Prevention of recurrent stroke

There is a considerable knowledge about risk factors for first ever stroke and a lack of knowledge about risk factors for recurrent stroke. As neurologists we rarely see the patient before the first transient ischemic attack (TIA) or stroke, and we are concerned with and need data on secondary stroke prevention. For lifestyle factors such as cigarette smoking, physical activity and alcohol consumption, data are scarce. For post-menopausal estrogen use there are no data on risk of recurrent stroke. Plasma homocysteine has emerged as a risk factor for stroke and cardiovascular disease. It is not yet documented if supplementation of folic acid, which may reduce plasma homocysteine, also lowers risk of stroke. There are four randomized trials of antihypertensive treatment after stroke indicating a tendency of reduced risk of stroke recurrence. Three studies of antihypertensive treatment after first stroke are in progress. Prevention of recurrent stroke is well documented in atrial fibrillation where warfarin is highly beneficial and aspirin has some effect. Carotid endartectomy in high grade carotid artery stenosis is also well documented. Antiplatelet therapy provides secondary prevention in most types of ischemic brain disease.