Despite substantial advances for treatment of patients with acute stroke, effective primary stroke prevention remains the best means for reducing the stroke burden [1]. More than 70% of all strokes occurring each year are first strokes and therefore primary prevention of stroke is of immense public health importance [2]. High-risk or stroke-prone individuals can be identified and targeted for specific management and interventions. The ultimate public health benefit, however, depends on not only identification of stroke risk but also on assessing global vascular risk and the management and modification of these risks [3]. Many preventive strategies are available to manage a number of factors that increase the risk of a first stroke. Such successful implementation in preventive medicine remains a great challenge worldwide.
The evidence-based guidelines for the management of risk factors to prevent first stroke have been published [4]. This article provides an overview of the management of risk factors in primary stroke prevention, the gaps in successful management, and future directions for the research and management of stroke risk factors. The management of modifiable and potentially modifiable risk factors or risk markers for a first stroke is reviewed. Nonmodifiable factors, such as age, sex, race/ethnicity, and various genetic factors, are mentioned in the context of risk stratification for a first stoke. The major focus is given to the management of modifiable risk factors for stroke, including hypertension, diabetes, dyslipidemia, atrial fibrillation and other cardiac conditions, carotid artery stenosis (CAS), smoking, poor diet, physical inactivity, and obesity. A brief discussion of the management of potentially modifiable risk factors, such as alcohol and drug abuse, sleep apnea, and hyperhomocysteinemia, is included, as is the use of antiplatelet therapy in primary stroke prevention. The less well documented risk factors for first stroke, such as inflammation, infection, and hypercoagulable disorders, are beyond the scope of this article. Finally, prognostic scores to assess an individual risk for a first stroke are reviewed.
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