Key result
Comprehensive intensive risk factor control, including lifestyle changes and appropriate medical therapy, can reduce the risk of recurrent stroke by 80% or more.
Comprehensive and intensive risk factor modification, including a Mediterranean diet, smoking cessation, and targeted medical therapy, is crucial for maximizing stroke prevention.
Supports intensive post-stroke risk factor control; leaves open confirmation by randomized trials before changing practice.
Stroke prevention is an urgent priority because of the aging of the population and the steep association of age and risk of stroke. Direct costs of stroke are expected to more than double in the US between 2012 and 2030. By getting everything right, patients can reduce the risk of stroke by 80% or more; however, getting everything right is a tall order. Roughly in order of importance, this requires smoking cessation, maintenance of a healthy weight, a Cretan Mediterranean diet, blood pressure control, lipid-lowering drugs, appropriate use of antiplatelet agents and anticoagulants, and appropriate carotid endarterectomy and stenting. A new approach called "treating arteries instead of targeting risk factors" appears promising but requires validation in randomized trials.
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J. David Spence (2013) conducted a review in Stroke prevention. Intensive risk factor control was evaluated. Comprehensive intensive risk factor control, including lifestyle changes and appropriate medical therapy, can reduce the risk of recurrent stroke by 80% or more.
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