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:
Sickle cell disease
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.