(i) Alcohol consumption
For a variety of health considerations, it is recommended that heavy drinkers reduce their alcohol consumption or abstain from drinking (Class I/Level A).
For drinkers, <2 drinks per day for men and <1 drink per day for non-pregnant women may be reasonable (Class IIb/Level B).
(ii) Drug abuse
It is reasonable for drug abusers to receive appropriate drug treatment (Class IIa/Level C).
(iii) Sleep disordered breathing (SDB)
Given the association between sleep apnea and other vascular risk factors as well as cardiovascular disease, it is recommended that the presence of SDB be assessed by taking a detailed history, supplemented by special tests if necessary, and special attention should be paid to patients with abdominal obesity, hypertension, cardiac disease, or drug-resistant hypertension (Class I/Class A).
It may be reasonable to reduce the risk of stroke by treating sleep apnea, but exact efficacy has not been demonstrated (Class IIb/Class C).
(iv) Hyperhomocysteinemia
In patients with hyperhomocysteinemia, B complex, vitamin B6, cyanocobalamin (vitamin B12), and folic acid may be considered for the purpose of stroke prevention, but their effectiveness has not been established (Class IIb/Grade B).
(v) Increased lipoprotein(a) [Lp(a)]
In patients with elevated Lp(a), it may be reasonable to take niacin for stroke prevention, but the effect has not been proven (Class IIb/Grade B).
(vi) Hypercoagulable states
The role of hypercoagulable states in primary stroke prevention has not been adequately demonstrated by genetic screening (Class IIb/Grade C).
(vii) Inflammation and infection
Detection of inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) or Lp-PLA2 from patients without cardiovascular disease to identify those at increased risk of stroke can be considered, but its usefulness as a routine clinical approach has not been fully demonstrated (Class IIb/Grade B).
Patients with chronic inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus should be considered at high risk of stroke (Class I/Grade B)
antimicrobial treatment of chronic infections is not recommended as a means of stroke prevention (Class III/Grade A)
in patients with increased hs-CRP, statin therapy may be considered with a view to reducing the risk of stroke (class IIb/level B)
For patients at high risk of stroke, annual influenza vaccination may be beneficial (Class IIa/Grade B).
(viii) Aspirin in primary stroke prevention
(i) Aspirin is recommended for the prevention of cardiovascular disease (including stroke) in those at high risk of cardiovascular disease with a treatment benefit sufficient to outweigh the risk of drug use (6-10% risk of cardiovascular disease over 10 years) (Class I/Grade A).
For female patients at higher risk, the benefit of treatment is sufficient to outweigh the risk of medication use aspirin (81 mg/day, or 100
mg/every other day) for primary stroke prevention may be effective (Class IIa/Class B).
For primary prevention of stroke in low-risk patients, aspirin is not effective (Class III/Grade A).
aspirin is ineffective as primary prevention of stroke in diabetic patients without other cardiovascular disease or with only asymptomatic peripheral arterial disease (defined as an ankle-arm blood pressure index <0.99) (Class III/Grade B)
For disorders such as atrial fibrillation and carotid stenosis, the effectiveness of aspirin for primary stroke prevention is described in the relevant section of this guideline.