Management of modifiable risk factors for stroke or accelerated atherosclerosis

Preventing stroke is key to reducing its societal burden from a human and financial perspective. Ischemic stroke represents 70–80% of all strokes, whereas atherosclerosis of the brain and heart vasculature play the predominant pathological role. It is well established that a majority of strokes are largely preventable. Major risk reductions in stroke are achieved in focused groups of patients where specific interventions can be prescribed, for example up to 80% are achieved with oral anticoagulation in patients with atrial fibrillation; and carotid endarterectomy reduces the risk of stroke by more than 60% in patients with symptomatic carotid stenosis. Yet in the general population at risk for stroke, there remain wide opportunities to reduce the risk of stroke beyond the use of oral antiplatelet medications which achieve at best a relative risk reduction of 25%. Therefore, modifying atherosclerotic risk factors that place patients at risk for stroke is key to reducing its burden.