Today, I review, link to, and excerpt from 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association. [PubMed Abstract] [Full-Text ePDF]. Stroke. 2024 Oct 21. doi: 10.1161/STR.0000000000000475. Online ahead of print.
All that follows is from the above resource.
Abstract
Aim: The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 “Guidelines for the Primary Prevention of Stroke.” This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals with no history of stroke.
Methods: A comprehensive search for literature published since the 2014 guideline; derived from research involving human participants published in English; and indexed in MEDLINE, PubMed, Cochrane Library, and other selected and relevant databases was conducted between May and November 2023. Other documents on related subject matter previously published by the American Heart Association were also reviewed.
Structure: Ischemic and hemorrhagic strokes lead to significant disability but, most important, are preventable. The 2024 primary prevention of stroke guideline provides recommendations based on current evidence for strategies to prevent stroke throughout the life span. These recommendations align with the American Heart Association’s Life’s Essential 8 for optimizing cardiovascular and brain health, in addition to preventing incident stroke. We also have added sex-specific recommendations for screening and prevention of stroke, which are new compared with the 2014 guideline. Many recommendations for similar risk factor prevention were updated, new topics were reviewed, and recommendations were created when supported by sufficient-quality published data.
Keywords: AHA Scientific Statements; guideline; hemorrhagic stroke; ischemic stroke; stroke.
TOP 10 TAKE-HOME MESSAGES
1. From birth to old age, every person should haveaccess to and regular visits with a primary carehealth professional to identify and achieve oppor-tunities to promote brain health.
2. Screening for and addressing adverse socialdeterminants of health are important in the approach to prevention of incident stroke. This updated guideline includes an orientation to social determinants of health, acknowledging its impacton access to care and treatment of stroke risk factors. Therefore, screening for social determinantsof health is recommended in care settings where at-risk stroke patients may be evaluated, with the acknowledgment that evidence-based interventions to address adverse social determinants ofhealth are evolving.
3. The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke,especially when supplemented with nuts and olive oil. However, low-fat diets have had little impact onreducing the risk. This guideline recommends thatadults with no prior cardiovascular disease and those with high or intermediate risk adhere to theMediterranean diet.
4. Physical activity is essential for cardiovascular health and stroke risk reduction. This guideline includes a summary of high-quality data showingthat prolonged sedentary behavior during waling hours is associated with an increased risk ofstroke. Therefore, we provide a new recommendation for screening for sedentary behavior andcounseling patients to avoid being sedentary, as well as a call for new studies of interventions to disrupt sedentary behavior. This is in addition to the recommendation to engage in regular moderate to vigorous physical activity.
5. Glucagon-like protein-1 receptor agonists have been shown to be effective not only for improving management of type 2 diabetes but also forweight loss and lowering the risk of cardiovasculardisease and stroke. On the basis of these robustdata, we provide a new recommendation for theuse of these drugs in patients with diabetes and high cardiovascular risk or established cardiovascular disease.
6. Blood pressure management is critical for strokeprevention. Randomized controlled trials havedemonstrated that treatment with 1 antihyper-tensive medication is effective for reaching theblood pressure goal in only ≈30% of participantsand that the majority of participants achievedthe goal with 2 or 3 medications. Therefore, ≥2antihypertensive medications are recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension.
7. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupuserythematosus without a history of stroke or unprovoked venous thromboembolism to preventstroke. Patients with antiphospholipid syndrome who have had a prior unprovoked venous thrombosis likely benefit from vitamin K antagonisttherapy (target international normalized ratio, 2–3) over direct oral anticoagulants.
8. Prevention of pregnancy-related stroke canbe achieved primarily through management ofhypertension. Treatment of verified systolic bloodpressure ≥160 mm Hg or diastolic blood pres-sure ≥110 mm Hg during pregnancy and within6 weeks postpartum is recommended to reducethe risk of fatal maternal intracerebral hemorrhage. In addition, adverse pregnancy outcomes are common and are associated with chronic hypertension and an elevated stroke risk laterin life. Therefore, screening for these pregnancy outcomes is recommended to evaluate for and manage vascular risk factors, and a screening tool is included to assist with screening in clinical practice.9. Endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all associated withan increased risk for stroke. Therefore, screen-ing for all 3 of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reducestroke risk.
10. Understanding transgender health is essentialto truly inclusive clinical practice. Transgender women taking estrogens for gender affirmation have been identified as having an increased riskof stroke. Therefore, evaluation and modificationof risk factors could be beneficial for stroke risk reduction in this population.
