Updated Guidelines for Primary Stroke Prevention

For people who have not had a stroke or a transient ischemic attack, a diet rich in fruits and vegetables and high in potassium may lower the risk of stroke, according to updated guidelines from the American Heart Association and the American Stroke Association. A Mediterranean diet supplemented with nuts may be considered as a means of lowering the risk of stroke, although the evidence for this recommendation is less strong, according to the guidelines, which were published online ahead of print October 28 in Stroke.

“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled—especially high blood pressure—account for 90% of strokes,” said James Meschia, MD, Professor and Chair of Neurology at the Mayo Clinic in Jacksonville, Florida, and lead author of the guidelines, which were affirmed by the American Academy of Neurology.

Dr. Meschia and colleagues reviewed the evidence on established and emerging risk factors for stroke, as well as for various interventions to lower stroke risk. Among the guidelines’ updated recommendations is that healthy adults should perform at least moderate- to vigorous-intensity aerobic physical activity for 40 minutes per day, three to four days per week. Class I evidence indicates that physical activity is associated with a reduction in the risk of stroke.

In addition, the guidelines recommend weight reduction for overweight and obese individuals to lower blood pressure and reduce the risk of stroke. Patients with type 1 or type 2 diabetes should control their blood pressure to a target of less than 140/90 mm Hg, said the authors. For patients with diabetes but low 10-year risk of cardiovascular disease, the usefulness of aspirin for primary stroke prevention is unclear, they added.

Many new recommendations focus on persons with hypertension. These recommendations include regular blood pressure screening and appropriate treatment of hypertension, including lifestyle modification and pharmacologic therapy. The guidelines also recommend annual screening for high blood pressure and health-promoting lifestyle modification for patients with prehypertension.

Other new recommendations are intended for migraineurs. For example, the authors recommend smoking cessation for women with migraine headaches with aura. These women also might consider alternatives to oral contraceptives, especially those containing estrogen. Closure of patent foramen ovale is not indicated for preventing stroke in patients with migraine, however.

New evidence has strengthened the recommendation that active smokers undergo counseling in combination with drug therapy using nicotine replacement, bupropion, or varenicline to assist in quitting smoking. The authors also stated that community-wide or statewide bans on smoking in public spaces are reasonable for reducing the risk of stroke and myocardial infarction.

“Talking about stroke prevention is worthwhile,” said Dr. Meschia. “In many instances, stroke isn’t fatal, but it leads to years of physical, emotional, and mental impairment that could be avoided.”

—Erik Greb

For people who have not had a stroke or a transient ischemic attack, a diet rich in fruits and vegetables and high in potassium may lower the risk of stroke, according to updated guidelines from the American Heart Association and the American Stroke Association. A Mediterranean diet supplemented with nuts may be considered as a means of lowering the risk of stroke, although the evidence for this recommendation is less strong, according to the guidelines, which were published online ahead of print October 28 in Stroke.

“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled—especially high blood pressure—account for 90% of strokes,” said James Meschia, MD, Professor and Chair of Neurology at the Mayo Clinic in Jacksonville, Florida, and lead author of the guidelines, which were affirmed by the American Academy of Neurology.

Dr. Meschia and colleagues reviewed the evidence on established and emerging risk factors for stroke, as well as for various interventions to lower stroke risk. Among the guidelines’ updated recommendations is that healthy adults should perform at least moderate- to vigorous-intensity aerobic physical activity for 40 minutes per day, three to four days per week. Class I evidence indicates that physical activity is associated with a reduction in the risk of stroke.

In addition, the guidelines recommend weight reduction for overweight and obese individuals to lower blood pressure and reduce the risk of stroke. Patients with type 1 or type 2 diabetes should control their blood pressure to a target of less than 140/90 mm Hg, said the authors. For patients with diabetes but low 10-year risk of cardiovascular disease, the usefulness of aspirin for primary stroke prevention is unclear, they added.

Many new recommendations focus on persons with hypertension. These recommendations include regular blood pressure screening and appropriate treatment of hypertension, including lifestyle modification and pharmacologic therapy. The guidelines also recommend annual screening for high blood pressure and health-promoting lifestyle modification for patients with prehypertension.

Other new recommendations are intended for migraineurs. For example, the authors recommend smoking cessation for women with migraine headaches with aura. These women also might consider alternatives to oral contraceptives, especially those containing estrogen. Closure of patent foramen ovale is not indicated for preventing stroke in patients with migraine, however.

New evidence has strengthened the recommendation that active smokers undergo counseling in combination with drug therapy using nicotine replacement, bupropion, or varenicline to assist in quitting smoking. The authors also stated that community-wide or statewide bans on smoking in public spaces are reasonable for reducing the risk of stroke and myocardial infarction.

“Talking about stroke prevention is worthwhile,” said Dr. Meschia. “In many instances, stroke isn’t fatal, but it leads to years of physical, emotional, and mental impairment that could be avoided.”

—Erik Greb

For people who have not had a stroke or a transient ischemic attack, a diet rich in fruits and vegetables and high in potassium may lower the risk of stroke, according to updated guidelines from the American Heart Association and the American Stroke Association. A Mediterranean diet supplemented with nuts may be considered as a means of lowering the risk of stroke, although the evidence for this recommendation is less strong, according to the guidelines, which were published online ahead of print October 28 in Stroke.

“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled—especially high blood pressure—account for 90% of strokes,” said James Meschia, MD, Professor and Chair of Neurology at the Mayo Clinic in Jacksonville, Florida, and lead author of the guidelines, which were affirmed by the American Academy of Neurology.

Dr. Meschia and colleagues reviewed the evidence on established and emerging risk factors for stroke, as well as for various interventions to lower stroke risk. Among the guidelines’ updated recommendations is that healthy adults should perform at least moderate- to vigorous-intensity aerobic physical activity for 40 minutes per day, three to four days per week. Class I evidence indicates that physical activity is associated with a reduction in the risk of stroke.

In addition, the guidelines recommend weight reduction for overweight and obese individuals to lower blood pressure and reduce the risk of stroke. Patients with type 1 or type 2 diabetes should control their blood pressure to a target of less than 140/90 mm Hg, said the authors. For patients with diabetes but low 10-year risk of cardiovascular disease, the usefulness of aspirin for primary stroke prevention is unclear, they added.

Many new recommendations focus on persons with hypertension. These recommendations include regular blood pressure screening and appropriate treatment of hypertension, including lifestyle modification and pharmacologic therapy. The guidelines also recommend annual screening for high blood pressure and health-promoting lifestyle modification for patients with prehypertension.

Other new recommendations are intended for migraineurs. For example, the authors recommend smoking cessation for women with migraine headaches with aura. These women also might consider alternatives to oral contraceptives, especially those containing estrogen. Closure of patent foramen ovale is not indicated for preventing stroke in patients with migraine, however.

New evidence has strengthened the recommendation that active smokers undergo counseling in combination with drug therapy using nicotine replacement, bupropion, or varenicline to assist in quitting smoking. The authors also stated that community-wide or statewide bans on smoking in public spaces are reasonable for reducing the risk of stroke and myocardial infarction.

“Talking about stroke prevention is worthwhile,” said Dr. Meschia. “In many instances, stroke isn’t fatal, but it leads to years of physical, emotional, and mental impairment that could be avoided.”

—Erik Greb