The American Stroke Association has released updated recommendations for preventing first-time strokes, emphasizing the importance of screening and healthy lifestyle choices.
Summary: Up to 80% of first strokes may be preventable through risk factor screening, lifestyle modifications, and appropriate medical interventions, according to new guidelines from the American Stroke Association.
Estimated reading time: 6 minutes
Each year in the United States, over 600,000 people experience their first stroke. However, a new clinical guideline from the American Stroke Association suggests that up to 80% of these strokes could be prevented through proper screening, lifestyle changes, and medical interventions.
The “2024 Guideline for the Primary Prevention of Stroke,” published in the journal Stroke, provides evidence-based recommendations for healthcare professionals to help identify and manage stroke risk factors in patients who have not previously experienced a stroke.
Identifying and Managing Risk Factors
The guideline emphasizes the critical role of primary care professionals in promoting brain health and preventing strokes. Regular screenings are recommended to identify modifiable risk factors such as:
- High blood pressure
- Elevated cholesterol
- High blood sugar
- Overweight and obesity
Dr. Cheryl D. Bushnell, chair of the guideline writing group and professor at Wake Forest University School of Medicine, states:
“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention. Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.”
Once risk factors are identified, the guideline recommends addressing them through lifestyle changes and, when appropriate, medication. Antihypertensive medications for high blood pressure and statins for high cholesterol are recommended for adults with increased cardiovascular disease risk. A new addition to the guideline is the consideration of GLP-1 receptor agonist medications for people with overweight, obesity, or Type 2 diabetes.
Promoting Healthy Lifestyle Behaviors
The guideline strongly emphasizes the importance of healthy lifestyle choices in reducing stroke risk. It references the American Heart Association’s Life’s Essential 8 cardiovascular health metrics, which include:
- Healthy nutrition
- Regular physical activity
- Avoiding tobacco
- Healthy sleep
- Maintaining a healthy weight
- Controlling cholesterol
- Managing blood pressure
- Managing blood sugar
Specifically, the guideline recommends following a Mediterranean dietary pattern, which has been shown to reduce stroke risk, especially when supplemented with nuts and olive oil.
Physical activity is also crucial for stroke prevention. The guideline advises adults to engage in at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, in line with recommendations from the U.S. Department of Health and Human Services.
Addressing Health Equity
For the first time, the guideline addresses the impact of social determinants of health on stroke risk. These non-medical factors, including education, economic stability, access to care, and structural racism, can contribute to health inequities.
Healthcare professionals are encouraged to:
- Provide patient education materials for various educational and language levels
- Choose effective and affordable treatments
- Connect patients with resources to address health-related social needs
- Refer patients to programs supporting healthy lifestyle changes
Gender-Specific Recommendations
The guideline includes new recommendations specific to women’s health. Healthcare professionals should screen for conditions that may increase a woman’s stroke risk, including:
- Use of oral contraceptives
- High blood pressure during pregnancy
- Pregnancy complications such as premature birth
- Endometriosis
- Premature ovarian failure
- Early onset menopause
The guideline also addresses stroke risk for transgender women and gender-diverse individuals taking estrogens for gender affirmation, recommending evaluation and modification of existing risk factors.
Dr. Bushnell emphasizes the potential impact of these recommendations:
“Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain.”
While the new guideline provides a comprehensive approach to stroke prevention, it’s important to note that individual risk factors and circumstances may vary. Patients should consult with their healthcare providers to develop personalized prevention strategies based on their specific risk profiles.
Quiz: Test Your Knowledge
- What percentage of first strokes may be preventable according to the new guideline? a) 50% b) 60% c) 70% d) Up to 80%
- How much weekly moderate-intensity aerobic activity is recommended for adults? a) At least 100 minutes b) At least 150 minutes c) At least 200 minutes d) At least 250 minutes
- Which of the following is NOT one of the Life’s Essential 8 cardiovascular health metrics? a) Healthy nutrition b) Regular physical activity c) Stress management d) Avoiding tobacco
Answer key:
- d
- b
- c
Glossary of Terms
- Primary prevention: Efforts to prevent the occurrence of a health condition before it develops.
- Social determinants of health: Non-medical factors that influence health outcomes, such as education, economic stability, and access to care.
- Mediterranean dietary pattern: A diet rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil, with moderate consumption of fish and poultry.
- Cardiovascular disease (CVD): A group of disorders affecting the heart and blood vessels.
- GLP-1 receptor agonists: A class of medications used to treat type 2 diabetes and obesity that may also reduce cardiovascular risk.
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