Prevention in stroke - Current state, present gaps and probable next steps.

BACKGROUND: Stroke is a leading cause of death and disability, and the top contributor to neurological disability-adjusted life years globally. Current trends suggest that stroke incidence will continue to rise, especially in low- and middle-income countries.

MAIN BODY: Prevention opportunities are substantial because the majority of stroke burden is linked to modifiable risk factors. Thus, stroke incidence can effectively be reduced if proven interventions are implemented early, consistently, and at sufficient scale. Effective prevention requires both individualized, risk-based targets and interventions, and health-system approaches that support systematic detection, longitudinal control, and sustained adherence in routine care. Importantly, prevention benefits will be maximized only if access is equitable and if prevention goals can be achieved across the population at large, including so far underserved groups that combine multiple cardiovascular risk factors and low affinity to traditional health care prevention programs.

FUTURE DIRECTIONS: Next steps may include strengthening of primary-care-based prevention programs, routine surveillance of risk-factor control, outreach to underserved groups, and transparent quality indicators. Long-term follow-up is essential to sustain risk-factor control and to enable translation of evidence into population-level impact.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42466-026-00479-3.

PMID: 42021367