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). Changed wording to match new AHA lifestyle guideline Dyslipidemia In addition to therapeutic lifestyle changes, treatment with an HMG coenzyme-A reductase inhibitor (statin) medication is recommended for primary prevention of ischemic stroke in patients estimated to have a high 10-y risk for cardiovascular events as recommended in the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (Class I; Level of Evidence A). Reworded to incorporate ACC/AHA guidelines (instead of NCEP); no change in class/LOE. Focusing on estimated cardiovascular risk as the determinant for initiating therapy is new. Niacin may be considered for patients with low high-density lipoprotein cholesterol or elevated lipoprotein(a), but its efficacy in preventing ischemic stroke in patients with these conditions is not established. Caution should be used with niacin because it increases the risk of myopathy (Class IIb; Level of Evidence B). Changed from LOE C to LOE B; the risk of myopathy is highlighted Treatment with nonstatin lipid-lowering therapies such as fibric acid derivatives, bile acid sequestrants, niacin, and ezetimibe may be considered in patients who cannot tolerate statins, but their efficacy in preventing stroke is not established (Class IIb; Level of Evidence C). Reworded from other to nonstatin (no change in class or LOE). Reference is no longer made to an low-density lipoprotein target for statin therapy because the decision to use moderate or intensive statin therapy depends on estimated risk of future cardiovascular events. 