Risk Factors and Secondary Prevention of Ischemic Stroke Recurrence
Summary
Ischemic stroke recurrence remains a leading cause of disability and mortality worldwide. Risk factors can be categorised as non-modifiable—such as advancing age, prior cerebrovascular events and certain genetic predispositions—and modifiable, including hypertension, diabetes mellitus, dyslipidaemia, obesity, smoking and excessive alcohol use. Cardioembolic sources, notably atrial fibrillation, account for a substantial proportion of recurrent events, while atherosclerotic disease of large and small cerebral vessels underlies many further cases. Secondary prevention targets these mechanisms through rigorous blood pressure control, lipid-lowering therapy, glycaemic management, antiplatelet agents for arterial disease and anticoagulation for cardioembolic strokes. Lifestyle interventions spanning dietary modification, structured exercise and smoking cessation reinforce pharmacological measures. Despite clear evidence of benefit, adherence to preventive regimens and individual response to treatment vary considerably. Stratification tools and stroke-subtype classification systems guide tailored interventions, but real-world implementation often falls short. Recent advances emphasise the interplay of oxidative stress, inflammation and endothelial dysfunction in modulating residual risk, pointing to novel biomarker-driven strategies. A comprehensive approach that integrates risk factor modification, personalised therapy and system-level support is essential to reduce the burden of recurrent ischaemic events and improve long-term outcomes.
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Risk Factors and Secondary Prevention of Ischemic Stroke Recurrence publication trend
The graph below shows the total number of articles in risk factors and secondary prevention of ischemic stroke recurrence across all publications each year (not limited to Nature Index journals).
Technical terms
Ischaemic stroke recurrence: The occurrence of a new cerebral infarction after an initial ischaemic event.
Secondary prevention: Pharmacological and lifestyle measures aimed at preventing further ischaemic strokes.
Atrial fibrillation: An irregular cardiac rhythm that predisposes to embolic stroke.
Pro-oxidant–Antioxidant Balance (PAB): A composite index of oxidative and antioxidative factors influencing vascular injury.
Large artery atherosclerosis: Stroke subtype caused by plaque in major cerebral arteries.
Cardioembolic stroke: Stroke subtype resulting from emboli originating in the heart.
Small vessel occlusion: Stroke subtype affecting deep penetrating cerebral arteries.
TOAST classification: A system categorising ischaemic strokes by underlying aetiology.
References
- Association between Hypertension and Stroke Recurrence as Modified by Pro-oxidant–Antioxidant Balance: A Multi-Center Study. Nutrients (2023).
- Risk and Secondary Prevention of Stroke Recurrence. Stroke (2020).
- Recurrent Ischemic Stroke – A Systematic Review and Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases (2021).
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