Reader response: The dimension of preventable stroke in a large representative patient cohort

In their report of data from the Poststroke Disease Management (STROKE-CARD) trial,1 and consistent with other studies,2,3 Boehme et al. found that a high proportion of stroke is associated with potentially modifiable risk factors that are incompletely addressed, representing an important opportunity for effective prevention. Boehme et al., however, list the impact of risk factor management on stroke among those with diabetes as being unclear because of the lack of data showing that tight glycemic control reduces stroke incidence. As a result, diabetes mellitus was not separately considered in their calculation that 79.5% (95% CI 77.6%–81.4%) of their cohort had at least one untreated risk condition. Although likely reflected in other intervention categories in their analysis, it needs to be stressed that the risk of stroke in persons with diabetes can be reduced with antihypertensives and statins.4,5 Use of these approaches—in addition to general risk factor modification and the use of aspirin in those at high risk—are proven strategies for reducing stroke and cardiovascular risk in this population.

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