New stroke prevention guidelines highlight lifestyle changes

• Thousands of people in the United States suffer a stroke each year. Stroke can lead to death and long-term disability.

• The American Heart Association and the American Stroke Association have just released updated guidelines for the primary prevention of stroke.

• The guidelines highlight gender-specific screening and prevention updates as well as healthy lifestyle recommendations.

• People can work with their doctors to take steps toward a healthy lifestyle that lower the chances of stroke.

Prevention of stroke is a critical interest of health promotion. In the United States, over 795,000 strokes occur every year.

Doctors are interested in helping people prevent blows whenever possible, and to do so must use accurate guidelines and research updates.

The American Heart Association (AHA) and American Stroke Association (ASA) assistance with research guides and data. The groups recently published the “2024 Guidelines for Primary Stroke Prevention” in the journal. Stroke.

The paper updates the 2014 guideline and aims to support the efforts of doctors and health groups to prevent stroke.

What do the new stroke prevention guidelines say?

These new guidelines aim to add information and make appropriate changes based on new data. To write the new guidelines, the researchers conducted a review of the literature published after 2014 in several databases. The authors also reviewed previous documents from the AHA and ASA on stroke prevention.

The guidelines also discuss the social determinants of health that may impact people’s stroke risk, but note that they focus primarily on individual changes rather than systemic interventions.

The authors further recommend screening for factors such as access to healthy food, health insurance, and neighborhood safety, as this may help identify barriers to stroke prevention efforts.

Migraine, endometriosis, emerging risk factors for stroke

In terms of assessment, they recommend screening adults for stroke risk factors such as diet, diabetes, high blood pressure (high blood pressure)body weight, smoking habits, substance abuse and physical inactivity.

The new guidelines also identify emerging evidence about surprising health conditions that increase stroke risk. One of these is migraine. For people with migraine, guidelines recommend assessment and modification of vascular risk factors and avoidance of combined hormonal contraception where appropriate.

They further discuss concerns during pregnancy and the early postpartum period, with experts recommending treatment for severe hypertension and noting that it is reasonable to use antihypertensive medications to treat hypertensive disorders of pregnancy to reduce the risk of stroke.

Additional screening for adverse pregnancy outcomes later may also be helpful.

Another risk factor identified was ENDOMETRIOSISand appropriate screening for this can help identify stroke risk.

The guidelines also discuss how some hormonal contraceptives — such as those with high levels of estrogen — may contribute to the risk of stroke.

It also recommends screening for premature ovarian failure and early menopauseand caution with menopausal hormone therapy containing oral estrogen in certain individuals.

Haris Kamal, MDsaid a vascular neurologist at Memorial Hermann Mischer Neuroscience Associates in Shenandoah, TX, who was not involved in developing the new stroke guidelines. Today’s medical news that:

“Detecting a history of premature ovarian failure, endometriosis, and early menopause is important because such patients are at increased risk of stroke,” he explained. “In people (women) considering oral contraceptive therapy, lower doses of estrogen are recommended because it can increase the risk of stroke by making the blood thicker than usual.”

Finally, the guidelines also highlight that some people—such as transgender women—who receive estrogen may benefit from doctors assessing risk factors and modifying risk factors to help lower the chances of a cerebrovascular accident.

What can you do to prevent a stroke?

The guidelines outline practical interventions that can help prevent stroke, focusing in particular on “The essentials of life 8” recommendations for heart health from the AHA. These include components such as diet, physical activity, blood pressure and tobacco use.

For example, guidelines note the benefit Mediterranean diet to help reduce the risk of stroke and suggests that salt replacement may be helpful for certain older adults who have uncontrolled blood pressure.

As for physical activity, they note that doctors should recommend about 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity activity or a combination of these to help lower the risk of stroke .

Doctors should also encourage avoiding excessive sedentary behavior to help people reduce their risk of stroke.

To help control diabetes, guidelines recommend screening for certain people prediabetes and diabetes. Evidence also supports the use of GLP-1 receptor agonists such as Ozempicin people with diabetes to reduce the risk of stroke.

Blood pressure control is also of great importance when it comes to stroke prevention. The guidelines recommend blood pressure screening, lifestyle improvements, and medications to help certain people with high blood pressure.

In addition, evidence supports the use of two or more antihypertensive drugs to help prevent stroke.

Another component discussed was tobacco use. The updated guidelines recommend that physicians monitor tobacco use, that nonsmokers continue, and that smokers stop to reduce the risk of stroke.

Cheng-Han Chen, MDa board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the development of the new guidelines, commented:

“More than half of strokes in the US are preventable”

However, the authors of the updated stroke guidelines noted some areas that still require further research to reach a firm conclusion.

For example, they acknowledged that there were no studies evaluating the benefits of screening for social determinants of health.

More research is also needed on aspects of the relationship between stroke and hormonal contraception, endometriosis and menopause. Additional research may also be helpful to better understand the unique stroke risk of transgender individuals, as there is limited data in this area.

Additional studies could help determine how often blood pressure is monitored to prevent stroke and to understand the relationship between migraine, stroke risk, and hormone therapy use.

Furthermore, the guidelines do not cover the management of certain stroke risk factors that have been adequately covered in other documents, such as the management of valvular heart disease or subarachnoid hemorrhage.

The authors further acknowledged that the guidelines do not address stroke risk related to certain societal and systemic issues.

They also pointed out that the evidence cited in support of new guidelines is not always the strongest. The cited studies have their own limitations, including limitations on included and excluded participants and lack of data on certain subpopulations.

Despite this, the updated guidelines highlight how people can take control of important modifiable risk factors to lower their stroke risk and improve their health, and highlight new emerging evidence for stroke prevention cerebral.

Kamal noted that:

“In addition, these guidelines address and identify specific patient populations and social determinants of health that have a direct correlation with increased risk of stroke. Overall, these new guidelines are a comprehensive enough assessment to guide clinicians from a primary prevention perspective, helping to target specific high-risk groups and factors,” he concluded.

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