Glycemic control reduces microvascular complications, but there remains no evidence that improved glycemic control reduces the risk of incident stroke. Adequately powered studies show that treatment of patients with diabetes mellitus with a statin decreases the risk of a first stroke. Although a subgroup analysis of VA-HIT suggests that gemfi- brozil reduces stroke in men with diabetes mellitus and dyslip- idemia, a fibrate effect was not seen in FIELD, and ACCORD found no benefit of adding fenofibrate to statin. However, the subgroup analysis from fibrate trials suggests a benefit of fibrates in patients with diabetes mellitus and a BMI >30 kg/m2 . Diabetes: Recommendations 1. Control of BP in accordance with an AHA/ACC/ to a target of <140/90 mmHg is rec- ommended in patients with type 1 or type 2 diabetes mellitus (Class I; Level of Evidence A). 2. Treatment of adults with diabetes mellitus with a statin, especially those with additional risk factors, is recommended to lower the risk of first stroke (Class I; Level of Evidence A). 3. The usefulness of aspirin for primary stroke prevention for patients with diabetes mellitus but low 10-year risk of CVD is unclear (Class IIb; Level of Evidence B). 4. Adding a fibrate to a statin in people with diabetes mellitus is not useful for decreasing stroke risk (Class III; Level of Evidence B). Cigarette Smoking Virtually every multivariable assessment of stroke risk factors and the Honolulu Heart Study327 ) has identified cigarette smoking as a potent risk factor for ischemic stroke, associated with an approximate doubling of risk. 