AHA Releases Updated Stroke Prevention Guidelines

Healthy lifestyle choices and emergency room interventions can help prevent first-time strokes, according to revised American Heart Association/American Stroke Association guidelines.

The guidelines, last updated in 2006, are published ahead of print in Stroke: Journal of the American Heart Association.

“Between 1999 and 2006, there’s been over a 30% reduction in stroke death rates in the United States and we think the majority of the reduction is coming from better prevention,” said Larry B. Goldstein, MD, chairman of the statement writing committee and director of the Duke Stroke Center in Durham, NC, in a news release.

Prior to 1999, the incidence of stroke may have been increasing, according to the statement that cites a 39% rise in hospitalizations between 1988 and 1997. As the population continues to age, the total number of Americans having a stroke is expected to rise.

According to the AHA, more than 77% of the 795,000 strokes occurring in Americans each year are first events. Storke is the third leading cause of death in the US after heart disease and cancer, and is a significant economic and social burden and one of the major causes of disability in adults.

The updated guidelines are the first to address stroke as a broad continuum of related events, including ischemic stroke (which accounts for 87% of all strokes), non-ischemic stroke, and transient ischemic attack (TIA). For prevention, there is often little difference along the stroke spectrum, said Goldstein, who is also a professor of medicine and director of Duke’s ASA-Bugher Foundation Center for Stroke Prevention Research.

The new guidelines feature several key prevention updates based on recent research:

• Those who make healthy lifestyle choices—such as not smoking, eating a low-fat diet high in fruits and vegetables, drinking in moderation, exercising regularly and maintaining a normal body weight—lower risk of a first stroke as much as 80% compared with those who don’t make such changes. The preventive benefit increases with each positive change adopted.
• Emergency room doctors should try to identify patients at high risk for stroke and consider making referrals, conducting screenings or beginning preventive therapy.
• Although genetic screening for stroke among the general population isn’t recommended, it may be appropriate in certain circumstances, depending on family history and other factors.
• The usefulness of stenting in persons who have a narrowing of a carotid artery in the neck as compared to an operation (endarterectomy) is still uncertain. Because of advances in standard medical therapies (including a change in lifestyle factors, treating high blood pressure and using antiplatelet and cholesterol lowering drugs) the usefulness of either procedure in persons who have not had symptoms is unclear. Doctors must decide whether to perform either procedure on a case-by-case basis.
• General population screening for carotid artery narrowing isn’t recommended.
• Aspirin doesn’t prevent a first stroke in low-risk persons or those with diabetes or asymptomatic peripheral artery disease. However, it’s recommended for those whose risk is high enough for the reduction in stroke risk to outweigh the bleeding risks of aspirin.

To access the guidelines, click here.

Do you believe that these guidelines will aid in the prevention of stroke? What are the most significant challenges you face in this area?