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Scientific Review

Sharon E. Straus, MD; Sumit R. Majumdar, MD; Finlay A. McAlister, MD

JAMA. 2002;288:1388-1395.

Context  Stroke is a major cause of morbidity and mortality, and the application of evidence for stroke prevention varies considerably.

Objective  To review the most recent, high-quality evidence for primary and secondary stroke prevention.

Data Sources and Study Selection  Searches of MEDLINE, The Cochrane Library, and the ACP Journal Club were performed to identify English-language articles published from 1998 to 2001 that focused on primary and secondary stroke prevention. The references of each retrieved article were scanned, and experts in the field were contacted to identify additional relevant articles.

Data Extraction  Each of the articles was appraised, and its quality was graded with levels of evidence based on specific scientific methods that affect a study's validity.

Data Synthesis  For primary prevention of stroke, adequate blood pressure reduction, and treatment of hyperlipidemia, use of antithrombotic therapy in patients with atrial fibrillation and of antiplatelet therapy in patients with myocardial infarction are effective and supported by evidence from several randomized trials. Effective strategies for the secondary prevention of stroke include treatment of hypertension and hyperlipidemia, antithrombotic therapy for patients with atrial fibrillation, antiplatelet therapy, and carotid endarterectomy in patients with severe carotid artery stenosis.

Conclusions  Stroke is a major public health concern, and a significant body of evidence supports many primary and secondary prevention strategies.

Author Affiliations: Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario (Dr Straus); and Division of General Internal Medicine, University of Alberta, Edmonton (Drs Majumdar and McAlister).

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