New Guidelines Emphasize Screening and Lifestyle Changes to Prevent First Strokes

The American Stroke Association has unveiled new guidelines for preventing first-time strokes, emphasizing the critical role of regular health screenings and lifestyle changes. Published in the journal Stroke, these updated recommendations replace the previous 2014 guidelines and provide healthcare professionals with evidence-based strategies to support brain health and prevent strokes throughout a person's lifespan.

Stroke, the fifth leading cause of death in the United States, claims nearly 160,000 lives annually. With over 600,000 Americans experiencing a first stroke each year, the new guidelines aim to address this significant public health concern. Dr. Cheryl D. Bushnell, chair of the guideline writing group and professor at Wake Forest University School of Medicine, stressed the importance of primary prevention: "The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke."

The guidelines outline key recommendations for stroke prevention, including regular health screenings, identification of risk factors, lifestyle interventions, and medications when necessary. Healthcare professionals are urged to promote brain health through education, screenings, and addressing risk factors from birth to old age. Modifiable risk factors such as high blood pressure, obesity, elevated cholesterol, and high blood sugar can be identified through physical exams and blood tests.

A significant focus of the new guidelines is on healthy lifestyle behaviors, as outlined in the American Heart Association's Life's Essential 8 cardiovascular health metrics. These include maintaining a healthy diet, engaging in regular physical activity, avoiding tobacco use, getting adequate sleep, and managing weight, cholesterol, blood pressure, and blood sugar levels. The guidelines specifically recommend following a Mediterranean dietary pattern, which has been shown to reduce stroke risk, especially when supplemented with nuts and olive oil.

The importance of physical activity in stroke prevention is heavily emphasized. Healthcare professionals are advised to screen patients for sedentary behavior and counsel them on regular physical activity. The guidelines reinforce the recommendation of at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity for adults.

A new addition to the guidelines is the emphasis on social determinants of health and their impact on stroke risk. Factors such as education, economic stability, access to care, and neighborhood characteristics can contribute to health inequities. Healthcare professionals are encouraged to ensure patient education is accessible at various educational and language levels and to advocate for affordable and effective treatments.

The guidelines also include new sex- and gender-specific recommendations for women, addressing conditions that can increase stroke risk such as oral contraceptive use, high blood pressure during pregnancy, and other pregnancy complications. Additionally, the guidelines acknowledge the potential increased stroke risk for transgender women and gender-diverse individuals taking estrogens for gender affirmation.

Dr. Bushnell highlighted the broader implications of these guidelines, stating, "Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. 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."

The release of these guidelines underscores the critical importance of stroke prevention in public health. By focusing on early identification of risk factors, promoting healthy lifestyles, and addressing social determinants of health, healthcare professionals and individuals can work together to significantly reduce the incidence of first-time strokes. As stroke remains a leading cause of death and disability in the United States, these updated guidelines provide a comprehensive framework for improving brain health and preventing strokes across diverse populations.