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WSC 2022 | Time for change: stroke primary prevention guidelines

Valery Feigin, MD, PhD, FRSNZ, FRAS, FAAN, AUT’s National Institute for Stroke and Applied Neuroscience (NISAN), discusses important issues regarding primary stroke prevention. Current primary stroke prevention guidelines are largely focused on the high cardiovascular risk approach, where patients with a predicted increased risk of cardiovascular disease can receive pharmacological treatment above a certain threshold, focusing on blood pressure and elevated lipids. This strategy was initiated about 15 years ago and was thought to be more cost effective, in comparison to population wide strategies. However, there is limited evidence to support the effectiveness of such strategies and accordingly, the global burden of stroke is continuing to rise. The high-risk approach overlooks patients with low-moderate risk, in whom 80% of strokes and myocardial infarctions are happening. Additionally, only intervening in high-risk patients can lead patients at low-moderate cardiovascular risk to falsely believe that they are protected from stroke and do not need to consider risk factors. This interview took place at the World Stroke Congress 2022 in Singapore.

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