Stroke Prevention Starts in Primary Care, Vascular Neurologist Says

Primary care clinicians are positioned to prevent a first stroke by finding and treating vascular risk factors before neurologic injury occurs, according to Rodica Di Lorenzo, MD, a vascular neurologist at Cleveland Clinic. In this video, Di Lorenzo identifies hypertension as the leading modifiable priority and urges clinicians not to dismiss elevated office readings without determining whether blood pressure is persistently high. She also reviews dyslipidemia, diabetes, tobacco use, physical inactivity, and poor diet as targets that can be addressed longitudinally in primary care.

Her emphasis aligns with the 2024 American Heart Association and American Stroke Association guideline for primary stroke prevention. The guideline recommends regular screening and management of major risk factors across the life span and gives primary care clinicians a central role in applying lifestyle, pharmacologic, and risk-assessment strategies before a first event.¹ The interview also highlights atrial fibrillation (AF), particularly in older adults. AF may be asymptomatic, but when present it promotes intracardiac thrombus formation and can lead to embolic stroke. The National Heart, Lung, and Blood Institute notes that AF can occur without symptoms and that stroke is among its serious complications.²

Di Lorenzo discusses adhesive rhythm monitors and consumer wearables as increasingly convenient ways to detect possible rhythm abnormalities. That distinction matters: wearable alerts may prompt clinical evaluation, but they are not a stand-alone AF diagnosis. The 2023 ACC/AHA/ACCP/HRS AF guideline states that an initial diagnosis should be made by a clinician who visually interprets electrocardiographic signals, regardless of the device used to capture them.³

For primary care, the practical message is to connect detection with action. Confirm elevated blood pressure with appropriate repeat or out-of-office measurements, assess global cardiovascular risk, treat established risk factors, ask about palpitations or unexplained dyspnea, and evaluate suspicious wearable findings with a diagnostic-quality rhythm tracing.

Di Lorenzo has no relevant disclosures.

References:

1. Bushnell C, Kernan WN, Sharrief AZ, et al. 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2024;55:e344-e424. doi:10.1161/STR.0000000000000475

2. National Heart, Lung, and Blood Institute. Atrial Fibrillation. Updated November 30, 2022. View source

3. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149:e1-e156. View source