Purpose of Review: Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity. This article reviews the current recommendations for the management of each of these modifiable risk factors.
Recent Findings: It has been documented that some blood pressure medications may increase variability of blood pressure and ultimately increase the risk for stroke. Stroke prevention typically includes antiplatelet therapy (unless an indication for anticoagulation exists), so the most recent evidence supporting use of these drugs is reviewed. In addition, emerging risk factors, such as obstructive sleep apnea, electronic cigarettes, and elevated lipoprotein (a), are discussed.
Summary: Overall, secondary stroke prevention includes a multifactorial approach. This article incorporates evidence from guidelines and published studies and uses an illustrative case study throughout the article to provide examples of secondary prevention management of stroke risk factors.
Address correspondence to Dr Cheryl Bushnell, Department of Neurology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, firstname.lastname@example.org.
Relationship Disclosure: Dr Guzik reports no disclosure. Dr Bushnell receives research/grant support from the Patient-Centered Outcomes Research Institute (PCS-1403-14532).
Unlabeled Use of Products/Investigational Use Disclosure: Drs Guzik and Bushnell report no disclosures.