ASA releases new primary stroke prevention guidelines

The American Stroke Association (ASA) has published new updated guidelines for primary stroke prevention.

In the first update in 10 years, 2024 Primary Stroke Prevention Guidelinesreplaces the 2014 edition and is intended to be a resource to help clinicians implement various prevention strategies in patients without a history of stroke. This is consistent with American Heart Association standards. necessities of life 8.

“This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at high risk of having a first stroke and supporting them to keep their heart and brain healthy. “Providing patients with a stroke can help prevent their first stroke,” said guideline development group chair Cheryl D. Bushnell, MD, MHS, FAHA, vice chair. The study was conducted by the Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; stated in the release.

it was published Online on October 21st stroke.

Stroke is up to 80% preventable

According to estimates, more than 500,000 people in the United States have their first stroke each year. However, the guideline authors note that up to 80% of strokes may be preventable. As a result, they called for improvements in primary stroke prevention, including improved screening and lifestyle changes.

This includes adopting a Mediterranean diet. A Mediterranean diet has been shown to significantly reduce the risk of stroke, especially when supplemented with nut and olive oil intake.

The guideline recommendations also emphasize the need for physical activity, which is “essential” to cardiovascular health and stroke reduction. The authors emphasized this point and offered new recommendations to screen for sedentary behavior, avoid inactivity, and advise patients to engage in regular moderate to vigorous physical activity.

Another new recommendation follows “robust” data showing that glucagon-like peptide-1 receptor agonists (GLP-1) significantly improve type 2 diabetes management, weight loss, and reduce the risk of cardiovascular disease. Based on. As a result, guideline authors called for the use of GLP-1 in patients with diabetes and high cardiovascular risk or established cardiovascular disease.

Effective blood pressure (BP) control is important for stroke prevention, the guideline authors noted. However, they noted that data from randomized controlled trials show that a single antihypertensive drug is effective in only about 30% of participants.

The researchers noted that most patients are unable to achieve their desired blood pressure goals even after taking two or three medications. In line with these data, the panel recommends the use of at least two antihypertensive drugs for the primary prevention of stroke for most patients who require antihypertensive drugs.

At least two drugs are needed to lower blood pressure

Effective blood pressure control is essential to prevent stroke. Randomized controlled trials have shown that only about 30% of participants achieve their blood pressure goals with one antihypertensive drug, and most participants achieve their blood pressure goals with two to three drugs. . Therefore, the panel recommends that most patients requiring treatment for hypertension receive at least two antihypertensive drugs for primary prevention of stroke.

The authors recommended antiplatelet therapy to prevent stroke in patients with antiphospholipid syndrome (APS) or systemic lupus erythematosus and no history of stroke or unexplained venous thromboembolism. Researchers found that patients with APS who had previously had unexplained venous thrombosis benefited from treatment with vitamin K antagonists (target international normalized ratio of 2 to 3) rather than direct oral anticoagulants. He added that it is likely.

Prevention of pregnancy-related stroke is primarily achieved by controlling hypertension, the guideline authors noted. They recommended treating any systolic blood pressure above 160 mmHg or diastolic blood pressure above 110 mmHg during pregnancy and up to six weeks postpartum to reduce the risk of fatal maternal intracerebral hemorrhage. .

The researchers noted that adverse pregnancy outcomes are also common and associated with chronic hypertension, which increases stroke risk later in life. Therefore, we recommended screening for these results to assess and manage vascular risk factors. The guidelines include screening tools to assist with this in clinical practice.

Endometriosis, premature ovarian failure (before age 40), and early menopause (before age 45) are all associated with increased stroke risk. As a result, the guideline authors stated that screening for all three conditions is “a reasonable step in the assessment and management of vascular risk factors in these individuals to reduce stroke risk.”

Finally, the guideline authors addressed primary prevention of stroke in transgender individuals, noting that transgender women receiving estrogen therapy for gender affirmation are at increased risk. They emphasized that assessing and modifying risk factors may be beneficial in reducing the risk of stroke in this patient population.