Stroke Prevention
Loren Bonner
In a new guideline, the American Stroke Association, a division of the American Heart Association (AHA), said that preventing a first stroke may be possible with healthy lifestyle changes along with routine health screenings and certain medications to manage risk factors.
This updated guideline provides the latest strategies for managing these risk factors, with a focus on populations at higher risk for stroke, said Anjail Sharrief, MD, one of the guideline authors and a professor of neurology at UTHealth Houston. The guideline was published October 21, 2024, in AHA’s journal Stroke.
“It has been 10 years since the last guideline was published. Since that time, we have made significant advances in understanding common and less common stroke risk factors, as well as in the prevention and management of conditions that increase stroke risk,” said Sharrief.
There are several key updates in this guideline. From a population health perspective, hypertension is recognized as the leading risk factor for stroke, and lowering hypertension is essential for stroke prevention, Sharrief noted.
The guideline includes the BP treatment target for individuals with hypertension: <130/80 mm Hg.
“All providers should emphasize this goal for patients with hypertension,” said Sharrief.
Some new sections also set this guideline apart from the previous version. These sections focus on pregnancy and its relationship to stroke risk. One section describes the risk of stroke during and shortly after pregnancy, offering recommendations for prevention and management. The second section addresses future stroke risk in individuals who have experienced adverse pregnancy outcomes, such as pre-eclampsia and gestational diabetes. It underscores the importance of screening for these conditions, educating patients on associated risks, and managing vascular risk factors in those with adverse pregnancy outcomes.
Transgender women and gender-diverse individuals taking estrogens for gender affirmation may also be at an increased risk of stroke. Guideline authors point out that evaluation and modification of any existing risk factors are needed to reduce the risk of stroke for these individuals.
Health equity
In addition, the guideline emphasizes social determinants of health and how they may affect stroke risk. There is even practical guidance for providers on screening for and addressing social needs.
AHA noted that health care professionals should make sure patient education is available for various educational and language levels and are 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 cover health care costs, including medication expenses.
Medications
AHA also said that health care professionals can advocate for their patients by choosing treatments and medications that are effective and affordable.
“For medications specifically, this guideline provides updated recommendations on diabetes management, including the use of GLP-1 receptor agonists, as well as updated guidance for lipid management,” said Sharrief. “The section on tobacco use includes recommendations for smoking cessation pharmacotherapies, such as varenicline.”
Sharrief said pharmacists provide crucial education to their patients and serve as a trusted source within their community.
“Pharmacists can help patients control and manage stroke risk factors effectively. It’s important for all health care providers to recognize their role in educating patients on lifestyle factors and medications that promote optimal health,” he said.
The guideline authors noted that writing recommendations focused on preventing a first stroke was challenging.
There were limitations to some of the evidence that informed the guideline, including the fact that many clinical trials enrolled adults who already had a cardiovascular event, which may include a stroke. The writing group also identified knowledge gaps to help inform topics for future research. ■