New AHA Guidelines Highlight Strategies to Prevent First Strokes: Emphasis on Lifestyle Changes, Screening
USA: In a significant update, the American Heart Association (AHA) and American Stroke Association (ASA) have released the 2024 Guideline for the Primary Prevention of Stroke, the first major revision in a decade. The new guideline replaces the 2014 version and aims to provide healthcare professionals with the latest strategies for preventing strokes in individuals with no prior history of the condition. The guideline emphasizes the importance of lifestyle management, risk factor control, and primary care screening.
According to the guidelines, adopting healthy lifestyle behaviors—such as maintaining good nutrition, quitting smoking, and staying physically active—can significantly reduce the risk of having a first stroke. Alongside these lifestyle changes, regular health screenings and effective management of cardiovascular disease and stroke risk factors through medication are crucial. Ideally, screening for stroke risk and educating individuals on how to lower their chances of experiencing a stroke should start with their primary care provider and incorporate evidence-based recommendations.
The guidelines, published in the journal Stroke, highlight that over 500,000 Americans experience their first stroke each year, with up to 80% of strokes being preventable. "This guideline is crucial because new evidence has emerged since the last update, allowing us to better identify individuals at risk for their first stroke," said Dr. Cheryl D. Bushnell, chair of the writing group and a professor at Wake Forest University School of Medicine, said in a press release. The guideline aligns with the AHA's "Life's Essential 8," a framework for promoting cardiovascular health.
One of the notable additions is the recommendation for glucagon-like peptide 1 receptor agonists (GLP-1s), which have shown strong evidence for reducing stroke risk in patients with diabetes and high cardiovascular risk. These medications, which include semaglutide (Ozempic or Wegovy), are recognized for their dual benefits in managing diabetes and promoting weight loss. However, the guideline stresses the need for further studies to confirm their efficacy in stroke prevention when used solely for weight management.
The updated guidelines also underscore the significance of addressing social determinants of health—factors such as education, economic stability, and access to care—that can influence stroke risk. The authors advocate for screening these determinants in clinical settings, recommending evidence-based interventions to tackle their adverse effects. Such measures include ensuring patient education is accessible and relevant, advocating for effective medications, and connecting patients to community resources to address health-related needs like food and housing insecurity.
In addition, the guideline introduces specific recommendations for women's health. It highlights the need for screening for stroke risks associated with oral contraceptives, endometriosis, and early-onset menopause. The authors emphasize the importance of managing hypertensive disorders during pregnancy to prevent maternal intracerebral hemorrhage.
Blood pressure management is another critical focus. The guidelines recommend that most patients requiring antihypertensive medications for stroke prevention should be prescribed at least two medications, as studies have shown that a single medication is often insufficient.
The guidelines also recognize the increased stroke risk among transgender individuals undergoing estrogen therapy and call for careful evaluation and modification of their risk factors.
Dr. Bushnell noted that implementing these recommendations could substantially reduce the incidence of first strokes and even lower the risk of dementia, another serious condition associated with vascular health. As clinicians adopt these guidelines, the hope is to see a marked decline in stroke incidence, paving the way for healthier communities.
Reference:
Bushnell C, et al "2024 guideline for the primary prevention of stroke: a guideline from the American Heart Association/American Stroke Association" Stroke 2024; DOI: 10.1161/STR.0000000000000475.
