Risk factor control to prevent a first stroke (primary prevention)

Medical
Conditions 		Therapeutic
Goal 		Measures
Hypertension • Decrease build-up of atherosclerotic plaque; reduce direct damage to walls of small arteries and arterioles

• Lifestyle modifications and antihypertensive medications reducing blood pressure to <140/90 mmHg

Diabetes Mellitus

• Decrease rate of atherosclerosis, and its secondary consequences such as hypertension

• Diet, oral hypoglycemics, or insulin to reduce or normalize blood glucose levels if possible
Hyperlipidemia • Reduce or prevent atherosclerotic plaque formation

• Diet limiting fats, increased physical activity, possible use of a statin or other lipid-lowering agent

Carotid Artery Stenosis (asymptomatic) • Prevent thrombus forming on existing atherosclerotic plaque
• Improve blood flow by increasing size of lumen 		• Antiplatelet agents
• Endarterectomy or angioplasty; possible plaque reduction by diet and statins
Heart Disease
Acute MI-especially if anterior or septal region of heart wall is damaged • Prevent thrombus from forming on ischemic endocardium • Oral anticoagulant or antiplatelet agents
Conditions, including MI, that reduce motion of the heart wall • Prevent thrombus from forming in ventricle • Oral anticoagulant (preferred) or antiplatelet agent
Atrial
Fibrillation		 • Restore normal rhythym
• Prevent clot formation in left atrium
• Cardioversion
• Antiarrhythmic drugs
• Oral anticoagulant (preferred) or antiplatelet agent