New clinical guidelines for the prevention of the first stroke, known as a primary stroke, have been outlined by the American Stroke Association (ASA), a division of the American Heart Association.

Stroke occurs when blood flow to the brain is blocked, either due to a clot (ischemic stroke) or a blood vessel burst (hemorrhagic stroke), depriving brain cells of oxygen.

The damage is severe as it can lead to disability such as difficulty in speaking, walking, thinking or even moving hands.

Most strokes are life-threatening and require immediate medical attention to prevent long-term damage or death.

Published in the ASA’s journal Stroke, the guidelines note the importance of healthy lifestyle choices, regular health checkups and management of risk factors to prevent stroke.

With proper prevention, 80% of first stroke cases can be avoided.

First stroke refers to the initial occurrence of stroke in a person. A person who has had a first stroke has a higher risk of having a repeat or second stroke. For prevention of second stroke, lifestyle choices and strict management of risk factors are important.

Understanding stroke and its risks

Stroke occurs when blood flow to the brain is blocked, either because of a clot or because a blood vessel bursts. Without the necessary oxygen, the brain becomes damaged, leading to serious disabilities such as problems with movement, speech, and cognitive function.

According to a recent report by The Lancet, stroke-related deaths are expected to increase from 6.6 million in 2020 to 9.7 million by 2050.

Key Recommendations

The new guideline focuses for the first time on reducing the incidence of stroke. Wake Forest University professor Cheryl D. Bushnell, who led the writing group, stressed the importance of identifying and managing risk factors early.

These risk factors include high blood pressure, high cholesterol, obesity, and elevated blood sugar levels, which can be managed with lifestyle changes and medications if necessary.

Primary care professionals play an important role in promoting brain health by educating patients, performing routine screenings, and addressing these modifiable risks.

Medications such as antihypertensives and statins can help manage high blood pressure and cholesterol, while newer medications such as GLP-1 receptor agonists are now recommended to reduce the risk of heart disease in individuals with obesity or type 2 diabetes.

Role of healthy lifestyle

Healthy lifestyle habits form the basis of stroke prevention. The American Stroke Association outlines key behaviors through its ‘Essential 8 of Life’ metrics:

• eating nutritious food
• being physically active
• abstinence from tobacco
• maintaining a healthy weight
• Cholesterol Management
• Managing blood pressure levels
• ensuring good sleep
• controlling blood sugar levels

Adults are encouraged to follow a Mediterranean diet, which includes olive oil and nuts, and engage in regular physical activity, such as 150 minutes of moderate exercise per week.

Physical activity improves many health indicators that reduce stroke risk, such as blood pressure, cholesterol and weight.

addressing health disparities

The guidelines also acknowledge the role of social factors in stroke risk. Factors such as education, access to care, and economic stability influence a person’s overall health and ability to prevent stroke.

Healthcare providers have been urged to provide resources to patients to address food insecurity, housing instability and other social challenges that may hinder stroke prevention efforts.

Recommendations for women

Women face certain risks of stroke, such as high blood pressure during pregnancy or the use of oral contraceptives, which require special attention.

Health professionals should screen women for these conditions to reduce the risk of stroke. Gender-diverse individuals taking estrogen therapy may be at increased risk and should receive individual care to manage stroke risk.

focus on early prevention

The updated guidelines emphasize early prevention and risk assessment through tools such as the Prevent risk calculator, which can predict the risk of heart disease and stroke as early as age 30.

By adopting these strategies, individuals can take proactive steps to avoid stroke and related conditions such as dementia.

According to the researchers, “This updated guideline is intended to be a resource for physicians to guide various prevention strategies for individuals with a history of stroke.”