Should I start all my ischaemic stroke and TIA patients on a statin, an ACE inhibitor, a diuretic, and aspirin today?

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Abstract
In neurological and neurosurgical practice, the people who have most to gain from secondary prevention are those with minimal or no disability who are at highest absolute risk of disabling stroke—that is, those who have had a recent TIA or minor stroke. Some individuals with atrial fibrillation but no history of a cerebrovascular event may have a comparably high absolute risk. If one follows up such individuals, they are likely to suffer not just strokes but also myocardial infarcts, or to require vascular surgical procedures (on the cerebral, coronary or peripheral arteries), or to die from vascular causes. For an intervention such as carotid endarterectomy for symptomatic carotid stenosis (with an average 3–5% risk of fatal or disabling stroke complicating the procedure), it is important to offer it only to those individuals at sufficiently high absolute risk of stroke to justify the hazard. On the other hand, in patients aged under 65 with non-rheumatic atrial fibrillation, no history of stroke or TIA and no vascular risk factors (that is, “lone atrial fibrillation”), the annual risk of stroke is well below 2%, and aspirin (rather than warfarin) becomes the antithrombotic agent of choice.3 To aid the process of clinical decision making there are predictive models that may help identify patients at high and low risk of vascular event after stroke or TIA,4 and risk stratification models for patients in atrial fibrillation.3