Updated Guidelines Stress Screenings, Lifestyle Changes to Prevent First Stroke

The American Stroke Association (ASA) has issued the first update in ten years to its “better primary stroke prevention” guidelines that strongly emphasize improved screenings. They also include a broader focus on lifestyle changes such as better nutrition, weight management, being physically active and smoking cessation.

The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 version and is a resource for clinicians in implementing stroke prevention strategies for individuals with no prior history of stroke. Stroke is the 5th leading cause of death in the U.S., resulting in nearly 160,000 deaths annually. Every year, more than 600,000 people in the U.S. have a first stroke.

An estimated 80 percent of strokes are preventable.

“These updated guidelines are comprehensive and well-grounded in current evidence,” explains Brian Snelling, M.D., stroke program director at Marcus Neuroscience Institute, part of Baptist Health Brain & Spine Care. “They offer more nuanced, personalized approaches to stroke prevention, particularly for previously underrepresented groups, while emphasizing the importance of addressing modifiable risk factors across the lifespan.”

Brian Snelling, M.D., stroke program director at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health.

 

Screening for stroke risk and educating people on how to lower their chances of having a stroke ideally begin with their primary care professional and include evidence-based recommendations, according to a new clinical guideline from the ASA, which is a division of the American Heart Association. The new guidelines were published in the Association’s journal Stroke.

“Everyone should have regular preventive visits with their established primary care physician and get their blood pressure checked and all other risk factors we talk about — no matter what,” said Felipe De Los Rios La Rosa, M.D., stroke program director at Baptist Health Miami Neuroscience Institute. “Prevention is critical because risk factors don’t necessarily give you a symptom — until you have a major complication like stroke.”

The new guidelines are “important because new discoveries have been made since the last update 10 years ago,” said the Chair of the guidelines writing group, Cheryl D. Bushnell, M.D., professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, in a statement. “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.”

‘Social Determinants of Health’

The new guidelines provide recommendations for strategies to support brain health and prevent stroke throughout a person’s lifespan by improving healthy lifestyle behaviors and getting preventive care.

Felipe De Los Rios La Rosa, M.D., stroke program director at Baptist Health Miami Neuroscience Institute.

“There are several key changes, including a greater emphasis on screening for and addressing social determinants of health as part of stroke risk assessment and management,” said Dr. Snelling.

New to the guidelines is an emphasis on “social determinants of health and the impact they have on stroke risk,” states the ASA. Social determinants of health are non-medical factors, including education, economic stability, access to care, discrimination, structural racism and neighborhood factors (such as the lack of walkability, lower availability of healthy food and fewer health resources), states the ASA.

There's also a new emphasis in the guidelines on using “GLP-1 receptor agonists” (a class of drugs that can help treat type 2 diabetes and obesity) to reduce stroke risk in patients with diabetes and high cardiovascular risk, based on compelling new data, adds Dr. Snelling. .

Demand is still surging for “weight-loss” medications sold under different brand names that contain the drug semaglutide in the form of injections. Semaglutide falls under a class of medications known as “glucagon-like peptide 1” (GLP-1) – and it is part of therapy already established for the management of type 2 diabetes, also resulting in some weight reduction and favorable management of heart disease

One of those medications, Wegovy, has become the first to be approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease who are either obese or overweight.

Stroke Prevention in Women

“The guidelines now also include more sex-specific recommendations for stroke prevention in women with a history of adverse pregnancy outcomes, those with endometriosis and early menopause,” said Dr. Snelling.

Increasing public awareness and knowledge about healthy lifestyle changes, such as smoking cessation, increased physical activity, improved dietary habits and better sleep, may also help people reduce their stroke risk, states a news release on the new guidelines. A stroke occurs when blood flow to the brain is interrupted after a blood vessel becomes blocked by a blood clot or ruptures

The most common, treatable lifestyle behaviors that can help reduce stroke risk are detailed in the Association’s Life’s Essential 8 cardiovascular health metrics. They include healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep and weight, controlling cholesterol, and managing blood pressure and blood sugar.

The guideline recommends that adults with no prior cardiovascular disease, as well as those with increased risk, follow a Mediterranean dietary pattern. Mediterranean dietary programs have been shown to reduce the risk of stroke, especially when supplemented with nuts and olive oil.

“My overall advice based on these guidelines is to focus on what you can control in your daily life to reduce your stroke risk: be more active, quit tobacco, get healthy sleep, manage your weight, and eat better foods,” said Dr. Snelling. “If you have risks for stroke like high blood pressure, high cholesterol and diabetes, make sure they are controlled.”