Stroke prevention in clinical practice for primary care physicians

Abstract

Stroke is a leading cause of death and a major source of disability. Prevention of recurrent or first-ever stroke is the most desirable approach, and one in which primary care physicians can play a major role. Effective stroke prevention can also minimise the occurrence of fatal and non-fatal cardiovascular events. The three main strategies of primary and secondary stroke prevention are identification plus appropriate management of the major modifiable risk factors, consideration of suitable antithrombotic therapy, and revascularisation of symptomatic extracranial carotid artery stenosis. The major modifiable risk factors are hypertension, hypercholesterolaemia, diabetes mellitus, atrial fibrillation, cigarette smoking, and extracranial carotid artery stenosis. The overall management must be individualised, bearing in mind the important pathogenic mechanisms operating in an individual along with the contraindications to antithrombotic therapy or revascularisation procedures.