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October 20, 2004

Stroke Prevention: Optimizing the Response to a Common Threat

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Toole and Bettermann) and Cardiology (Dr Sane), Wake Forest University School of Medicine, Winston-Salem, NC.

JAMA. 2004;292(15):1885-1887. doi:10.1001/jama.292.15.1885

In this issue of JAMA, the articles by Tran and Anand1 and Spagnoli and colleagues2 contribute useful information about prevention of ischemic stroke. Tran and Anand rightly consider that atherosclerosis is a patchy disease for which platelet anti-aggregants, in addition to reduction of modifiable risk factors, are recommended and have chosen transient ischemic attack (TIA) and cerebral infarction as the indices for the successful intervention. The authors consider aspirin alone and in combination with clopidogrel, ticlopidine, and dipyridamole and conclude that clopidogrel alone or with aspirin is the most efficacious method for primary and secondary prevention of TIA and recurrent ischemic stroke. However, they concentrate only on antiplatelet therapy and do not specifically address the important effects of diet, lipids, exercise, smoking, and other modifiable risk factors.