Stroke prevention is an important health promotion concern. More than 795,000 strokes occur in the United States each year.
Physicians are interested in helping people prevent stroke as much as possible, and to do so they must use accurate guidelines and the latest research.
This paper updates the 2014 guidelines and aims to support the efforts of physicians and health organizations in stroke prevention.
These new guidelines require additional information and appropriate changes based on new data. To create the new guidelines, researchers conducted a review of literature published since 2014 in several databases. The authors also reviewed previous AHA and ASA documents on stroke prevention.
The guidelines also discuss social determinants of health that can influence people’s risk of stroke, but note that they primarily focus on individual changes rather than systemic interventions. Please.
The authors further recommend screening for factors such as access to healthy food, health insurance, and neighborhood safety, as they may help identify barriers to stroke prevention efforts. .
Migraine and endometriosis become new risk factors for stroke
In terms of evaluation, it recommends screening adults for stroke-related risk factors such as diet, diabetes, hypertension, body weight, smoking habits, substance abuse, and physical inactivity.
The new guidelines also identify new evidence about alarming health conditions that increase the risk of stroke. One of them is migraine. For people with migraine, the guidelines recommend evaluating and modifying vascular risk factors and avoiding combined hormonal contraceptive use, if applicable.
They also discussed concerns during pregnancy and the early postpartum period, with experts recommending the treatment of severe hypertension and the use of antihypertensive drugs to treat hypertensive disorders during pregnancy to reduce the risk of stroke. He points out that it is reasonable.
Additional screening for adverse pregnancy outcomes later may also be helpful.
Another identified risk factor is endometriosis, for which appropriate screening may help identify stroke risk.
The guidelines also discuss how some hormonal contraceptives, such as those containing high levels of estrogen, may contribute to stroke risk.
Dr. Harris Kamal, a vascular neurologist at Memorial Hermann Mischer Neuroscience Associates in Shenandoah, Texas, who was not involved in drafting the new stroke guidelines, told Medical News Today: spoke.
“These guidelines identify and highlight specific groups in the general population who are at increased risk of stroke. Careful monitoring and counseling of such patients can help prevent stroke. One such group is women who are pregnant or have given birth within the past six weeks.To reduce the risk of intracerebral hemorrhage, blood pressure should be closely monitored and kept below 160/110. You need to check.”
“Screening for a history of premature ovarian failure, endometriosis, and early menopause is important because such patients are at increased risk of stroke,” he also explained. “For those considering oral contraceptive treatment (women), a reduced dose of estrogen is recommended as it can increase the risk of stroke by making the blood thicker than normal.”
Finally, the guidelines state that some individuals receiving estrogen (such as transgender women) may benefit from having their physician evaluate risk factors and risk factor modification to reduce the likelihood of stroke. It also emphasizes that there is a possibility that
These guidelines focus specifically on the AHA’s 8 heart health recommendations and outline practical interventions to help prevent stroke. These include factors such as diet, physical activity, blood pressure, and smoking.
For example, the guidelines cite the benefits of a Mediterranean diet that helps reduce stroke risk and suggest that salt substitution may be helpful for certain older adults with uncontrolled blood pressure.
When it comes to physical activity, researchers say doctors should recommend about 150 minutes of moderate-intensity exercise, or 75 minutes of vigorous exercise, or a combination of these per week to reduce the risk of stroke. I am doing it.
Doctors should also encourage people to avoid excessive sedentary behavior to reduce the risk of stroke.
To help manage diabetes, guidelines recommend screening certain individuals for prediabetes and diabetes. This evidence also supports the use of GLP-1 receptor agonists, such as Ozempic, to reduce stroke risk in diabetic patients.
Blood pressure control is also very important when it comes to preventing stroke. Guidelines recommend blood pressure screening, lifestyle changes, and medications to help certain patients with high blood pressure.
Additionally, there is evidence to support the use of two or more antihypertensive drugs to help prevent stroke.
Another factor discussed was tobacco use. The latest guidelines recommend that doctors screen for tobacco use, that people who don’t use tobacco continue this pattern, and that people who smoke quit to reduce their risk of stroke.
Chen-Han Chen, M.D., medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., and a board-certified interventional cardiologist, also was not involved in drafting the new guidelines, but said: I commented like this.
“It is great to see updated evidence-based recommendations for the prevention of such a prevalent and debilitating cardiovascular disease. This includes many new developments in our understanding of the risk factors behind stroke. In the past decade, we have become more aware of the need to manage lifestyle-related cardiometabolic risk factors such as hypertension, overweight/obesity, cholesterol, and blood sugar. It became.”
Nevertheless, the authors of the latest stroke guidelines note that there are still several areas where additional research is needed before firm conclusions can be drawn.
For example, it acknowledged that no trials have evaluated the benefits of screening for social determinants of health.
Aspects of the relationship between stroke and hormonal contraception, endometriosis, and menopause also require further research. Data in this area are limited, so additional research may also be helpful to better understand stroke risk specific to transgender individuals.
Further research may help establish how often blood pressure should be monitored for stroke prevention and understand the relationship between migraine, stroke risk, and the use of hormone therapy.
The authors further acknowledged that the guidelines do not address stroke risk associated with specific social and organizational issues.
They also emphasized that the evidence cited to support new guidelines is not always the strongest. The cited studies have their own limitations, such as limitations regarding included and excluded participants and lack of data on certain subpopulations.
Nevertheless, the updated guidelines emphasize how people can control important modifiable risk factors to reduce their risk of stroke and improve their health, making clear recommendations for stroke prevention. It brings to the fore new evidence that
“The 2024 Primary Stroke Prevention Guidelines are a much-needed and much-needed update to the previous Primary Stroke Prevention Guidelines published in 2014. We have increased knowledge and understanding of the impact of lifestyle changes to prevent and control cerebrovascular disease, and these guidelines are consistent with this knowledge. With better implementation of known strategies, more than half of stroke events in the United States, along with associated disability and cognitive decline, could be prevented.”
“Additionally, these guidelines address and identify specific patient populations and social determinants of health that directly correlate with increased stroke risk. “It is a fairly comprehensive assessment to guide clinicians from a primary prevention perspective to help target factors and factors,” he concluded.
