Although prevention of stroke is the primary outcome of interest, many of the grades for the recommendations were chosen to reflect the existing evidence on the reduction of all vascular outcomes after stroke, including stroke, myocardial infarction (MI), and vascular death. We have organized our recommendations in this statement to aid the clinician who has arrived at a potential explanation of the cause of the ischemic stroke in an individual patient and is embarking on therapy to reduce the risk of a recurrent event and other vascular outcomes. Our intention is to have these statements updated every 3 years, with additional interval updates as needed, to reflect the changing state of knowledge on the approaches to prevention of a recurrent stroke.

Lifestyle factors

Advise people to eat a diet in which:
- Total fat intake is 30% or less of total energy intake.
- Saturated fats are 10% or less of total energy intake.
- Dietary cholesterol is less than 300 mg/day.
- Saturated fats are replaced by monounsaturated and polyunsaturated fats.

Dietary advice:
- Advise eating at least five portions of fruit and vegetables per day.
- Advise eating at least two portions of fish per week, including a portion of oily fish.
- Advise pregnant women to limit their intake of oily fish to two portions a week.
- Do not routinely recommend omega-3 fatty acid supplements or plant sterols and stanols for primary prevention.

Physical activity:
- Advise people to take 30 minutes of at least moderate-intensity exercise a day at least five days a week.
- Encourage people who cannot manage this to exercise at their maximum safe capacity.
- Recommend exercise that can be incorporated into everyday life, such as brisk walking, using stairs and cycling.
- Tell people that they can exercise in bouts of 10 minutes or more throughout the day.
- Take into account the person’s needs, preferences and circumstances.
- Agree goals and provide written information about the benefits of activity and local opportunities to be active.

Weight management:
- Offer people who are overweight or obese advice and support to work towards achieving and maintaining a healthy weight.
- Alcohol consumption:
- Advise men to limit their alcohol intake to 3-4 units a day.
- Advise women to limit their alcohol intake to 2-3 units a day.
- Advise everyone to avoid binge drinking.

Smoking cessation:
- Advise all people who smoke to stop.
- If people want to stop:
- Offer support and advice.
- In addition, provide medication to help with smoking cessation when indicated.