12B. Primary prevention of stroke

The primary prevention of stroke is similar to that of all cardiovascular disease. Many major risk factors for CVD are modifiable. 90% of stroke burden globally is due to modifiable risk factors.

Anticoagulation in atrial fibrillation

The CHA2DS2-VASC score is used to determine whether patients with atrial fibrillation should receive anticoagulants or not. The score is like this:

• Congestive heart failure – 1 point
• Hypertension – 1 point
• Age > 75 years – 2 points
• Diabetes mellitus – 1 point
• Stroke, TIA, or thromboembolism – 2 points
• Vascular disease (CAD, PAD, etc.) – 1 point
• Age 65 – 74 years – 1 point
• Sex Category: female – 1 point

Anticoagulation is indicated if the score is 2 or more in men or 3 or more in women, or if the score is 1 or 2 respectively but 1 of the risk factors is age 65 – 74 (as this is a stronger risk factor). The recommended anticoagulant is a DOAC.

Other primary preventions

• Healthy diet – increase intake of
  • Fruits and vegetables
  • Fibre
  • Foods with low glycaemic index and low glycaemic load
  • Monounsaturated fat rather than trans or saturated fat
  • Omega-3 fatty acids from foods
• Smoking cessation
• Hypertension – treat
• Dyslipidaemia – treat
• Increase physical activity
  • Moderate intensity exercise for 150 minutes/week OR:
  • Vigorous intensity exercise for 75 minutes/week
• Weight loss – in cases of overweight or obesity
• Treatment of type 2 diabetes