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Secondary prevention

People who have had a stroke or transient ischaemic attack (TIA) are at much higher risk of having another stroke. Almost 30% of all strokes are recurrent events1. The risk is typically around 5% in the first 90 days but can be up to 18%, with 10-16% at risk of having another stroke within one year. This risk stays high over time, with a 15% chance of stroke after one year and 25% risk after five years, compared with only 2.9% in the general population2,3.

Why secondary stroke prevention is important

Second strokes tend to be more severe and have higher mortality rates than first strokes4. A second stroke can often result in greater disability and a lower quality of life compared with the initial stroke5,6.

People who have had a second stroke are also more often discharged to hospice care, rather than returning home or to inpatient rehabilitation facilities. Care demands on the family and wider community can be greater after the second stroke than first stroke4,7,8.

Secondary strokes also tend to mean higher financial costs for the survivor, caregivers and community compared with primary strokes. This is because after a second stroke, stroke survivors are less likely to return to work and more likely to be hospitalised and experience poor outcomes1,9,10.

Reducing risk of secondary strokes

Secondary stroke prevention is all about reducing risk. It is vital that everyone who has had a stroke or TIA has:

  1. The correct investigations to work out if there are any specific risk factors which may have caused their stroke, for example scans, electrocardiograms (ECGs) and blood tests.
  2. Access to medical care and information needed to reduce their risk. For example, by detecting potential atrial fibrillation, by managing any risk factors that can be changed such as high blood pressure, diabetes and high cholesterol and by making lifestyle changes like quitting smoking and maintaining a healthy diet.
  3. Regularly reviewed and monitored secondary prevention strategies to ensure medicines are taken as they are prescribed. This is essential to prevent further strokes and it is also cost effective11.

The risk of secondary stroke can be reduced by managing risk factors12,13. Read more about the types of risk factors and how to manage them here:

References

  1. Ferrone SR, Boltyenkov AT, Lodato Z, et al. Clinical outcomes and costs of recurrent ischemic stroke: a systematic review. J Stroke Cerebrovasc Dis. 2022;31(6):106438.https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106438
  2. Diener H-C, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage. J Am CollCardiol. 202075(15):1804–1818. https://doi.org/10.1016/j.jacc.2019.12.072
  3. Imoisili OE. Prevalence of Stroke — Behavioral Risk Factor Surveillance System, United States, 2011–2022. MMWR Morb Mortal Wkly Rep 2024;73(20):449–455. https://doi.org/10.15585/mmwr.mm7320a1
  4. Feigin VL, Owolabi MO, World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group. Pragmatic Solutions to Reduce the Global Burden of Stroke: A World Stroke Organization–Lancet Neurology Commission. Lancet Neurol. 2023;22(12):1160–1206. https://doi.org/10.1016/S1474-4422(23)00277-6
  5. Gurková E, Štureková L, Mandysová P, Šaňák D. Factors Affecting the Quality of Life after Ischemic Stroke in Young Adults: A Scoping Review. Health Qual Life Outcomes. 2023;21(1):4. https://doi.org/10.1186/s12955-023-02090-5
  6. Chun H-YY, Whiteley WN, Dennis MS, Mead GE, Carson AJ. Anxiety after Stroke. Stroke. 2018;49(3):556–564. https://doi.org/10.1161/strokeaha.117.020078
  7. Shah S, Liang L, Kosinski A, Hernandez AF, Schwamm LH, Smith EE, et al. Safety and Outcomes of Intravenous TPA in Acute Ischemic Stroke Patients with Prior Stroke within 3 Months. Circ Cardiovasc Qual Outcomes. 2020;13(1):e006031. https://doi.org/10.1161/circoutcomes.119.006031
  8. Ferrone SR, Boltyenkov AT, Lodato Z, O’Hara J, Vialet J, Malhotra A, et al. Clinical Outcomes and Costs of Recurrent Ischemic Stroke: A Systematic Review. J Stroke Cerebrovasc Dis. 2022;31(6):106438. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106438
  9. N Engel-Nitz. Costs and Outcomes of Noncardioembolic Ischemic Stroke in a Managed Care Population. Vasc Health Risk Manag. 2010;6:905–913. https://doi.org/10.2147/vhrm.s10851
  10. La Torre G, Lia L, Francavilla F, Chiappetta M, De Sio S. Factors That Facilitate and Hinder the Return to Work after Stroke: An Overview of Systematic Reviews.  Med Lav. 2022;113(3):e2022029. https://doi.org/10.23749/mdl.v113i3.13238
  11. Rodgers H, Howel D, Bhattarai N, Cant R, Drummond A, Ford GE, et al. Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS): A Randomized Controlled Trial and Economic Analysis. Stroke. 2019;50(12):3561–3568. https://doi.org/10.1161/STROKEAHA.119.024876
  12. Govori V, Budincevic H, Morovic S, et al. Updated perspectives on lifestyle interventions as secondary stroke prevention measures: a narrative review. Medicina (Kaunas). 2024;60:504. https://doi.org/10.3390/medicina60030504
  13. Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CA, Arora P, Avery CL, Baker-Smith CM, Bansal N, Beaton AZ, Commodore-Mensah Y. 2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2025 Feb 25;151(8):e41-660. https://doi.org/10.1161/CIR.0000000000001303

STROKE RISKS

Read about risk factors we can change 

LIFESTYLE

ENVIRONMENT

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