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简介：摘要在中国，卒中是死亡及致残的最重要原因，而且大部分卒中（约80-90%）是可以预防的。本文对近期卒中预防措施方面的进展进行综述，包括戒烟、地中海饮食、限制盐摄入量、使用B族维生素降低同型半胱氨酸、抗血小板治疗、抗凝、治疗卵圆孔未闭和颈动脉狭窄。使用B族维生素降低同型半胱氨酸水平的确能预防卒中，但是携带MTHFR变异的患者需要更高剂量的叶酸，并且由于氰钴胺对肾损伤患者有害，我们应该使用甲钴胺或羟钴胺。阿司匹林抵抗似乎是肠溶衣导致，而超过50%的中国人因存在细胞色素酶CYP2C19变异而对氯吡格雷反应减弱，该酶将药物从前体转化为活性状态。作为目前抗凝治疗的重大变革，新型口服抗凝药（DOACs）因其直接效应而备受关注，本文将着重讨论各个DOACs之间的主要差异。经皮卵圆孔封堵可降低卒中风险，但是在大多数有卵圆孔未闭的卒中患者中卵圆孔未闭是偶然出现的，因此识别出以反常栓塞为可能卒中机制的患者亚组十分重要。一些卵圆孔未闭的患者由于肺栓塞的风险更适宜使用抗凝治疗。颈动脉支架给高龄患者带来更高的风险，大多数无症状颈动脉狭窄患者接受强化药物治疗更优于支架置入术或内膜剥脱术，而只有少数患者可从颈动脉支架或内膜剥脱术中获益。

简介：摘要Stroke is the most important cause of death and disability in China, and most strokes (~80-90%) are preventable. Recent advances in a number of measures to reduce stroke are discussed in this narrative review, including smoking cessation, a Mediterranean pattern of eating, salt restriction, B vitamins to lower homocysteine, antiplatelet therapy, anticoagulants and the management of patent foramen ovale and carotid stenosis. Lowering of homocysteine with B vitamins does prevent stroke, but patients with variants of MTHFR require higher doses of folic acid, and because of harm from cyanocobalamin among persons with renal impairment, we should use methylcobalamin or oxocobalamin instead. Aspirin resistance appears to be due to enteric coating, and ＞ 50% of Chinese have a reduced response to clopidogrel because of variants of CYP2C19, required to convert the prodrug to its active form. Direct acting oral anticoagulants (DOACs) have revolutionized anticoagulation; important differences among the DOACs are discussed. Percutaneous closure of patent foramen ovale (PFO) does reduce the risk of stroke, but in most patients with stroke and PFO the PFO is incidental; it is important to identify the subgroup in whom paradoxical embolism was the probable cause of the stroke. Some patients with PFO would be better treated with anticoagulants because of the risk of pulmonary embolism. Carotid stenting carries a higher risk in older patients, and most patients with asymptomatic carotid stenosis would be better treated with intensive medical therapy than with either stenting or endarterectomy; the few who could benefit can be identified.