in the first place. Some preventative methods, such as anticoagulation in atrial fibrillation and control of high blood pressure, are discussed elsewhere in these pages. This section concentrates on prevention of strokes in those at the highest risk - the people who have had a stroke or a TIA (mini-stroke) already.
'Thinning the blood'
In theory all people who have had a stroke or TIA should take drugs to reduce blood stickiness (such as aspirin) unless they are already taking an anticoagulant (warfarin) for other reasons.
It would be too dangerous to do this in people at risk from bleeding (say, from stomach ulcers) so they are excluded from this graph.
Even so, despite years of trying, we can't quite reach our practice target of 90%. There may be some recording discrepancies, there may be people who can't take the treatment for other reasons, but there are also people who would just rather not.
Controlling Blood Pressure
Keeping blood pressure down (our target is 145/85 or less) reduces the risk of strokes.
But the drugs used can have side effects, and combinations of many drugs are difficult to use safely, particularly for older people. So we set our target at 35%.
In 2004 we were not getting beyond this so we looked at a 150/90 target as well to see how close we were getting to our ideal. Since then we have reduced blood pressure a little further in a few more people but we suspect this is about as good as things can get without doing more harm than good.
Reducing Cholesterol
Reducing cholesterol reduces the risk of further strokes (our target is 5 mmol/l or less).
People who cannot take cholesterol-lowering drugs are not excluded from this graph so the target is set at 80%. The over-75s are excluded because the value of reducing cholesterol over this age is not clear.
We still don't achieve our target though, partly due to people's reluctance to take drugs and partly due to our reluctance to impose them if the cholesterol is nearly 5 naturally. We also tend not to remeasure cholesterol levels every 5 years in people who already have a very low cholesterol simply to confirm that it remains low.
