Secondary prevention

People who have had a stroke or transient ischaemic attack (TIA) are at much higher risk of having another stroke. The risk is typically around 5% in the first 90 days but can be up to 18%, with 10-16% at risk 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 to only 2.9% in the general population1,2.
Why secondary stroke prevention is important
Second strokes tend to be more severe and have higher mortality rates than first strokes3. A second stroke can often result in greater disability and a lower quality of life compared to the initial stroke4,5.
People who have had a second stroke are also more often discharged to hospice care, rather than returning home or to inpatient rehabilitation facilities. There are often increased care demands on the family and wider community after a second stroke compared to after a first stroke3,4,6.
Secondary strokes also tend to mean higher financial costs for the survivor, caregivers and community compared to primary strokes. This is because after s second stroke, stroke survivors are less likely to return to work and more likely to be hospitalised and experience poor outcomes7,8,9.
Reducing risk of secondary strokes
Secondary stroke prevention is all about reducing that risk. It is vital that everyone who has had a stroke or TIA has:
- The correct investigations to work out if there are any specific risk factors which may have caused their stroke, for example scans.
- 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.
- Secondary prevention strategies that are regularly monitored and reviewed. This is essential to prevent further strokes and it also cost effective10
Read more about the types of risk factors and how to manage them here:
- Risk factors you cannot change (non-modifiable risk factors)
- Risk factors you can change (modifiable risk factors)
References
- Hans-Christoph Diener, Graeme J. Hankey. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage. Journal of the American College of Cardiology. 2020. 75(15):1804-18. https://doi.org/10.1016/j.jacc.2019.12.072
- Omoye E Imoisili. 2024. Prevalence of Stroke — Behavioral Risk Factor Surveillance System, United States, 2011–2022. MMWR. Morbidity and Mortality Weekly Report 73. https://doi.org/10.15585/mmwr.mm7320a1
- Valery L Feigin, Mayowa O Owolabi, Foad Abd-Allah, Rufus O Akinyemi, Natalia V Bhattacharjee, Michael Brainin, et al. Pragmatic Solutions to Reduce the Global Burden of Stroke: A World Stroke Organization–Lancet Neurology Commission. The Lancet Neurology. 2023. 22(12). https://doi.org/10.1016/S1474-4422(23)00277-6
- Elena Gurková, Lenka Štureková, Petra Mandysová, Daniel Šaňák. Factors Affecting the Quality of Life after Ischemic Stroke in Young Adults: A Scoping Review. Health and Quality of Life Outcomes. 2023. 21(1). https://doi.org/10.1186/s12955-023-02090-5
- Ho-Yan Yvonne Chun, William N. Whiteley, Martin S. Dennis, Gillian E. Mead, Alan J. Carson. Anxiety after Stroke. Stroke. 2018. 49(3):556–64. https://doi.org/10.1161/strokeaha.117.020078
- Shreyansh Shah, Li Liang, Andrzej Kosinski, Adrian F. Hernandez, Lee H. Schwamm, Eric E. Smith, Gregg C. Fonarow, et al. Safety and Outcomes of Intravenous TPA in Acute Ischemic Stroke Patients with Prior Stroke within 3 Months. Circulation: Cardiovascular Quality and Outcomes. 2020. 13(1).https://doi.org/10.1161/circoutcomes.119.006031
- Sophia R Ferrone, Artem T. Boltyenkov, Zachary Lodato, Joseph O’Hara, Jaclyn Vialet, Ajay Malhotra, Jeffrey M. Katz, Jason J. Wang, Chinara Feizullayeva, Pina C. Sanelli. Clinical Outcomes and Costs of Recurrent Ischemic Stroke: A Systematic Review. Journal of Stroke and Cerebrovascular Diseases. 2022. 31(6):106438. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106438
- N Engel-Nitz. Costs and Outcomes of Noncardioembolic Ischemic Stroke in a Managed Care Population. Vascular Health and Risk Management. 2010. October, 905. https://doi.org/10.2147/vhrm.s10851
- Giuseppe La Torre, Lorenza Lia, Federico Francavilla, Marta Chiappetta, Simone De Sio. Factors That Facilitate and Hinder the Return to Work after Stroke: An Overview of Systematic Reviews. La Medicina Del Lavoro. 2022. 113(3):e2022029. https://doi.org/10.23749/mdl.v113i3.13238
- H Rodgers, D Howel, N Bhattarai, R Cant, A Drummond, GA Ford, A Forster, K Francis R, Hills, AM Laverty, C McKevitt, P McMeekin, CIM Price, E Stamp, E Stevens, L Vale, L Shaw. Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS): A Randomized Controlled Trial and Economic Analysis. Stroke. 2019. Dec;50(12):3561-3568. https://doi.org/10.1161/STROKEAHA.119.024876