Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation. • Up to 90% of all strokes are preventable, and attributable to 10 modifiable risk factors. • Hypertension is ubiquitously the major modifiable risk factor for stroke, accounting for one-third of stroke in developed countries and two-thirds in developing countries. • Optimal stroke prevention requires a harmonious, integrated approach to educating about stroke risk and healthy lifestyle behaviors, simple screening and management of individuals for a history and presence of modifiable and treatable causal risk factors, and improving social and environmental factors.