Christopher Patterson, MD, FRCPC, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON.
John W. Feightner, MD, MSc, FCFP, Chair, Canadian Task Force on Preventive Health Care; Department of Family Medicine, Faculty of Medicine, University of Western Ontario, London, ON.

The ultimate aim of critical appraisal is to decide whether the conclusions of an article are helpful in the prevention or management of illness in your patients. This requires the article to be relevant to your practice and to contain sufficient information to determine if the conclusions are supported by the evidence within it. We offer approaches to the appraisal of different types of publications addressing primary and secondary prevention.
Key words: prevention (primary, secondary), clinical research, critical appraisal, clinical practice guidelines.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Secondary prevention has been shown to decrease coronary artery disease morbidity and mortality by 20-25%. Exercise, smoking cessation, and management of dyslipidemia, hypertension, diabetes, and obesity, along with psychological therapies, are typical elements of secondary prevention programs offered by a multidisciplinary clinical team often including physicians, nurses, pharmacists, exercise physiologists, registered dieticians, and psychologists. Special considerations for older adults in a secondary prevention setting in reference to medications, exercise, diet, smoking cessation, and hypertension are addressed. Current practice guidelines and clinical trials are presented, along with practical tools for the primary care physician treating the older coronary artery disease patient.
Key words: multidisciplinary, cardiac rehabilitation, coronary artery disease, secondary prevention.

D'Arcy L. Little, MD, CCFP
York Community Services, Toronto, ON

Introduction
Every year there are approximately 50,000 strokes in Canada. Currently, close to 300,000 Canadians are stroke survivors. As stroke is an age-related condition, the number of strokes is predicted to increase as the Canadian population ages. The resultant national cost, which is estimated at 2.7 billion annually, will also increase unless improvements are made to prevention and treatment.¹ Approximately 1 in 6 survivors of a first stroke experiences a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days.² The above statistics suggest that attention to secondary stroke prevention would be important in reducing the morbidity, mortality and cost to society of stroke. The purpose of this article is to review the role of anti-platelet and anticoagulant agents in the secondary prevention of stroke.

Goals of Therapy
Therapeutic measures in secondary stroke prevention aim to prevent recurrent stroke or transient ischemic attacks, with the aim of preventing morbidity and mortality from incremental neurological deficits, as well as preventing associated cardiac ischemic events.