New guidelines for preventing strokes

The American Heart Association/American Stroke Association (AHA/ASA) has released new guidelines for the primary prevention of stroke, both ischemic (caused by lack of blood flow to an area of the brain) and hemorrhagic (strokes that bleed into the brain).In 1999, AHA set a goal for 2010 of decreasing mortality from heart disease and stroke by 25%, Dr. Goldstein told Medscape Medical News. That goal was achieved early, in 2008, probably due to better prevention strategies, he said.

Of more than 790,000 strokes that occur each year, 75% of those are first events, "so prevention is particularly important." Because risk factors for both ischemic and hemorrhagic strokes largely overlap, he said, "in this guideline we address primary prevention of stroke, not just ischemic stroke, so that's one significant change."The new guideline, affirmed as an "educational tool for neurologists" by the American Academy of Neurology, was published online December 2 and will appear in the December issue of Stroke.

The document is extremely thorough and long, with 68 pages and almost 800 references, so here are a few highlights. I particularly like the Lifestyle Factors paragraph per Medscape:
• Lifestyle Factors:The writing committee evaluated the gamut of new and emerging risk factors, modifiable and nonmodifiable. What remains first among strategies for primary stroke prevention is modification of lifestyle factors, including physical activity, not smoking, moderate alcohol consumption, maintaining a normal body weight, and eating a low-fat diet high in fruits and vegetables, Dr. Goldstein emphasized.

"Those types of lifestyles are associated with about an 80% — that's 8-zero percent — lower risk of a first stroke, and that's true for both men and women," he said. "There's virtually nothing that we can do with medicine or interventions of any kind that's going to have that kind of impact, so that I think is of paramount importance."

• Secondhand Smoke: Cigarette smoking is an established risk factor for stroke, but the new recommendations suggest that avoiding environmental tobacco smoke is also a "reasonable" strategy, he noted.

"We don't know that limiting that exposure decreases the risk because that data just isn't available," he said. "It seems to be true for coronary heart disease and communities that institute clean indoor air acts, for example, the rate of hospital admission for acute [myocardial infarction] drops precipitously in the year after those measures are taken. We believe the same should be true for stroke, although again we don't have that data yet."

• ED Screening: Visits to the emergency department (ED) may be a valuable opportunity to screen for and treat stroke risk factors, including smoking cessation strategies, cholesterol and blood pressure monitoring, or atrial fibrillation screening and treatment implementation, the new guidelines note.

"As we know, a fairly high proportion of Americans don't have healthcare insurance, and they don't seek regular preventive care," Dr. Goldstein said. "They get their healthcare usually because of an acute illness of some kind by going to the emergency department.

"Even though emergency departments are currently overwhelmed with patients receiving their primary care there for these types of illnesses, it's also an opportunity to identify risk factors and potentially have patients referred for appropriate prevention," he said.

Although ED-based smoking cessation programs and interventions, atrial fibrillation identification, and evaluation for anticoagulation are recommended, and ED population screening for hypertension and drug abuse is considered "reasonable," the document adds that the effectiveness of screening, brief intervention, and referral for treatment of diabetes and lifestyle risk factors in the ED setting is "not established."

Taken from http://www.medscape.org/viewarticle/733726?src=cmemp (you may need a subscription to view the article, not sure).