More than half a million people have their first stroke every year in the U.S. Although the condition is serious and potentially deadly, the attack is preventable in up to 80% of cases, according to the new prevention guidelines issued by the American Stroke Association.
A stroke is a medical condition that occurs when the blood vessel in the brain ruptures or forms clots, thereby blocking the flow of blood. When the blood flow and oxygen supply get disrupted, the brain cells die leading to further complications such as paralysis, memory loss, disabilities, and even death. Risk factors include high blood pressure, smoking, high cholesterol, diabetes, sleep apnea, some types of cardiovascular diseases such as atrial fibrillation, and a personal or family history of a stroke or heart attack.
The current ASA stroke prevention guidelines replace the 2014 guidelines and target the prevention of the first stroke.
"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," said the Chair of the ASA guideline writing group, Dr. Cheryl D. Bushnell, from the Wake Forest University School of Medicine in Winston-Salem, North Carolina.
To prevent the first stroke in adults, healthcare providers are asked to evaluate patients for risk factors such as high blood pressure, elevated cholesterol, high blood sugar, and obesity. They are encouraged to prescribe antihypertensive medications to reduce blood pressure and statins to lower cholesterol in at-risk individuals. Experts also recommend considering the use of FDA-approved glucagon-like protein-1 (GLP-1) receptor agonist medications for people with obesity or Type 2 diabetes.
The new guidelines also include sex-specific recommendations for stroke screening and prevention, a change from the 2014 guidelines. This includes screening women who are at higher risk based on factors such as the use of oral contraceptives, endometriosis, pregnancy complications such as high blood pressure and premature birth, premature ovarian failure, and early onset menopause. Individuals on estrogen therapy for gender affirmation may also be at an increased risk of stroke.
The ASA also emphasizes the importance of public awareness and education on healthy lifestyle choices, aligning with the American Heart Association's Life's Essential 8, which promotes smoking cessation, increased physical activity, healthy eating, and improved sleep.
"This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke," said Dr. Bushnell.
