Stroke continues to have a major impact on the public health of developed and developing nations. Ranking among the leading causes of death, stroke is far more disabling than fatal and results in enormous costs measured in both health-care dollars and lost productivity. Once considered untreatable, ischemic stroke is now much more treatable with acute intravenous thrombolysis and mechanical thrombectomy. Multiple randomized clinical trials have provided evidence-based approaches for prevention of first or recurrent stroke in a variety of settings. Carotid endarterectomy and angioplasty and stenting are effective for treating symptomatic patients with large artery atherosclerotic disease. Oral anticoagulants are effective for primary and secondary prevention for cardioembolic stroke due to atrial fibrillation. Multiple anti-platelets alone or in-combination can be used for a variety of ischemic stroke subtypes. Ongoing trials are addressing other options to prevent recurrent stroke. Key risk factors for stroke include blood pressure, glucose, cholesterol, as well as behaviors such as smoking, physical activity, obesity, and diet. Enhanced dissemination and adherence to programs to improve cardiovascular health are critical to preventing stroke and maintaining brain health.
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