Courtesy of the American Heart/Stroke Association

The American Stroke Association (ASA) issued new guidelines for stroke prevention, which emphasize the importance of good nutrition, quitting smoking, and being physically active as important. The guidelines also state that maintaining routine health screenings and managing risk factors for cardiovascular disease and stroke, with medication, can help prevent a first stroke.

A stroke occurs when blood flow to the brain is interrupted when a blood vessel is blocked by a blood clot or a rupture, preventing the brain from functioning. Strokes can cause brain damage that results in significant disability, including difficulty thinking, talking, walking and more. The fifth leading cause of death in the U.S., stroke is responsible for 160,000 deaths annually. More than 600,000 people in the U.S. have a first stroke every year, even though up to 80% of strokes are preventable.

Cheryl D. Bushnell, M.D., M.H.S., FAHA, professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, says the most effective way to reduce strokes and stroke-related death is to prevent the first stroke. Bushnell, who is chair of the guidelines writing group, says that some populations are at an elevated risk of stroke due to genetics, lifestyle, biological factors, and/or social determinants of health. Also, some people do not receive appropriate screening to identify their risk.

The most common, treatable lifestyle behaviors that can help reduce stroke risk are detailed in the Association’s Life’s Essential 8 Cardiovascular Health Metrics. These behaviors include healthy nutrition, regular physical activity, tobacco avoidance, healthy sleep and weight, controlling cholesterol, and managing blood pressure and blood sugar. The guidelines also say that following the Mediterranean diet is helpful. Finally, adults should get about 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous aerobic activity, or a combination of both spread throughout the week.

Social determinants of health, such as education, economic stability, access to care, discrimination, structural racism, and neighborhood factors (such as lack of walkability, reduced availability of healthy food, and fewer health resources), contribute to care inequities. Health care professionals should also be doing more, including providing patient education at various levels of understanding and in different languages; choosing affordable treatments and medications; and connecting patients to resources related to food and housing insecurity.

The guidelines also point out that a woman’s risk of stroke is higher due to oral contraceptives; possible high blood pressure during pregnancy and other pregnancy complications; endometriosis; premature ovarian failure; and early onset menopause. Treatment of elevated blood pressure during pregnancy and within six weeks of delivery is recommended to reduce the risk of maternal intracerebral hemorrhage. Gender-diverse individuals taking estrogens may also be at an increased risk of stroke.

The Association created a Predicting Risk of Cardiovascular Disease Events calculator (PREVENT) risk calculator as a screening tool. The tool is capable of estimating 10-year and 30-year stroke and heart disease risk in individuals starting at age 30.