Secondary prevention

 

Recommendations 5.3.1

A. All patients who smoke should be advised to stop.  Smoking cessation should be promoted in the initial prevention plan using individualised programmes which may include pharmacological agents and/or psychological support

B. All patients should be advised to take regular exercise as far as they are able:

• Exercise programmes should be tailored to the individual following appropriate assessment, starting with low-intensity physical activity and gradually increasing to moderate levels
• All adults should aim to be active daily and minimise the amount of time spent being sedentary (sitting) for extended periods
• For adults over the age of 19 years, this activity should add up to at least 150 minutes of moderate intensity, over a week, in bouts of 10 minutes or more (e.g. 30 minutes on at least 5 days per week).  They should also engage in muscle strengthening activities at least twice per week
• For older people at risk of falls, additional physical activity which incorporates balance and coordination, at least twice per week, is also recommended

C. All patients should be advised to eat the optimum diet:

• Eating five or more portions of fruit and vegetables per day from a variety of sources
• Eating two portions of oily fish per week (salmon, trout, herring, pilchards, sardines, fresh tuna)
  

D. All patients should be advised to reduce and replace saturated fats in their diet with polyunsaturated or monounsaturated fats by:

• Using low-fat dairy products
• Replacing butter, ghee and lard with products based on vegetable and plant oils
• Limiting red meat intake especially fatty cuts and processed forms

E. Patients who are overweight or obese should be offered advice and support to aid weight loss, which may include diet, behavioural therapy and physical activity

F. All patients, but especially people with hypertension, should be advised to reduce their salt intake by:

• Not adding salt to food at the table
• Using as little as possible in cooking
• Avoiding high-salt foods, e.g. processed meat products, such as ham and salami, cheese, stock cubes, pre-prepared soups and savoury snacks such as crisps and salted nuts

G. Patients who drink alcohol should be advised to keep within recognised safe drinking limits of no more than three units per day for men and two units per day for women

H. The following interventions have not been shown to reduce stroke reoccurrence:

• Vitamin B and folate supplementation
• Vitamin E supplementation

Sources 5.3.2

A. Cahill et al. 2008; Silagy et al. 2002; Lancaster and Stead 2005
B. Consensus; Department of Health 2011
C. National Institute for Health and Clinical Excellence 2007c; Brunner et al. 2009; He et al. 2006; Wang et al. 2006, Giannuzzi et al. 2008
D. Giannuzzi et al. 2008; Galan et al. 2010; Hooper et al. 2011; Marik and Varon 2009
E. National Institute for Health and Clinical Excellence 2006a
F. He and MacGregor 2004; Jürgens G 2004; Brunner et al. 2009; Suckling et al. 2010
G. Consensus
H. Alkhenizan and Al-Omran 2004; Bazzano et al. 2006; Bin et al. 2011; Bolland et al. 2010; Bolland et al. 2011; Eidelman et al. 2004; Elamin et al. 2011; Galan et al. 2010; Hankey et al. 2010; Hsia et al. 2007; LaCroix et al. 2009; Marti-Carvajal et al. 2009; VITATOPS Trial Study Group 2010