Guidelines highlights:
More than 500,000 people in the United States have their first stroke each year. However, up to 80% of strokes may be preventable. The American Stroke Association’s new primary stroke prevention guidelines call for health care professionals to screen for stroke risk factors such as high blood pressure, elevated cholesterol, high blood sugar, and obesity. Public awareness and knowledge about healthy lifestyle changes, such as quitting smoking, increasing physical activity, improving eating habits, and improving sleep quality, may also help reduce stroke risk. The new guidelines focus on the American Heart Association’s eight essential lifelong health indicators for cardiovascular optimization. How to address brain health, medications for risk factor management, women-specific risks, and social determinants of health.
Healthy lifestyle behaviors such as proper nutrition, smoking cessation, and physical activity, along with managing cardiovascular disease and stroke risk factors with regular medical checkups and medications, can help prevent a stroke in the first place. Screening for stroke risk and educating people about how to lower their chances of having a stroke ideally starts with their primary care physician, according to new clinical guidelines from the American Stroke Association, a division of the American Heart Association. It is desirable to include evidence-based recommendations. , and was published today in the association’s journal Stroke.
A stroke occurs when blood flow to the brain is cut off after a blood vessel is blocked or ruptured by a blood clot. As a result, the brain does not receive the oxygen it needs to function properly. Stroke can cause brain damage and cause serious disabilities, including difficulty thinking, speaking, walking, and interacting with the environment. Stroke is now the fifth leading cause of death in the United States, killing nearly 160,000 people each year. Although up to 80% of strokes are preventable, more than 600,000 people in the United States have their first stroke each year.
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“The most effective way to reduce the incidence of stroke and stroke-related death is to prevent a stroke in the first place, known as primary prevention,” said Cheryl D. Bushnell, MD, MHS, FAHA, chair of the guideline development group. said. Professor and Associate Director of Research, Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. “Some people are at increased risk for stroke due to genetics, lifestyle, biological factors, and social determinants of health, and in some cases, people may not have been adequately screened to identify their risk. Masu.”
The 2024 Guidelines for Primary Prevention of Stroke replaces the 2014 edition and serves as a resource for clinicians to implement various prevention strategies for individuals without a history of stroke. New guidelines provide evidence-based recommendations for strategies to support brain health and prevent stroke throughout life by improving healthy lifestyle behaviors and receiving preventive care. We offer
“This guideline is important because new discoveries have been made since the last update 10 years ago. “Providing support can help prevent a stroke in the first place,” Bushnell said.
Key recommendations for stroke prevention include regular health checkups, identification of risk factors, lifestyle interventions, and medication as needed.
Identifying and managing risk factors
Unidentified and uncontrolled cardiovascular disease risk factors can cause damage to arteries, brain, and heart years before cardiovascular disease or stroke occurs. Primary care health professionals must promote brain health in their patients through stroke prevention education, screening, and addressing risk factors from birth to old age.
Modifiable risk factors for stroke, such as high blood pressure, being overweight or obese, high cholesterol, and high blood sugar levels, can be identified through a physical exam and blood tests. These symptoms must be managed with healthy lifestyle and behavioral changes, which may include medication for some patients. Antihypertensive drugs, which lower blood pressure, and statin drugs, which lower cholesterol, can help reduce the risk of a first stroke in adults at high risk for cardiovascular disease or those receiving CVD treatment. A new recommendation is to consider glucagon-like protein-1 (GLP-1) receptor agonist drugs. This drug is approved by the FDA to reduce the risk of cardiovascular disease in people who are overweight or obese and/or have type 2 diabetes.
healthy lifestyle behaviors
The most common and treatable lifestyle behaviors that help reduce the risk of stroke are detailed in the association’s Life’s Essential 8 Cardiovascular Health Indicators. These include healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep and weight, managing cholesterol, and managing blood pressure and blood sugar levels. The guidelines recommend that adults without a history of cardiovascular disease or at increased risk follow a Mediterranean diet pattern. A Mediterranean diet program has been shown to reduce the risk of stroke, especially when consuming nuts and olive oil.
