Stroke therapies in Asian populations

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Abstract

In spite of concerns about differing risk factor profiles in patients with stroke in Asian populations, there is some evidence that, for acute stroke therapies and secondary prevention, benefits may be at least equal to the benefits seen in Western countries. Some of the earliest evidence of potential benefits for intravenous tissue plasminogen activator (tPA) using surrogate outcome measures and randomised controlled clinical trial design were shown in a Japanese population, and one of the largest trials of acute stroke therapy was conducted on mainland China—Chinese Acute Stroke Trial (CAST) [Lancet 349 (1997) 1641]. For secondary stroke prevention, both the PATS and Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trials suggested that lowering of blood pressure with either indapamide alone or indapamide+perindopril was as effective or even more so in Asian populations. Generalisation to a broad range of racial groups should be considered when conducting large international trials of stroke therapy.

Section snippets

Background

Thirty years ago, there were no interventions for patients with acute stroke or secondary prevention which were of proven benefit. Fortunately, that has changed, and there are now three acute stroke interventions for which there exists level 1 evidence of efficacy and five secondary prevention strategies.

It is often suggested that there may be racial differences in response to various forms of therapy in vascular and other diseases. This is an extension of the observation that different

Acute therapies

There is level 1 evidence that the use of intravenous tissue plasminogen activator (tPA) given within 3 h of acute ischaemic stroke, oral aspirin within 48 h and management within a Stroke Care Unit (SCU) improves outcomes. The administration of neuroprotective therapies has been the subject of numerous clinical trials, but none have proven to be effective. For both intravenous tPA and aspirin, there is additional evidence that these approaches may be effective in Asian populations.

Secondary prevention

Five secondary prevention strategies have now been proven to be of benefit based on level 1 evidence. Because hypertension is the most powerful risk factor for stroke apart from increasing age, it is of particular interest in Asian populations.

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