Look at two men above: same age, same weight (yes, it is, muscle is heavier than fat). So statistically they are the same. Would you treat them the same for stroke?

According to recently released POINT study, yes: aspirin for life, Plavix for 3 months. I guess in 3 months all risk factors will resolve, including obesity, diabetes, hypertension.

Stroke workup should address risk factors long term. If a patient has diabetes, no medications will help unless patient will take care of his life style. Obesity commonly causes sleep apnea, which in turn causes hypertension and atrial fibrillation. Per guidelines, physicians will try to treat hypertension and atrial fibrillation, but sleep apnea will rarely be approached or addressed.

In addition, risk factors for the above examples would likely be different. Fit patients may develop strokes as a result of vascular dissection, parodoxical embolism (fancy term, meaning clot originating below the heart, typically related to patent foramen ovale) or hypercoagulation (thickness of blood). While young but obese patients typically have the same risk factors as elderly: diabetes, hypertension, high lipids, sleep apnea, etc. So the initial work up should take those factors into account.

Great book “Biochemical individuality” by Roger Williams points out numerous differences between people. Even twins are biochemically different. They may have the same genes, but expression of those genes depends on the environment.

So, in my opinion, it is a great mistake to treat everybody as a statistic. We have to provide a personalized approach to management, depending on numerous factors, such as lifestyle, stress, diet, sleep, environment, exposure to toxins, other medical issues, etc.