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Prevention of Stroke Definitions

5th Edition
2014 UPDATE 
December 2014

Primary prevention: is an individually based clinical approach to disease prevention, directed toward preventing the initial occurrence of a disorder in otherwise healthy individuals. Primary prevention is usually implemented in the primary care setting, and the physician, advanced practice nurse, pharmacist or patient may initiate a discussion of stroke risk reduction. Primary prevention and health promotion recommendations related to stroke (lifestyle and risk factor management, hypertension screening, dyslipidemia screening, diabetes management, management of atrial fibrillation, and asymptomatic carotid stenosis) emphasize the importance of screening and monitoring those patients at high risk of a first stroke event. Primary prevention strategies are also promoted through health-oriented organizations and agencies such as the Heart and Stroke Foundation, Canadian Cardiovascular Society, Hypertension Canada, Canadian Diabetes Association, and Health Canada.

Primary prevention and the reduction of risk factor prevalence in the general population are not the main focus of the Canadian Best Practice Recommendations for Stroke Care; therefore, only selected recommendations related to primary prevention are included. A comprehensive set of recommendations in this area is being developed for inclusion in future updates.  A list of existing high quality stroke prevention guidelines, including primary prevention, is provided in the reference section at the end of this chapter for further guidance.

Secondary prevention is an individually based clinical approach aimed at reducing the risk of a recurrent vascular events in individuals who have already experienced a stroke or transient ischemic attack and in those who have one or more of the medical conditions or risk factors that place them at high risk of stroke.1,2 Secondary prevention recommendations in this document are directed to those risk factors most relevant to stroke, including lifestyle (diet, sodium intake, exercise, weight, smoking, and alcohol intake), hypertension, dyslipidemia, previous stroke or transient ischemic attack, atrial fibrillation and stroke, and carotid stenosis. Secondary prevention recommendations can be addressed in a variety of settings—acute care, stroke prevention clinics, and community-based care settings. They pertain to patients initially seen in primary care, those who are treated in an emergency department and then released and those who are hospitalized because of stroke or transient ischemic attack.

Recommendations for secondary prevention of stroke should be implemented throughout the recovery phase, including during inpatient and outpatient rehabilitation, reintegration into the community and ongoing follow-up by primary care practitioners. Secondary prevention should be addressed at all appropriate healthcare encounters on an ongoing basis following a stroke or transient ischemic attack.  The health care and stroke system should be set up to ensure secondary prevention is offered and maintained in all stages of stroke care.