There is often no reason to think that the mechanism of stroke prevention and benefits would be different in pri- mary versus secondary prevention, although not studied within a purely secondary stroke prevention trial. There- fore, this writing group occasionally includes recommen- dations with evidence based in the primary prevention of atherosclerotic cardiovascular disease (ASCVD), athero- sclerosis, or combined end points of cardiac disease and stroke in this guideline. To acknowledge that some studies were not performed in a purely ischemic stroke population, the LOE was down- graded. In this way, the writing group agreed that this would provide the best and most complete recommendations to the clinician about important strategies for secondary stroke prevention. Principles guiding inclusion and extrapo- lation of the results of these studies were as follows: 1. The quality of the trial/trials was acceptable. (Ideally, stroke or TIA occurrence or recurrence was a prespecified end point, with clear protocols for assessing stroke end points.) 2. From a physiological perspective, the primary pre- vention strategy used in the study will likely be effective for secondary prevention. 3. Patients with ischemic stroke were included in the population studied when possible. Table 2. 