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Lifestyle interventions are associated with lower stroke risk and recurrent events, and are core to guideline-based prevention; effect sizes vary by risk factor, adherence, and setting. This review begins with the pathophysiology of stroke, focusing on the roles of sex hormones, genetics, environment, and lifestyle. We then outline how lifestyle interventions can aid in primary and secondary prevention of stroke by targeting modifiable risk factors responsible for approximately 90% of stroke risk, including hypertension, diabetes, high cholesterol, poor diet, sedentary behavior, abdominal obesity, psychological stress, smoking, cardiac causes, and alcohol use. We also discuss clinical implementation, policy strategies, health equity, cost-effectiveness, and future directions. These insights highlight the critical role of lifestyle medicine in stroke prevention, aimed at reducing the global stroke burden.<\/jats:p>","DOI":"10.1177\/15598276261418006","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T16:47:56Z","timestamp":1769878076000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lifestyle Medicine for Primary and Secondary Stroke Prevention: A Narrative Review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0714-3548","authenticated-orcid":false,"given":"Rikka Yzzabelle","family":"Tagayuna","sequence":"first","affiliation":[{"name":"California State University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charis","family":"Rowden","sequence":"additional","affiliation":[{"name":"Loma Linda University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Sherzai","sequence":"additional","affiliation":[{"name":"Charles R. 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