To better understand the onset of a first stroke, members of the American Heart Association’s Stroke Council and the American Stroke Association, worked to assess what common factors—either modifiable or non-modifiable—puts patients most at risk.
“This is a fairly complete update of the guidelines published in 2006,” Larry B. Goldstein, MD, chairman of the statement writing committee, told Cardiovascular Business News.
“We have had a fairly significant 30 percent decline in stroke-related mortality in this country. Much of that reduction, if not most of it, was related to improved prevention,” said Goldstein, who is director of the Duke Stroke Center at the Duke University Medical Center in Durham, N.C.
Along with other healthcare organizations, the AHA set the goal of decreasing cardiovascular and stroke mortality by 25 percent over 10 years. Between 1996 and 2006, the death rate for stroke fell by 33.5 percednt, with the total number of stroke deaths declining by 18.4 percent. The goal of a 25 percent reduction was exceeded in 2008.
Almost 795,000 people in the U.S. experience stroke annually, which has resulted in 134,000 deaths annually. And even though the rates of stroke death declined by 33.5 percent between 1996 and 2006, the incidence of stroke, stroke-related hospitalizations and costs continue to rise.
To help understand how to curb these high numbers, Goldstein and colleagues evaluated multiple factors that have the potential to increase the risk of a stroke and outlined preventive strategies to reduce patient risk. The guidelines were published in the Dec. 2 issue of Stroke.
The authors looked at both modifiable—hypertension, cigarette smoke exposure, diabetes, atrial fibrillation (AF)—and non-modifiable—sex, low birth weight, race/ethnicity and genetic predisposition—factors that have been previously outlined to increase a patient’s risk of stroke.
Goldstein said that the new set of guidelines addresses hemorrhagic stroke in addition to ischemic stroke, a series of diseases and the role that preventive tools can help decrease risk.
“There are two sets of messages,” Goldstein offered. “One is for the general public and another is for the healthcare practitioner. I think it’s particularly important to know that people need to take charge of their own lives. A lot of the reduction in stroke risk that we are seeing is likely due to improved risk factor management from the standpoint of lifestyle changes.
"Doing things like not smoking and avoiding secondhand tobacco smoke, exercising regularly and following a diet that’s rich in fruits and vegetables … can account for an 80 percent reduction in the risk of stroke,” Goldstein noted.
“The document itself goes through a variety of well documented and well established modifiable risk factors, as well as a series of risk factors that aren’t necessarily modifiable but that people should know about because they do put them at an increased risk.”
For example, for the modifiable condition of hypertension, which can cause cerebral infarction and intracranial hemorrhage, the authors recommended that lifestyle modifications for patients with elevated blood pressure should be undertaken, and in nonhypertensive patients with an elevated blood pressure (120 mm Hg to 139 mm Hg systolic or 80 mm Hg to 89 Hg diastolic).
While previous studies have shown that first-line drug therapy including beta-blockers, ACE inhibitors and thiazide diuretics can help reduce blood pressure, the researchers wrote that “although the benefits of lowering blood pressure as a means to prevent stroke are undisputed, there is no definitive evidence that any class of antihypertensive agents offers special protection against stroke.
“Hypertension remains the most important well-documented, modifiable risk factor for stroke, and treatment of hypertension is among the most effective strategies for preventing both ischemic and hemorrhagic stroke,” the authors wrote.
The guidelines recommend the following for the other modifiable conditions:
- Diabetes: A comprehensive program that includes tight control of hypertension with ACE inhibitors or ARBs reduces risk of stroke in persons with diabetes. The authors recommended that patients with type 1 or type 2 diabetes should undergo blood pressure control to reduce the risk of cardiovascular events. In addition, the committee recommended the treatment of hypertension for diabetic adults with an ACE inhibitor or ARBs and statins for those with