Objectives. The aim of this paper is to review selected aspects of the primary and secondary prevention of ischaemic stroke with a special emphasis on recent publications, as well as the differences between these two types of prevention.
Literature review. The role of lifestyle and its modification, treatment of blood hypertension and dyslipidaemia, the use of antiplatelet agents and the management of carotid stenosis are reviewed. For each of the elements of stroke prevention, the scientific background and current recommendations are provided.
Conclusions. Stroke is a condition that can be prevented. To achieve this, it is vital to recognize early and properly treat concomitant diseases such as hypertension, carotid atherosclerosis, atrial fibrillation or dyslipidaemia. However, on the population level, it is lifestyle optimization that is even more important. It has been estimated that about 50% of strokes can be avoided by the implementation of five low-risk behaviours, including regular physical activity, healthy diet, moderate alcohol consumption or avoiding excessive drinking, and weight control. This kind of lifestyle improves control of the major vascular risk factors in a way that is directly reflected in lower risk of first-ever stroke. Secondary stroke prevention should additionally involve detailed assessment of extracranial arteries and screening for atrial fibrillation. In the case of a symptomatic carotid stenosis of 70% or more it is recommended that early carotid endarterectomy is performed or, in some cases, stenting. Long-term use of oral anticoagulants is indicated in all individuals suffering from cardio-embolic strokes. Other patients should receive antiplatelets.