This year, over 600,000 individuals in the United States are projected to experience their initial stroke. To combat this, the American Stroke Association (ASA), a division of the American Heart Association, is dedicated to equipping medical professionals and patients with the necessary knowledge to reduce this figure. After a decade, the ASA has revised its Guideline for the Primary Prevention of Stroke, introducing a range of new recommendations. These are aimed at assisting healthcare providers and clinicians in identifying stroke risk factors and advising patients on measures to mitigate this risk. The updated guidelines were recently published in the ASA's journal, Stroke.

"Individuals at the greatest risk of stroke are those with multiple poorly managed risk factors," stated Dr. Cheryl Bushnell, the 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 and care from a healthcare provider regarding these risks, the consequences of a stroke can be fatal or severely disabling." The new strategies are designed to "support brain health" and lower the risk of a first-time stroke, also known as primary prevention. The US Centers for Disease Control and Prevention (CDC) define a stroke as an event where blood supply to a part of the brain is blocked or a blood vessel in the brain ruptures. Strokes can result in lasting brain damage, long-term disability, or even death.

The 2024 update to the guidelines includes novel dietary suggestions, acknowledges social and economic influences, and underscores the specific risks that women face regarding preventable strokes. The guidelines advocate for a series of healthy behaviors that can help individuals avoid common stroke risk factors such as obesity, hypertension, and high cholesterol levels. Recent findings within the guidelines indicate that GLP-1 receptor agonists, including popular weight-loss and diabetes medications like Ozempic, Wegovy, Mounjaro, and Zepbound, can reduce stroke risk by aiding in weight loss and blood sugar management for individuals with type 2 diabetes.

The guidelines also recommend a Mediterranean diet to enhance cardiovascular health and maintain a healthy weight. Diets similar to the MIND diet demonstrate that consuming leafy greens, olive oils, fish, and other whole foods can decrease the risk of cognitive decline. "The risks for dementia are essentially identical to those for stroke," Bushnell remarked. "All of our recommendations will not only lead to improved stroke prevention but also enhance overall brain health."

The revised guidelines highlight that even the walkability of neighborhoods, access to nutritious food, and general availability of resources can impact stroke risk. These "social determinants of health" encompass non-medical factors such as education, economic stability, access to healthcare, discrimination, and structural racism. The guidelines now encompass a list of food and housing resources for patients, as well as more affordable medication options. "There is substantial evidence that adverse social determinants of health can act as barriers to prevention and, consequently, increase stroke risk," Bushnell stated.

According to the CDC, the risk of a primary stroke is nearly twice as high for non-Hispanic Black adults compared to White adults. Non-Hispanic Black adults and Pacific Islanders, who often face greater structural racism and have less access to healthcare, also have the highest mortality rates from stroke. The guidelines now include gender- and sex-specific recommendations for women, advising them to monitor blood pressure increases if they are pregnant or using contraceptives, as these factors may elevate the risk of hypertension.

"There has been a surge of new research on women's health and stroke risk, providing a wealth of new data for these recommendations," Bushnell said. "Even though these women are young, they can still experience preventable strokes, such as treating extremely high blood pressures in a pregnant woman who is about to give birth to prevent a cerebral hemorrhage." The guidelines also note that individuals undergoing hormone therapy for gender-affirming care may be at a higher risk of stroke. It is advised to consult with a doctor about adjusting dosages and to monitor blood pressure regularly.

The association also urges people to be vigilant about the warning signs of stroke. The B.E. F.A.S.T. acronym is a straightforward method to remember these signs. If someone starts to feel dizzy; if they experience blurry vision or numbness in the arms or face; or if their speech becomes slurred, it is crucial to call 911 immediately. "There are treatments available in the emergency department that can save the lives of individuals who have just had a stroke," Bushnell said. "The sooner a stroke is recognized, the sooner treatment can commence."

Stroke is a leading cause of death and severe long-term disability for Americans, according to the CDC. On average, a stroke occurs in the US every 40 seconds, and someone dies from a stroke approximately every three minutes. High blood pressure, high cholesterol, smoking, obesity, and diabetes are the primary causes of stroke, and nearly one in three US adults has at least one of these risk factors. These new recommendations have the potential to save lives and promote healthier lifestyles. "The guideline offers relatively straightforward strategies that could be highly effective in reducing the risk of stroke," Bushnell concluded.