Meschia et al Guidelines for the Primary Prevention of Stroke 3801 Table 5. New and Revised Recommendations for 2014* Section 2014 Recommendation Description of Change from 2011 Assessing the risk of first stroke The use of a risk assessment tool such as the AHA/ACC CV Risk Calculator (http:// my.americanheart.org/cvriskcalculator) is reasonable because these tools can help identify individuals who could benefit from therapeutic interventions and who may not be treated on the basis of any single risk factor. These calculators are useful to alert clinicians and patients of possible risk, but basing treatment decisions on the results needs to be considered in the context of the overall risk profile of the patient (Class IIa; Level of Evidence B). Reworded to add AHA/ACC CV Risk Calculator and link Genetic factors Treatment of Fabry disease with enzyme replacement therapy might be considered but has not been shown to reduce the risk of stroke, and its effectiveness is unknown (Class IIb; Level of Evidence C). Slightly reworded; no change in class or level of evidence Screening for intracranial aneurysms in every carrier of autosomal-dominant polycystic kidney disease or Ehlers-Danlos type 4 mutations is not recommended (Class III; Level of Evidence C). Previous statement was worded with less specificity, referring to mendelian disorders associated with aneurysms Pharmacogenetic dosing of vitamin K antagonists may be considered when therapy is initiated (Class IIb; Level of Evidence C). Changed from Class III (is not recommended) to Class IIb (may be considered) Physical inactivity Healthy adults should perform at least moderate- to vigorous-intensity aerobic physical activity at least 40 min a day 3 to 4 d/wk (Class I; Level of Evidence B). 