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Beyond antithrombotics: recent advances in pharmacological risk factor management for secondary stroke prevention
  1. Dimitrios Sagris1,
  2. George Ntaios1,
  3. Haralampos Milionis2
  1. 1 Department of Internal Medicine, University of Thessaly, Faculty of Medicine, Larissa, Greece
  2. 2 Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
  1. Correspondence to Professor Haralampos Milionis, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Stavrou Niarchou Avenue, Ioannina, Epirus 45110, Greece; hmilioni{at}


Patients with ischaemic stroke represent a diverse group with several cardiovascular risk factors and comorbidities, which classify them as patients at very high risk of stroke recurrence, cardiovascular adverse events or death. In addition to antithrombotic therapy, which is important for secondary stroke prevention in most patients with stroke, cardiovascular risk factor assessment and treatment also contribute significantly to the reduction of mortality and morbidity. Dyslipidaemia, diabetes mellitus and hypertension represent common and important modifiable cardiovascular risk factors among patients with stroke, while early recognition and treatment may have a significant impact on patients’ future risk of major cardiovascular events. In recent years, there have been numerous advancements in pharmacological agents aimed at secondary cardiovascular prevention. These innovations, combined with enhanced awareness and interventions targeting adherence and persistence to treatment, as well as lifestyle modifications, have the potential to substantially alleviate the burden of cardiovascular disease, particularly in patients who have experienced ischaemic strokes. This review summarises the evidence on the contemporary advances on pharmacological treatment and future perspectives of secondary stroke prevention beyond antithrombotic treatment.


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  • Contributors DS: concept and design, data collection and interpretation, manuscript preparation. GN, HN: concept and design, interpretation and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GN reports speaker fees/advisory boards/research support from Abbott, Amgen, Bayer, BMS/Pfizer, Boehringer Ingelheim, Elpen and Galenica. All fees are paid directly to his institution (University of Thessaly). HM reports speaker fees/advisory boards/research support from Alexion, Amgen, AstraZeneca, Bayer, Elpen, Genesis Pharma, MSD, Pfizer, Sanofi, Servier, Viatris and Winmedica.

  • Provenance and peer review Commissioned; externally peer reviewed.