For example, a stroke prediction model derived for use in Chinese adults in Taiwan included age, sex, SBP, diastolic BP (DBP), family history of stroke, AF, and dia- betes mellitus and was found to have a discriminative capacity similar to or better than those of other available stroke models.23 The model, however, has not been independently validated. Recent guideline statements from the AHA/American StrokeAssociation have emphasized the importance of includ- ing both stroke and coronary heart disease events as outcomes in risk prediction instruments intended for primary preven- The AHA/American College of Cardiology (ACC) CV Risk Calculator is available online for use in estimating risk at http://my.americanheart.org/cvriskcalculator. Assessing the Risk of First Stroke: Summary and Gaps An ideal stroke risk assessment tool that is simple, is widely applicable and accepted, and takes into account the effects of multiple risk factors does not exist. Each available tool has limi- tations. Newer risk factors for stroke such as obstructive sleep apnea, not collected in older studies, need to be considered.25 Risk assessment tools should be used with care because they do not include all the factors that contribute to disease risk.25 Some potential for harm exists from unnecessary application of interventions that may result from inappropriate use of risk assessment tools or from the use of poorly adjudicated tools. The utility of the FSP or other stroke risk assessment scales as a way of improving the effectiveness of primary stroke prevention is not well studied. Research is needed to validate risk assessment tools across age, sex, and race/ethnic groups; to evaluate whether any of the more recently identified risk factors add to the predic- tive accuracy of existing scales; and to determine whether the use of these scales improves primary stroke prevention. Assessing the Risk of First Stroke: Recommendations 1. 