Stroke remains a leading cause of death and long-term disability. Yet, much of its burden is preventable through earlier and more intensive management of vascular and cardiovascular-kidney-metabolic risk factors. Primary prevention is challenging as the first clinical event is often unpredictable and may manifest as stroke, myocardial infarction, heart failure, or peripheral arterial disease. Contemporary tools, therefore, estimate overall cardiovascular risk rather than stroke risk in isolation. The goal of this review is to emphasize that effective stroke prevention requires a shift toward global cardiovascular risk assessment and to highlight the potential clinical utility of newer risk prediction tools. The predicting risk of cardiovascular disease events equations, developed by the American Heart Association, update absolute risk estimation by modeling overall cardiovascular disease risk using sex-specific, race-free equations that incorporate kidney function, account for competing noncardiovascular death, and optionally include neighborhood deprivation. External validations suggest improved calibration compared with pooled cohort equations, supporting a more reliable estimation of absolute treatment benefit. For clinicians managing patients at risk for stroke, predicting risk of cardiovascular disease events is most useful when the clinical question is how aggressively to optimize risk factors before the first event, including decisions about blood pressure, lipid-lowering therapy, cardiovascular-kidney-metabolic management, and patient communication using 10-year, 30-year, and risk age outputs. Key limitations include its focus on overall rather than cause-specific cardiovascular risk, lack of stroke mechanism-specific estimates, absence of major nonatherosclerotic stroke drivers such as atrial fibrillation, and lack of imaging-stratified treatment-effect estimates. Predicting the risk of cardiovascular disease events' ultimate clinical impact and equity will depend on implementation within electronic health record workflows, autopopulated inputs, treatment pathways tied to estimated risk, and complementary cause-specific evaluation when clinically indicated.

Stroke has become the single leading neurological illness that results in neurological disability and is the second most common cause of death worldwide. Approximately 85% of strokes are ischemic, whereas the remaining 15% are hemorrhagic. With the advent of increasingly effective treatment modalities, such as intravenous thrombolytics and endovascular mechanical thrombectomy, there has been a growing disparity in the ability to provide standard of care, despite substantial efforts made in lower- and middle-income countries. substantial effort in high-income countries to provide the current standard of care to patients with stroke, with the hope of improving outcomes. Extensive research has shown that the disparities in treatment among various countries stem from multiple sociocultural barriers and the lack of robust healthcare infrastructure. The societal influences in play include the lack of knowledge of stroke symptoms, cultural beliefs, health, and spiritual fatalism, which are then associated with delayed healthcare-seeking behaviors. As a result, it is imperative to increase access to treatment for patients with stroke to address inequities in stroke care and diminish the global burden of stroke. This narrative review highlights causes of major gaps in stroke treatment infrastructure in several global communities and examines the pertinent sociocultural factors that impede progress in stroke treatment.