New stroke prevention guidelines, which had previously been updated in 2006, are being issued.
The researchers say two factors can significantly reduce the incidence of first time strokes:
- Health lifestyle choices
- Emergency room interventions
"Between 1999 and 2006, there's been over a 30 percent reduction in stroke death rates in the United States and we think the majority of the reduction is coming from better prevention."
The authors say the stroke rate in America will rise because people are living longer.
This time the stroke prevention guidelines address the condition as a broad continuum of related events, including ischemic stroke, non-ischemic-stroke and TIA (transient ischemic attack).
A stroke is a condition in which a blood clot or ruptured blood vessel interrupts the flow of blood to a specific area of the brain. Lack of glucose and oxygen flowing to the brain results in the death of brain cells and subsequent brain damage. The patient may have problems with speech, memory and movement. There are two main types of stroke:
- Ischemic stroke - represent about 87% of all strokes. A thrombus (blood clot) forms, blocking blood flow to a part of the brain. Sometimes the clot can form in another part of the body, becomes dislodged and free-floating (an embolus). The embolus can make its way through the bloodstream to the brain where it can cause an ischemic stroke.
- Hemorrhagic stroke (non-ischemic stroke) - a blood vessel ruptures. The leaking blood fills the space between the brain and skull (subarachnoid hemorrhage). Can also occur if a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). In both cases there is poor bloodflow to the brain, plus the accumulation of leaking blood places excessive pressure on the brain.
Goldstein said there is little difference along the stroke spectrum for effective prevention.
Highlighted below are some major updates in the new stroke prevention guidelines:
- Healthy lifestyle choices - don't smoke, follow a healthy low fat diet with plenty of fruits and vegetables, if you consume alcohol do so in moderation, keep your body weight within normal limits, and exercise regularly. People who adopt ALL these lifestyle choices can have an 80% lower risk of developing a stroke.
- Emergency room doctors - attempts should be made to spot those who are at high risk for stroke. The doctors should consider screening, referrals, or even starting preventive treatment.
- Genetic screening - not recommended for the general population. However, in some cases, depending on family history and some other factors, screening might be appropriate.
- Stenting vs. endarterectomy - this is still uncertain. Doctors need to view each case individually, and take into account advances in standard medical therapies, including hypertension treatment, administering antiplatelet and cholesterol lowering medications, and encouraging healthy lifestyle choices.
- Carotid artery narrowing screening - no recommended for the general population.
- Aspirin - for low risk individuals, patients with diabetes, and those with asymptomatic peripheral artery disease aspirin does not help prevent a first stroke. Aspirin is recommended for patients whose stroke risk is higher than bleeding risk (which aspirin can cause).
Goldstein LB, Cheryl D. Bushnell, M.D., M.H.S.; Robert J. Adams, M.S., M.D.; Lawrence J. Appel, M.D., M.P.H.; Lynne T. Braun, Ph.D., C.N.P.; Seemant Chaturvedi, M.D.; Mark A. Creager, M.D.; Antonio Culebras, M.D.; Robert H. Eckel, M.D.; Robert G. Hart, M.D.; Judith A. Hinchey, M.D., M.S.; Virginia J. Howard, Ph.D.; Edward C. Jauch, M.D., M.S.; Steven R. Levine, M.D.; James F. Meschia, M.D.; Wesley S. Moore, M.D.; J.V. (Ian) Nixon, M.D.; and Thomas A. Pearson, M.D.
Stroke Journal 2010; DOI:10.1161/STR.0b013e3181fcb238