Management of risk factors for accelerated atherosclerosis

Atherosclerosis is a relentlessly progressive process of segmental vessel narrowing or occlusion involving several vascular beds. It accounts for the majority of strokes, which remain a global leading cause of death and long-term disability. The limited options for acute stroke therapy make stroke prevention an important therapeutic approach, particularly in patients who have already experienced stroke. Given the multifactorial pathogenesis of atherosclerotic disease, an aggressive multimodal preventive strategy is required to mitigate risk of recurrent stroke. Such a strategy would incorporate proven treatments specifically targeting the underlying disease process. A vast number of strokes could be prevented by optimal treatment of modifiable vascular risk factors. This paper presents current evidence-based management of conventional and novel vascular risk factors in patients with ischemic stroke whose underlying pathophysiologic mechanism is accelerated atherosclerosis. Therapies discussed include antithrombotics, statins, antihypertensives, and surgical/endovascular treatments.