New Guidelines Promote Awareness, Prevention

Larry B. Goldstein, MD, director of the Duke Center for Cerebrovascular Disease and the Duke Stroke Center, has worked with the American Heart Association (AHA) for over 15 years. He is currently president of the AHA's Mid-Atlantic affiliate and has served as chair of AHA's stroke council, a body charged with developing scientific policy and advancing the science of stroke care.

In May 2006, the council released revised guidelines for primary stroke prevention.

“We now do regular updates of our major stroke-related guidelines every three years,” says Goldstein. “They are all evidence-based and follow a rigorous process of peer review. The new guidelines focus on primary stroke prevention.

"We divided stroke risk factors into those that aren’t modifiable but are important to recognize, those for which we know treatment reduces risk, and then we have a group of evolving or new potential risk factors that we’re either not quite sure how to fit into the mix, or for which there is limited or no evidence that their treatment reduces stroke risk.” These include conditions like sleep apnea and migraine.

Know the Risks

Nonmodifiable risk factors include age, gender, race/ethnic group, and family history.

Stroke risk increases with age, doubling every ten years past age 55. Men have a higher risk than women. African Americans have a 38 percent higher incident of stroke than whites, with Hispanic Americans having intermediate risk. A person with a parent, brother, or sister who had a stroke, particularly at a younger age, is also at increased risk.

While you can’t change these factors, it’s important to know about them, says Goldstein. “You can then become all the more aggressive in changing those things you can modify.” These include making lifestyle changes and treating medical conditions.

The revised guidelines recommend the following:

• Control blood pressure. The higher the blood pressure, the greater the risk of stroke. Get screened for high blood pressure at least every two years; more often if you are at increased risk. Lowering high blood pressure, whether by medication or lifestyle changes such as weight loss, effectively lowers the stroke risk. It’s especially important for diabetics to get and keep high blood pressure under control.
• Quit smoking, and avoid exposure to secondhand smoke. The risk of stroke is doubled for active smokers, and those exposed to secondhand cigarette smoke aren’t very far behind. Stroke risk rapidly goes down when the smoker quits.
• Get active. Aim for thirty minutes or more of daily physical activity.
• Eat right. Reduce sodium intake (no more than 2.3 grams per day), increase potassium (at least 4.7 grams per day), and eat a diet rich in fruits and vegetables -- provided that your doctor has not recommended a special diet because of other medical conditions.
• Lower cholesterol. Statin drugs in addition to lifestyle changes are recommended for people with high cholesterol, coronary artery disease, or diabetes.
• Drink alcohol in moderation, and don’t use recreational drugs.

Learning your specific risk factors for stroke is vital to prevention, emphasizes Goldstein. “This time around we recommended using a stroke risk assessment tool so physicians and patients can better determine actual risk.”

The guidelines stress that everyone should be assessed to learn if therapeutic interventions are needed. “People still think stroke is a problem that only affects old men, but no one is immune -- and it can often be prevented.”