Practice Essentials
Primary stroke prevention refers to the treatment of individuals with no history of stroke. Secondary stroke prevention refers to the treatment of individuals who have already had a stroke or transient ischemic attack.
Primary Prevention of Stroke
Risk-reduction measures in primary stroke prevention may include the use of antihypertensive medications, anticoagulants, platelet antiaggregants, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), smoking cessation, dietary intervention, weight loss, and exercise.
Modifiable risk factors include the following:
Hypertension
Air pollution
Cigarette smoking
Diabetes
Dyslipidemia
Atrial fibrillation
Sickle cell disease
Postmenopausal HRT
Depression
Diet and activity
Weight and body fat
Secondary Prevention of Stroke
Secondary prevention can be summarized by the mnemonic A, B, C, D, E, as follows:
A – Antiaggregants (aspirin, clopidogrel, extended-release dipyridamole, ticlopidine) and anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban, warfarin)
B – Blood pressure–lowering medications
C – Cessation of cigarette smoking, cholesterol-lowering medications, carotid revascularization
D – Diet
E – Exercise
Smoking cessation, blood pressure control, diabetes control, a low-fat diet (eg, Dietary Approaches to Stop Hypertension [DASH] or Mediterranean diets), weight loss, and regular exercise should be encouraged.