Interventions for improving modifiable risk factor control in the secondary prevention of stroke

Is it possible to prevent a second stroke?

Stroke is a rapidly developing neurological deficit of vascular origin that lasts 24 hours and can lead to a neurological dysfunction caused by a focal brain lesion. When the deficit lasts less than 24 hours it is called “transient ischemic attack”.
The World Health Organization reported that stroke is the second leading cause of mortality and disease burden among adults aged 60 and older and that people who have sustained a transient ischemic attack have a higher risk of recurrence in the next year.
What risk factors can be modified to prevent a stroke?
Cohort studies have shown that the risk of having a cardiovascular event after having a transient ischemic attack remains high for at least 10 years. Some conditions such as hypertension, hyperlipidaemia, atrial fibrillation, diabetes and obesity and some lifestyle factors such as smoking, physical inactivity, alcohol consumption and an unhealthy diet can be targeted for secondary prevention.
What interventions can be done to prevent a second stroke?
Stroke services aim to improve patient adherence to medications and lifestyle advices. Studies show that most people with stroke have at least one cardiovascular risk factor and are often inadequately managed during follow up. Despite the effectiveness of secondary prevention is well established, non-treatment rates for antithrombotic, antihypertensive and statin therapies remain high after stroke. Only 31% of people with a stroke and 35% with a transient ischemic attack receive combination treatment with all three medication classes.
These inequalities in the provision of stroke care seem to increase with age and with the rate of disability due to stroke.
Are interventions to implement secondary stroke prevention effective?
This review included 42 studies with 33,840 participants. The review produced mixed findings regarding the effectiveness of stroke service interventions for the secondary prevention of stroke. Evidence for educational or behavioural interventions for patients compared to usual care for improving modifiable risk factor were ranked low to moderate due to the lack of consistently used outcome measures as well as duration of the different studies.    
Comment by Sara Laxe