Physical activity is also essential for stroke risk reduction and overall heart health. Physical activity can help improve important health indicators such as blood pressure, cholesterol, inflammatory markers, insulin resistance, endothelial function, and weight. The guidelines call on health professionals to regularly screen patients for sedentary behavior, which has been identified as a risk factor for stroke, and advise them to engage in regular physical activity. The association reinforces the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion’s recommendation that adults get at least 150 minutes of moderate-intensity aerobic activity and/or 75 minutes of vigorous-intensity aerobic activity per week. do. Spread it out throughout the week if possible.
Health equity and stroke risk
New to the guidelines is an emphasis on social determinants of health and their impact on stroke risk. Social determinants of health include education, economic stability, access to care, discrimination, structural racism, neighborhood factors (lack of walkability, low availability of healthy food, health care resources) non-medical factors that contribute to inequality, such as a decline in It helps in your care and affects your overall health. Health professionals must ensure that patient education is accessible to different educational and language levels and advocate for patients in choosing effective and affordable treatments and medications.
Health professionals also connect patients with resources that help address health-related social needs, such as food and housing insecurity, and refer patients to programs that support healthy lifestyle changes, including drug costs. They are also encouraged to refer you to assistance programs that may help cover your medical costs. .
New sex and gender-specific recommendations
The guidelines also include new sex- and gender-specific recommendations for women. Health professionals recommend conditions that may increase a woman’s risk of stroke, such as oral contraceptive use, high blood pressure during pregnancy, preterm birth, endometriosis, premature ovarian failure, and other pregnancy complications such as early menopause. must be inspected. It is recommended to treat high blood pressure during pregnancy and within 6 weeks after delivery to reduce the risk of maternal intracerebral hemorrhage.
Transgender women and gender diverse individuals who take estrogen to affirm their gender may also be at increased risk of stroke. To reduce stroke risk in these individuals, existing risk factors must be evaluated and modified.
“Implementing the recommendations in this guideline will significantly reduce people’s risk of having their first stroke. Most of the strategies we recommend to prevent stroke are It also helps reduce the risk of dementia, another serious health condition associated with this problem,” Bushnell said.
The writing group noted that it was difficult to write recommendations that focused on stroke prevention in the first place. Some of the evidence that informed the guidelines has limitations, including that many clinical trials involve adults who have already had a cardiovascular event, including a stroke. The writing group also identified knowledge gaps that will help inform future research topics.
This guideline emphasizes the need for risk assessment in the primary prevention of stroke, and to estimate the risk of atherosclerotic cardiovascular disease so that patients receive timely prevention and treatment strategies. Includes use of risk prediction tools. The association recently developed the new Predictive Risk of Cardiovascular Disease Events (PREVENT) risk calculator as a screening tool to aid in preventive treatment decisions. The PREVENT calculator can estimate an individual’s 10-year and 30-year stroke and heart disease risk starting at age 30. This is 10 years earlier than another CVD risk calculator, the pooled cohort equation.
According to the American Stroke Association, learning about stroke warning signs and prevention strategies is the best way to avoid a stroke and prevent it from happening again. The abbreviation “FAST” (Facial Droop, Arm Weakness, Difficulty Speech, Time to Call 911) is a tool that can help you recognize the warning signs of a stroke and know when to call for help.
This guideline was developed by a volunteer writing group on behalf of the American Stroke Association and endorsed by the Society of Preventive Cardiovascular Nurses and the Society of Vascular Surgery. The American College of Obstetricians and Gynecologists endorses the clinical value of this document as an educational tool.
Since 1990, the American Stroke Association has translated scientific evidence into clinical practice guidelines, including recommendations for improving cerebrovascular health. The 2024 Primary Stroke Prevention Guidelines replace the 2014 Primary Stroke Prevention Guidelines. This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals without a history of stroke. The association supports the development and publication of clinical practice guidelines without commercial support, and members volunteer their time on writing and review efforts.
reference
Bushnell C, Kernan WN, Shareef AZ, et al. 2024 Stroke Primary Prevention Guidelines: Guidelines from the American Heart Association/American Stroke Association. stroke. 2024.doi: 10.1161/STR.0000000000000475
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