Healthy eating, stopping smoking and staying active, alongside routine screening and education, could stop people from having a first stroke.
Guidance by the American Stroke Association on preventing stroke has recently been updated to reflect new discoveries that have been made over the last decade.
Experts say that healthy lifestyle behaviours, coupled with screening, education and medication to lower the risk factors for cardiovascular disease and stroke, could stop a first stroke.
The ‘2024 Guideline for the Primary Prevention of Stroke’ covers a range of prevention strategies for people with no history of stroke. It includes recommendations to support brain health and stroke prevention throughout a person’s life.
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Chair of the guideline writing group, Professor Cheryl D. Bushnell, vice chair of research in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, said: “The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke – referred to as primary prevention.
“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.”
Despite the fact that 80% of strokes are preventable, more than half a million people in the US have a stroke for the first time every year, with the condition being the fifth leading cause of death.
A stroke happens when a blood vessel becomes blocked by a blood clot or it ruptures, causing the blood flow to the brain to be interrupted.
Without the oxygen it needs to function, the brain can become damaged, which can cause disability and problems with talking and walking.
The updated guidance aims to reduce the number of people having a stroke for the first time, with Professor Bushnell saying: “This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.
“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.”
Risk factors
Cardiovascular disease risk factors that are unidentified or not managed can lead to damage to the brain, arteries and heart well before cardiovascular disease and stroke happen.
Conditions including high blood pressure, obesity, raised cholesterol and blood sugar need to be identified and addressed through lifestyle changes and medication.
One of the new recommendations in the guidance is the potential use of glucagon-like protein-1 (GLP-1) receptor agonist medications, which help reduce the risk of cardiovascular disease in people with obesity or overweight and/or type 2 diabetes.
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Healthy lifestyles
The Association outlines the most common lifestyle factors that can reduce the risk of stroke, including healthy eating, regular exercise, smoking cessation, good sleep, a healthy weight and healthy cholesterol, blood pressure and blood sugar.
It also recommends a Mediterranean diet for those at risk, or with no history of, cardiovascular disease.
Patients should be screened for sedentary behaviour, a risk factor for stroke, and should be encouraged to undertake at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity, spread throughout the week.
One update to the guidance is the social determinants of health and how they affect stroke risk.
These can include education, economic stability, access to care, discrimination, structural racism and neighbourhood factors (including the lack of walkability, poor access to healthy food and fewer health resources) – all factors which add to inequities in care.
New gender and sex-specific guidance
There are new recommendations around assessing women’s increased risk of stroke, including use of oral contraceptives, high blood pressure during pregnancy, other pregnancy complications, endometriosis, premature ovarian failure and early onset menopause.
In addition, the experts highlight that transgender women and gender-diverse people taking oestrogen may also be at an increased risk of stroke.
