More than 600,000 people in the US will have their first stroke this year. The American Stroke Association wants to arm doctors and patients with the knowledge to help lower that number.
For the first time in a decade, the American Stroke Association, a division of the American Heart Association, has updated its Guideline for the Primary Prevention of Stroke with a series of new recommendations for health-care professionals and clinicians to screen for the risk of stroke and offer steps patients can take to cut that risk. The updated recommendations were published this week in the Association’s journal Stroke.
“The people at the highest risk of having a stroke are those who have multiple risk factors that are not well-controlled,” said Dr. Cheryl Bushnell, lead author of the recommendations and vice chair of research at Wake Forest University’s School of Medicine. “Stroke is preventable, and without the awareness of care of a provider for these risks, a stroke could be deadly or severely disabling.”
The new strategies aim to “support brain health” and help lower first stroke risk, referred to as primary prevention.
The US Centers for Disease Control and Prevention says a stroke occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. Strokes can cause lasting brain damage, long-term disability or death.
The 2024 guideline update adds new diet ideas, recognizes social and economic factors, and highlights the potential risks that women face for preventable strokes.
The guidelines encourage a series of healthy behaviors to help people avoid some common risk factors for strokes like obesity, high blood pressure and elevated cholesterol. New findings in the guidelines show that GLP-1 receptor agonists, like the popular weight-loss and diabetes drugs Ozempic, Wegovy, Mounjaro and Zepbound, can decrease the risk of stroke by helping with weight loss and blood sugar control for those with type 2 diabetes.
The guidelines also suggest a Mediterranean diet to improve heart health and maintain a healthy weight. Diets like the MIND diet show that feasting on leafy greens, olive oils, fish and other whole foods can reduce the risk of cognitive decline, as well.
“The risks of dementia are essentially the same as the risks for stroke,” Bushnell said. “All of our recommendations will not only lead to better stroke prevention but also improve brain health.”
The new guidelines emphasize that even the walkability of neighborhoods, access to healthy foods and general access to resources can affect the risk of stroke.
These “social determinants of health” are nonmedical factors like education, economic stability, access to health care, discrimination and structural racism.
The guidelines now include a list of food and housing resources for patients, along with more affordable medication options.
“There is abundant evidence that adverse social determinants of health can be barriers to prevention and therefore increase stroke risk,” Bushnell said.
According to the CDC, the risk of primary stroke is nearly twice as high for non-Hispanic Black adults than for White adults. Non-Hispanic Black adults and Pacific Islanders – groups that tend to face more structural racism and that may have less access to health care – also have the highest rates of death from stroke.
The guidelines also now include gender- and sex-specific recommendations for women, who it says should watch out for blood pressure increases if they are pregnant or taking birth control, two things that might raise the risk of high blood pressure.
“There has been an explosion of new research on women’s health and stroke risk, so there was quite a bit of new data to draw from for these recommendations,” Bushnell said. “Even though these women are young, they can still have strokes that are preventable, such as treating very high blood pressures in a pregnant woman who is about to deliver her baby to prevent a brain bleed.”
The guidelines note that those using hormones for gender-affirming care may be at a higher risk of stroke. Talk to your doctor about modifying dosages, and monitor your blood pressure.
The association also encourages people to watch out for the warning signs of stroke. The B.E. F.A.S.T. mnemonic is a simple way to do that. If someone begins feeling dizzy; if they have blurry vision or numbness in the arms or face; or if their speech begins to slur, it’s time to call 911.
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“These are treatments that can be given in the emergency department that can save the lives of people who have a stroke onset,” Bushnell said. “The sooner a stroke is recognized, the sooner treatment can begin.”
Stroke is a leading cause of death and serious long-term disability for Americans, according to the CDC. Every 40 seconds, someone in the US has a stroke, and someone dies of stroke roughly every three minutes. High blood pressure, high cholesterol, smoking, obesity and diabetes are leading causes of stroke, and 1 in 3 US adults has at least one of these risk factors.
These new recommendations could help save lives and lead to healthier lifestyles along the way.
“The guideline offers relatively simple strategies that could be very effective to lower the risk of stroke,” Bushnell said.