Updated guidelines for healthcare professionals to use as prevention strategies for people with no history of strokes includes new discoveries that have been made in the last 10 years. They were prepared by the American Stroke Association, a division of the American Heart Association, and published Monday in the association’s journal Stroke.
The most effective way to reduce strokes and stroke-related death is to prevent the first stroke, Cheryl D. Bushnell, M.D., chair of the guidelines writing group, said in a statement.
“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,” Bushnell said.
Carrying out the recommendations in the guidelines would make it possible to significantly reduce the risk of people having a first stroke, she said, adding, most of the strategies will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain.
In the United States, strokes are currently the fifth leading cause of death, resulting in nearly 160,000 deaths annually. Every year, more than 600,000 people in the U.S. have a first stroke, even though up to 80 percent of strokes are preventable.
Identifying and managing risk factors
Unidentified and unmanaged cardiovascular disease risk factors can cause damage to the arteries, brain, and heart years before cardiovascular disease and stroke occur. Primary care health professionals should promote brain health for patients through stroke prevention education, screenings, and addressing risk factors from birth to old age, the guidelines recommend.
Risk factors for strokes that can be modified – such as high blood pressure, overweight and obesity, elevated cholesterol, and elevated blood sugar – can be identified with physical exams and blood tests.
These conditions should be addressed with healthy lifestyle and behavioral changes and may include medications for some patients, according to the guidelines. Antihypertensive medications to reduce blood pressure and statin medications to lower cholesterol can help to reduce the risk of first stroke in adults with increased cardiovascular disease risk and those receiving CVD care.
A new recommendation is considering medications, such as Ozempic, which are FDA-approved to reduce the risk of cardiovascular disease in people with overweight or obesity and/or Type 2 diabetes.
New sex- and gender-specific recommendations
Health professionals need to look for stroke risks unique to women, according to the guidelines. They should screen for conditions that can increase a woman’s risk of strokes, including use of oral contraceptives, high blood pressure during pregnancy, other pregnancy complications such as premature birth, endometriosis, premature ovarian failure, and early onset menopause.
Treatment of elevated blood pressure during pregnancy and within six weeks of delivery is recommended to reduce the risk of maternal intracerebral hemorrhage, according to the guidelines.
The guidelines also suggest that transgender women and individuals taking estrogens for gender affirmation may be at an increased risk of stroke. Evaluation and modification of any existing risk factors are needed to reduce the risk of strokes for these people.
Health equity and stroke risk
New to the guidelines is an emphasis on social factors that impact stroke risk. They’re non-medical factors including education, economic stability, access to care, discrimination, structural racism, and neighborhood factors (such as the lack of walkability, lower availability of healthy food, and fewer health resources) that contribute to inequities in care and influence overall health.
The guidelines recommend health care professionals should ensure patient education is available for various educational and language levels and advocate for their patients by choosing treatments and medications that are effective and affordable.
Health care professionals are also encouraged to connect patients to resources that help address food and housing insecurity, programs that support healthy lifestyle changes, and programs that may help defray health care costs including medication expenses.
Healthy lifestyle behaviors
Healthy lifestyle behaviors include healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep and weight, controlling cholesterol, and managing blood pressure and blood sugar. The guidelines recommend following a Mediterranean diet that has been shown to reduce the risk of strokes, especially when supplemented with nuts and olive oil.
Physical activity can improve blood pressure, cholesterol, inflammatory markers, insulin resistance, the lining of blood vessels, and weight.
The guidelines urge health care professionals to routinely screen patients for sedentary behavior, a risk factor for stroke, and counsel them to engage in regular physical activity. Adults should get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.
How strokes occur and when to get help
A stroke occurs when blood flow to the brain is interrupted after a blood vessel becomes blocked by a blood clot or ruptures. Then, the brain doesn’t receive the oxygen it needs to properly function. A stroke causes brain damage that can lead to significant disability, including difficulty thinking, talking, walking, and interacting with one’s environment.
Learning the warning signs of stroke and preventative measures are the best way to avoid strokes and keep them from happening again, according to the American Stroke Association. Use the abbreviation FAST – for face drooping, arm weakness, speech difficulty, and time to call 911.
All very good advice.
It’s discouraging that these important recommendations for women took so long to be included in the guidelines. It shows, once again, that medical research is geared mainly towards men.