The hallmark of stroke prevention at the current time is the treatment of stroke risk factors. The most important stroke risk factor to control is blood pressure. A resting blood pressure in the sitting position (15 minutes, relaxed) should consistently be less than 140/90 to prevent future strokes.

In patients with a history of heart disease, recent studies have demonstrated that the use of some blood pressure medications may be more effective at lowering stroke risk than others. Specifically, it appears the use of ACE inhibitors or ACE receptor blockers with or without a diuretic prevents more strokes than one would expect on the basis of blood pressure alone. It has even been demonstrated that patients with a history of heart disease will reduce their stroke risk with these blood pressure lowering agents even if they have normal blood pressure.

Smoking is known to be a major risk factor for stroke. Cessation will reduce the future risk of stroke, as well as heart disease, certain types of cancer, and the progression of lung disease. It is never too late to stop. Even second-hand smoke appears to be a risk factor for the development of stroke.

Control of lipids in the blood is also important in the prevention of stroke, at least in those patients who also have heart disease. Current guidelines call for a LDL level (the bad cholesterol) to be less than 100 in patients who have had a prior stroke.

The use of drugs which inhibit platelet function has been a mainstay of stroke prevention for decades. Aspirin has been shown to help prevent stroke even in patients without prior strokes. For patients who have had prior strokes, then a combination of aspirin and Plavix® or Clopidogrel, or Aggrenox®, a combination of aspirin and extended release persantine, is currently favored by most stroke experts. For patients who cannot tolerate aspirin, then Plavix® is typically used. The dose of aspirin has been debated over the decades, but most stroke experts feel that a baby aspirin is more than sufficient, that higher dose aspirin is not clearly warranted, and that the higher dose pose a higher risk of bleeding in the stomach. For some special cases, particularly atrial fibrillation, anticoagulation will be recommended. Currently the only outpatient therapy used for this is Coumadin® or Warfarin.

A relatively recently identified risk factor for stroke appears to be homocysteine. Homocysteine is an amino acid that is critical for protein production. There does not, however, appear to be a homocysteine level that is too low. The higher the level found in stroke patients, the higher the risk for recurrent stroke. A prescription multiB vitamin called Foltx® has been shown to lower the homocysteine but studies proving it also lowers the risk of stroke have not been completed.

Another very important risk factor for the prevention of stroke in patients with prior stroke is the use of carotid endarectomy in patients who have had a stroke in the distribution of the carotid vessel that is partially obstructed. This holds true as long as the obstruction is at least 60%. The use of carotid endarectomy in patients who have not had stroke is quite controversial and must be individually discussed between the patient and preferably a neurologist familiar with stroke.

In studies of people who have stroke compared with similar people who do not, the moderate use of alcohol has consistently been shown to be correlated with fewer strokes than either those who abuse alcohol or abstain from alcohol.

Finally, it does appear that moderate exercise is also associated with a reduced stroke risk.