The overwhelming majority of strokes can be pre- vented through BP control, a healthy diet, regular physi- cal activity, and smoking cessation. In fact, 5 factors BP, diet, physical inactivity, smoking, and abdominal obe- sity accounted for 82% and 90% of the population- attributable risk (PAR) for ischemic and hemorrhagic stroke in the INTERSTROKE study (Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries).5a Similarly, the Global Burden of Disease Study showed that 90.5% (95% uncertainty interval, 88.5 92.2) of the global burden of stroke was attributable to modifiable risk factors.6 A modeling study showed that targeting multiple risk factors has additive benefits for secondary prevention; specifically, aspirin, statin, and antihypertensive medi- cations, combined with diet modification and exercise, can result in an 80% cumulative risk reduction in recur- rent vascular events.7 Although the benefits of a healthy lifestyle and vascular risk factor control are well docu- risk factors remain poorly controlled among 1.1. Methodology and Evidence Review This guideline provides a comprehensive yet succinct compilation of practical guidance for the secondary prevention of ischemic stroke or TIA (ie, prevention of ischemic stroke or TIA in individuals with a history of stroke or TIA). We aim to promote optimal dissemina- tion of information by using concise language and for- matting. The recommendations listed in this guideline are, whenever possible, evidence based and supported by an extensive evidence review. A search for literature derived from research involving human subjects, pub- lished in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases rel- evant to this guideline was conducted between July 2019 and February 2020. Additional trials published between February and June 2020 that affected the guideline recommendations were also included. 