Will new health guidelines help prevent strokes?

As many as 80% of the more than half-million strokes in the U.S. each year could be preventable, according to the American Stroke Association’s new clinical guideline that calls for a combination of better primary care screening, evidence-based risk management and healthy life choices.
The guideline also looks at the risks specific to women and the need to address social determinants of health, which is new to the guideline, just published in the journal Stroke. It calls for regular health screenings, identification of factors that create risk, lifestyle interventions and appropriate medication when needed.
The association is a division of the American Heart Association.
Per the association, “A stroke occurs when blood flow to the brain is interrupted after a blood vessel becomes blocked by a blood clot or ruptures.” The resulting inadequate oxygen harms brain function and can cause significant disability. Speech, thinking and movement may all be impaired. “In the U.S. stroke is 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% are preventable.”
Stopping that first stroke from ever happening is called “primary prevention,” according to Dr. Cheryl D. Bushnell, professor and vice chair of research in the neurology department at the Wake Forest University School of Medicine in North Carolina. She chaired the group that wrote the guideline, which was last updated in 2014, to target stopping that first stroke from happening.
“This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke,” Bushnell said in the association’s news release.
The association said to think “FAST”: face drooping, arm weakness, speech difficulty, time to call 911.
Reducing stroke also reduces the risk of dementia, Bushnell said.
Modifiable risk factors include high blood pressure, overweight and obesity, high cholesterol and high blood sugar. Those can all be managed with lifestyle change and, where appropriate, medication. A new recommendation is determining whether one of the newer medications that is a glucagon-like-protein-1 (GLP-1) like Ozempic or Wegovy approved for weight control or type 2 diabetes would be appropriate.
The guideline hails the American Heart Association’s Life’s Essential 8 cardiovascular metrics: healthy nutrition, regular physical activity, no tobacco, healthy sleep and weight, cholesterol control, and maintaining a healthy blood pressure and blood sugar. The Mediterranean diet is also recommended as helpful to reduce stroke, “especially when supplemented with nuts and olive oil.”
As for exercise, it reduces blood pressure, cholesterol, inflammatory markers, insulin resistance and weight. It also improves endothelial function. The guideline touts the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion’s recommendation that adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination. It helps to spread it out over the week.
Nonmedical factors like education, access to care, economic health, discrimination, structural racism and whether one’s neighborhood is user-friendly to walking and shopping and getting care also contribute to the risk of having a stroke, per the guidance.
“Health care professionals are also encouraged to connect patients to resources that help address health-related social needs such as food and housing insecurity, refer them to programs that support healthy lifestyle changes and direct them to support programs that may help defray health care costs including medical expenses,” the association said in its news release.
Per the association, health professionals should screen women for conditions that raise stroke risk, such as use of oral contraceptives, high blood pressure in pregnancy or other complications, endometriosis, premature ovarian failure and early onset menopause. The group noted that elevated blood pressure during pregnancy and within six months of delivery could result in intracerebral hemorrhage.
Those taking estrogen for gender affirmation could also be higher risk for stroke and should be monitored and appropriate adjustments made as needed.
The association created a new Predicting Risk of Cardiovascular Disease Events risk calculator as a screening tool to help inform preventive treatment decisions. The calculator can estimate 10-year and 30-year stroke and heart disease risk in individuals starting at age 30 — a decade earlier than the Pooled Cohort Equations, another risk calculator.