Gynnild MN, Hageman SHJ, Dorresteijn JAN, et al. - Findings demonstrate suboptimal current risk factor control after ischemic stroke, and high residual risk was observed even after optimization according to current guidelines. There is considerable interindividual variation in risk, with a corresponding variation in advantage from treatment intensification. The SMART-REACH model, an available risk prediction tool, can be employed to find patients with the largest benefit from more intensive treatment and follow-up.

• A total of 465 patients admitted with acute ischemic stroke were analyzed in a multicenter observational study.

• In participants, the SMART-REACH (Secondary Manifestations of Arterial Disease-Reduction of Atherothrombosis for Continued Health) model was applied for 10-year and lifetime risk of cardiovascular events.

• A new event occurred in 11.2%, and adequate agreement was evident between estimated and observed 2-year prognosis (C-statistics 0.63).

• The median 10-year risk of recurrent cardiovascular events was estimated to be 42% and could be decreased to 32% via optimal guideline-based therapy.

• The corresponding numbers for lifetime risk were noted to be 70% and 61%.

• If guideline targets were met, an overall median gain of 1.4 (Interquartile range 0.2– 3.4) event-free life years was estimated.