Primary stroke prevention: refining the "high risk" approach

The impact of stroke remains considerable, despite a modest decline in case fatality1 and an encouraging reduction in incidence on the west coast of Australia during the past decade.2 To the optimists among us, it appears that some efforts, particularly in public health and primary care, are paying off. However, population risk-factor surveys indicate that, although the prevalence of smoking has declined, the prevalences of hypertension and hypercholesterolaemia have changed minimally and the prevalences of obesity and diabetes have increased dramatically over the past decade.1,3 The role of the general practitioner is pivotal in identifying and managing these risk factors.