New Guidelines on Primary Stroke Prevention From AHA/ASA
By Susan Jeffrey, From Medscape
The American Heart Association/American Stroke Association (AHA/ASA) has released new guidelines for the primary prevention of stroke, both ischemic and hemorrhagic.
Larry B. Goldstein, MD, professor of medicine (neurology) and director of the Duke Stroke Center at Duke University Medical Center in Durham, North Carolina, chaired the writing group for the new document.
STROKE PROCESS, EXPLAINED
In 1999, AHA set a goal for 2010 of decreasing mortality from heart disease and stroke by 25%, Dr. Goldstein told Medscape Medical News. That goal was achieved early, in 2008, probably due to better prevention strategies, he said.
790,000 STROKES PER YEAR
Of more than 790,000 strokes that occur each year, 75% of those are first events, “so prevention is particularly important.” Because risk factors for both ischemic and hemorrhagic strokes largely overlap, he said, “in this guideline we address primary prevention of stroke, not just ischemic stroke, so that’s one significant change.”
The new guideline, affirmed as an “educational tool for neurologists” by the American Academy of Neurology, was published online December 2 and will appear in the December issue of Stroke.
- Lifestyle Factors
The writing committee evaluated the gamut of new and emerging risk factors, modifiable and nonmodifiable. What remains first among strategies for primary stroke prevention is modification of lifestyle factors: physical activity (not smoking), moderate alcohol consumption, maintaining a normal body weight, eating a low-fat diet high in fruits and vegetables.
“Those types of lifestyles are associated with about an 80%, that’s 8-zero percent, lower risk of a first stroke, and that’s true for both men and women,” he said.
There’s virtually nothing that we can do with medicine or interventions of any kind that’s going to have that kind of impact…
- Secondhand Smoke
Cigarette smoking is an established risk factor for stroke, but the new recommendations suggest that avoiding environmental tobacco smoke is also a “reasonable” strategy, he noted.
“It seems to be true for coronary heart disease and communities that institute clean indoor air acts, for example, the rate of hospital admission for acute [myocardial infarction] drops precipitously in the year after those measures are taken. We believe the same should be true for stroke, although again we don’t have that data yet.”
SCREENING IN THE EMERGENCY ROOM
- ED Screening
Visits to the emergency department (ED) may be a valuable opportunity to screen for and treat stroke risk factors, including smoking cessation strategies, cholesterol and blood pressure monitoring, or atrial fibrillation screening and treatment implementation, the new guidelines note.
“As we know, a fairly high proportion of Americans don’t have healthcare insurance, and they don’t seek regular preventive care,” Dr. Goldstein said. “They get their healthcare usually because of an acute illness of some kind by going to the emergency department.
“Even though emergency departments are currently overwhelmed with patients receiving their primary care there for these types of illnesses, it’s also an opportunity to identify risk factors and potentially have patients referred for appropriate prevention,” he said.
- Aspirin in Low-Risk Subjects
Another recommendation of note is that aspirin is not advocated for low-risk subjects. Aspirin is used “ubiquitously,” Dr. Goldstein notes, but “doesn’t seem to offer any particular protection and even in very low doses does carry side effects, so it’s important for people to understand what their risks are for heart disease and for stroke to determine whether aspirin may have some benefit.”
Use of aspirin to prevent cardiovascular events, including but not limited to stroke, is recommended for those at sufficiently high risk to outweigh the risks associated with treatment defined as a 10-year risk of 6% to 10%.
Dr. Pinna says:
Your most important way of preventing stroke is by undertaking a life style change.
Do not smoke. Lose weight. Exercise. Eat fruits, veggies, fish and little fatty meat. Control your blood pressure and your blood sugar. Get a spiritual frame of mind.