Secondary prevention strategies in ischemic strike: Identification and optimal management of modifiable risk factors

The identification and treatment of modifiable ischemic stroke risk factors, in addition to appropriate antithrombotic therapy, can reduce the likelihood of first or recurrent stroke, prevent long-term morbidity and mortality after first stroke or transient ischemic attack, and lower health care costs. Long-term morbidity and mortality in patients with ischemic stroke includes patients with coronary artery disease. Therefore, in patients with ischemic stroke (especially those with carotid artery disease and lacunar disease), the goal is to prevent not only recurrent stroke but also coronary artery disease. Neurologists and general practitioners must be aware of the specific risk factors and recommendations for patients with ischemic stroke and apply the information systematically. We review known risk factors for ischemic stroke and current recommendations for treatment, focusing primarily on atherosclerotic risk factors as they apply to patients with stroke. In particular, recent data on hypertension and hyperlipidemia are described. In addition, we discuss the challenges in managing these risk factors and the potential strategies for overcoming them.