The American Stroke Association, a division of the American Heart Association, has released new clinical guidelines for the primary prevention of stroke, emphasizing the critical role of health screenings and lifestyle changes in reducing the risk of first-time strokes. Published in the journal Stroke, the ‘2024 Guideline for the Primary Prevention of Stroke’ replaces the previous version from 2014 and provides evidence-based recommendations for healthcare professionals to implement prevention strategies throughout a person’s lifespan.
Stroke, the fifth leading cause of death in the United States, results in nearly 160,000 deaths annually. Each year, more than 600,000 people in the U.S. experience a first stroke, despite up to 80% of strokes being preventable. The new guideline aims to address this significant public health issue by promoting brain health and stroke prevention through improved lifestyle behaviors and preventive care.
Dr. Cheryl D. Bushnell, chair of the guideline writing group and professor at Wake Forest University School of Medicine, emphasized 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 guideline provides a comprehensive approach to stroke prevention, including regular health screenings, identifying risk factors, lifestyle interventions, and medications when indicated.
Key recommendations include screening for modifiable risk factors such as high blood pressure, overweight and obesity, elevated cholesterol, and high blood sugar. The guideline also promotes the American Heart Association’s Life’s Essential 8 cardiovascular health metrics, which include healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep, and weight management.
New to this guideline is an emphasis on social determinants of health and their impact on stroke risk. Healthcare professionals are encouraged to ensure patient education is accessible for various educational and language levels and to connect patients with resources addressing health-related social needs.
The guideline also introduces sex- and gender-specific recommendations for women, including screening for conditions that can increase stroke risk, such as oral contraceptive use, high blood pressure during pregnancy, and other pregnancy complications. Additionally, it addresses the potential increased stroke risk for transgender women and gender-diverse individuals taking estrogens for gender affirmation.
To support risk assessment, the American Heart Association has developed a new Predicting Risk of Cardiovascular Disease Events (PREVENT) risk calculator. This tool can estimate 10-year and 30-year stroke and heart disease risk in individuals starting at age 30, a decade earlier than previous risk calculators.
The implementation of these guidelines has the potential to significantly reduce the risk of first-time strokes and, consequently, decrease stroke-related disabilities and deaths. As Dr. Bushnell noted, ‘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.’
Healthcare professionals are encouraged to utilize these guidelines to promote brain health and prevent strokes through education, screenings, and addressing risk factors from birth to old age. By focusing on primary prevention, the American Stroke Association aims to create a world with fewer strokes and longer, healthier lives for all.
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