Disease of aging
Stroke
Last updated Sat May 30 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
RCT evidence— Decades of secondary-prevention RCTs
What it is
Stroke is sudden brain injury from either a blocked artery (ischaemic stroke, including transient ischaemic attack or TIA) or a ruptured artery (intracerebral or subarachnoid haemorrhage). Symptoms reflect the brain territory affected: weakness, sensory loss, speech changes, vision changes, vertigo.
Why prevention matters most
Up to 90% of stroke risk is attributable to modifiable factors (INTERSTROKE):
- Hypertension (#1).
- Physical inactivity.
- Dyslipidaemia.
- Diet quality.
- Waist:hip ratio.
- Smoking.
- Stress.
- Alcohol.
- Cardiac causes (AFib).
- Diabetes.
Acute treatment
Time is brain.
- Ischaemic: IV tPA (alteplase, tenecteplase) within 4.5 hours; large vessel occlusion → mechanical thrombectomy up to 24 hours in selected cases.
- Haemorrhagic: BP control, reversal of anticoagulants if applicable, selected neurosurgical intervention.
Secondary prevention
After ischaemic stroke / TIA:
- Antiplatelet therapy (aspirin, clopidogrel; sometimes dual short-term).
- High-intensity statin therapy.
- Aggressive BP control.
- DOAC if AFib present.
- Carotid revascularisation for significant ICA stenosis.
- Diabetes optimisation.
- Lifestyle: smoking cessation, exercise, diet, weight management.
Related entries
Blood pressure, Atrial fibrillation, Cardiovascular disease, Statins, SPRINT.
References
- Powers, W. J. et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke 50, e344–e418 (2019).