Preventive and Pharmacological Interventions for Stroke: A Narrative Review of Evidence, Challenges, and Future Directions

<i>Stroke remains one of the leading causes of death and long-term disability worldwide, exerting a significant burden on individuals, healthcare systems, and economies. Preventive strategies are critical in reducing the incidence and recurrence of stroke, especially among populations at high risk due to modifiable and non-modifiable factors. This narrative review synthesizes current evidence on pharmacological and non-pharmacological interventions aimed at stroke prevention. It begins by examining key modifiable risk factors, such as hypertension, smoking, excessive alcohol consumption, and physical inactivity. Hypertension, in particular, is highlighted as the most impactful risk factor, with studies showing that even modest reductions in blood pressure can significantly decrease stroke risk. Similarly, smoking cessation and regular physical activity are strongly associated with a reduced likelihood of stroke events. The review also explores pharmacological measures, including antiplatelet and anticoagulant therapies. Aspirin remains a widely used antiplatelet agent, especially in secondary prevention, although its efficacy must be balanced against potential bleeding risks. Alternatives like clopidogrel and combinations such as dual antiplatelet therapy (DAPT) are examined considering recent clinical trial evidence. In patients with atrial fibrillation, anticoagulants such as warfarin and newer direct oral anticoagulants (DOACs) like apixaban have demonstrated effectiveness in reducing stroke risk with varying safety profiles. This review identifies ongoing challenges, including patient adherence, personalized therapy decisions, and the need for broader public health implementation of preventive strategies. It concludes by highlighting the importance of integrating lifestyle interventions with individualized pharmacological treatments to optimise stroke prevention. Further research is recommended to refine these strategies and address existing gaps in knowledge, particularly in low-resource settings where the stroke burden continues to rise.</i>