Future of Stroke Prevention

Approximately 9 to 10 million adults (4%) have experienced a stroke in the United States. While stroke incidence has generally declined, progress has been less pronounced among young individuals, and such trends have underlined the importance of focusing on the primary prevention of stroke. In 2024, the American Heart Association and American Stroke Association released new guidelines for the primary prevention of stroke. Here, we review major updates in 7 domains: dietary modification, glucagon-like peptide-1 receptor agonists, blood pressure targets, lipid-lowering medications, antithrombotic agents, colchicine therapy, and sex-specific preventive risk assessment. Through this process, we review important randomized controlled trial evidence contributing to guideline updates and provide key perspectives on the incorporation of lifestyle and pharmacotherapy for personalized stroke prevention. • Declines in stroke incidence have been less pronounced in younger adults. • Benefits of <130/<80 mm Hg blood pressure extend to diabetes and older adults. • New Class 1 indication for GLP-1RA in type 2 diabetes for stroke risk reduction. • Further research required to define the precise role of colchicine in stroke risk reduction.