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November 7th, 2014

Experts Update Stroke Prevention Guidelines

Experts Update Stroke Prevention Guidelines

October 29, 2014

Tools for preventing strokes include a healthy diet, home blood pressure monitoring and an online stroke-risk estimator, according to updated guidelines issued Wednesday by a leading heart health organization.

Together with traditional measures like smoking cessation aids, medications and surgeries, the updated recommendations can help to substantially reduce the risk of stroke, said Dr. James Meschia, who led the group that wrote the new guildelines for the American Heart Association/American Stroke Association.

"Clearly treating stroke is very difficult," said Dr. Gregory Albers. "If you can prevent the stroke, it's much better," added Albers, who was not part of the guidelines group but directs the Stanford Stroke Center in California.

A 2010 study found that 90% of stroke risk is tied to risk factors, such as high blood pressure, overweight and smoking. While controlling those factors won't eliminate stroke risk, it can substantially reduce it, said Meschia, who is also chair of neurology at the Mayo Clinic in Jacksonville, Florida.

The guidelines, which were last updated in 2011, focus on what can be done to prevent a first-time stroke.

"Some of it isn't as new because it's pulling together guidelines from other areas," said Dr. Andrew Russman, who also wasn't involved in updating the guidelines but is a stroke expert from the Cleveland Clinic in Ohio.

For example, the new guidelines recommend use of an online tool that estimates a person's risk of stroke over the next 10 years based on race, gender, age, cholesterol, blood pressure, diabetes and smoking. (More information is available here: http://bit.ly/1uGpcMK.)

The tool was announced in conjunction with other guidelines last year and sparked controversy.   Some feared it would put too many people on statins.

The updated guidelines say statins should be used in addition to diet and exercise among people with a high risk of stroke over the next 10 years.

The guidelines also recommend use of new anticoagulants to reduce the risk of stroke among people with atrial fibrillation.

Meschia said the newer medications require less monitoring than older drugs and may have other advantages, such as a reduced risk of brain bleeds.

"From that point of view - at least for the general population with atrial fibrillation at risk for stroke - they present a new option," he said.

The guidelines also advise that people cut back on sodium and consume more potassium to lower blood pressure, and they recommend either a Dietary Approaches to Stop Hypertension (DASH) diet or a Mediterranean-style diet.

"Clearly blood pressure - for stroke - is the number one risk factor," Albers said. "A lot of the stroke specialists like to see blood pressure down to 120 over 80."

Meschia agreed and said the new guidelines also recommend that people monitor their own blood pressure - not just wait for it to be measured at the doctor's office.

"If you had to do one thing and do one thing only, it's know your pressure and keep it down," he said.

Russman said the risk factors addressed by the new guidelines are important and controlling them early enough may prevent strokes.

"I think it stressed the importance of eating a healthy diet - like a Mediterranean diet - and the benefit of regular exercise and follow up with a primary care physician to identify problems early when they arise, so we can initiate lifestyle and medication interventions early to prevent future problems," Russman said.


SOURCE: http://bit.ly/102rXe9

Stroke 2014.

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