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A New Paradigm for Stroke Prevention

By William Davis, MD, FACC

April 2005

“You know that medicines when well used restore health to the sick: they will be well used when the doctor, together with his understanding of their nature, shall understand also what man is, what life is, and what constitution and health are. Know these well and you will know their opposites; and when this is the case, you will know well how to devise a remedy.”

—Leonardo da Vinci


Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, as more and better tools become available to us. To determine your own stroke risk, the best and most widely available imaging tool is carotid ultrasound, which aims to identify carotid plaque or intima-media thickness of more than 1.0 mm. Any degree of calcification of the aorta, such as that indicated by a CT heart scan, is another useful measure of risk. A prior transient ischemic attack, or “mini-stroke,” also puts you at heightened risk for future stroke.

Treatment to reduce risk is multifaceted and should examine all sources of risk, such as metabolic syndrome and levels of small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one crucial ingredient in any stroke-prevention program. Other supplements can be used in a targeted fashion, depending on the sources of carotid or aortic plaque. Ideally, repeat scanning of the carotids should be performed some years after beginning your treatment program to assess whether you have successfully reversed plaque growth.


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