Secondary prevention of stroke.

Stroke has been defined as a rapid onset of focal neurological deficit lasting more than 24 hours, with no apparent cause other than disruption of the blood supply to the brain (World Health Organization, 1989). A transient ischaemic attack (TIA) refers to a similar presentation that resolves within 24 hours (Hankey and Warlow, 1994). Approximately 15% of strokes are haemorrhagic, with the rest being ischaemic. Stroke is common, affecting approximately 150 000 people every year in the UK. It is the third leading cause of death and the single largest cause of adult physical disability in the world (Bath and Lees, 2000). At any given time there are about 2500 stroke patients in an average health district. Very few stroke survivors make a complete recovery; 12–18% are left with speech problems, 25% are unable to walk, 50% have residual weakness and 24–53% remain dependent on carers for day-to-day activity (Sacco, 1997). Although primary prevention remains the best method of reducing stroke, secondary prevention strategies have proven benefits (Straus et al, 2002).