What new guidelines say to do to prevent a stroke

Hundreds of thousands of people in the U.S. have a first stroke each year. Newly updated recommendations spell out methods for changing that.

The new guidelines from the American Heart Association and American Stroke Association, published Monday in the journal Stroke, aim to prevent stroke throughout a person's life via preventive care and healthy lifestyle behaviors. The recommendations, last updated a decade ago, have new guidance for preventing stroke in women and include a new emphasis on social drivers of health.

The guidelines urge health care professionals to screen people for risk factors such as high blood pressure, elevated cholesterol, high blood sugar and obesity. They also recommend raising public awareness about the benefits of healthy lifestyle changes such as quitting smoking, increasing physical activity, improving dietary habits and getting better sleep.

"This guideline is important because new discoveries have been made since the last update 10 years ago," Dr. Cheryl D. Bushnell, who led the panel of experts that wrote the new guidelines, said in a news release. She is a professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

"Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke," Bushnell said. "Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain."

A stroke occurs when blood flow to the brain is interrupted after a vessel becomes blocked by a blood clot or ruptures. A stroke causes brain damage that can lead to significant disability, including difficulty thinking, talking and walking.

The AHA/ASA uses the abbreviation FAST – short for face drooping, arm weakness, speech difficulty, time to call 911 – to help people recognize the signs of a stroke. Every year, more than 600,000 people in the U.S. have a first stroke, the guidelines say. Stroke leads to nearly 160,000 deaths annually and is the nation's fifth-leading cause of death.

But more than half of strokes are considered preventable, according to the guidelines that say primary care professionals should promote brain health through education, screenings and addressing risk factors starting at birth. Unmanaged risk factors can damage arteries, the brain and the heart years before cardiovascular disease and stroke occur.

"The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke," Bushnell said.

Although some people might benefit from medications, lifestyle behaviors that can help reduce stroke risk include healthy nutrition. The guidelines recommend a Mediterranean-style diet, which has been shown to reduce the risk of stroke.

The guidelines also urge health care professionals to screen patients for sedentary behavior, a confirmed risk factor for stroke, and to counsel them to engage in regular physical activity. Federal physical activity guidelines recommend that adults get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.

Women should be screened for sex- and gender-specific factors that can increase their stroke risk, the guidelines recommend. Such factors include the use of oral contraceptives and pregnancy complications such as high blood pressure or premature birth. Treatment of elevated blood pressure during pregnancy and within six weeks of delivery is recommended to reduce the risk of intracerebral hemorrhage.

Other risk factors include endometriosis, premature ovarian failure and early-onset menopause.

Transgender women and people taking estrogens for gender affirmation may also be at an increased risk of stroke, the guidelines say.

Also addressed are social drivers of health. These are non-medical factors that contribute to inequities in care and influence overall health. Among the factors are education, economic stability, access to care, discrimination and structural racism. Neighborhood factors such as the lack of walkability or lower availability of healthy food also play a role.

"Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk," Bushnell said.

Health care professionals should ensure patient information is available for various educational and language levels and advocate for their patients by choosing treatments and medications that are effective and affordable, the guidelines say. Professionals are encouraged to connect patients with resources that help address challenges such as food and housing insecurity and to refer them to programs that support healthy lifestyle changes.

The guidelines' authors acknowledge limitations to some of the evidence that informed the recommendations, and they identify knowledge gaps to help inform topics for future research.