Stroke is ideally suited for prevention.1 It has a high prevalence, burden of illness, and economic cost, and safe and effective prevention measures. The estimated $30 billion that is being spent for stroke each year in the United States should not come as a surprise given the approximately 3 million stroke survivors and 400 000 to 500 000 new or recurrent stroke cases annually.2 Stroke remains the third leading cause of death among adults3 and has been targeted for cost containment by managed care health systems and other insurers. The US Public Health Service in conjunction with the National Health Promotion and Disease Prevention Objectives has set a goal to reduce stroke deaths to 20 per 100 000 by the year 2000.4 This goal could be attained as the estimate of "preventable" strokes could be as high as 80%.5 In this article, I will review the status of stroke risk factors, prevention approaches to reduce stroke, clinical trial data from primary and secondary stroke prevention studies, and future directions in stroke prevention.
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