Abstract Much of the decline in stroke incidence and
mortality for the past several decades in Western countries
has been attributed to better treatment of risk factors. Many
epidemiological studies and clinical trials confirmed the
importance of managing hypertension. Comparative trials of
anti-hypertensive drugs or drug classes have not yielded clear
results, but blood pressure variability may play an important
role beyond the absolute value of blood pressure. Diabetes
therapy remains a conundrum. Although diabetes is clearly a
risk factor for ischemic stroke, treatment trials targeting
different glycemic goals have not indicated that glucose
lowering results in stroke prevention. Trials focused on
insulin resistance are ongoing and they may be able to help
establish the management of diabetes/impaired glucose
tolerance. Evidence for treatment of dyslipidemia has
contrasted science to diabetes mellitus. Dyslipidemia has not
been strongly or consistently linked to ischemic stroke but the
Stroke Prevention by Aggressive Reduction in Cholesterol
Levels (SPARCL) trial showed the impact of statin treatment
in stroke prevention. The results of clinical trials investigating
dabigatran and rivaroxaban clearly indicate alternative strategies
to vitamin K antagonists in stroke prevention for
persons with atrial fibrillation. Evidence for stroke prevention
by life style modification, treating metabolic syndrome, sleep
disordered breathing, lipoprotein (a), hyperhomocysteinemia,
and coagulation disorders are also discussed.