Dec. 2, 2010 -- A healthy lifestyle -- which includes not smoking, eating a low-fat diet with plenty of fruits and vegetables, exercising, and maintaining a healthy body weight -- may help prevent a first-time stroke. That’s according to the American Heart Association, whose revised guidelines say such healthy behaviors reduce the risk for stroke by as much as 80%.
In addition to a healthy lifestyle, authors of the guidelines say primary care visits and emergency room visits provide a major opportunity to intervene and reduce the risk of stroke. Emergency room physicians could identify people at risk, particularly patients with diabetes, asymptomatic high blood pressure, or atrial fibrillation, and make recommendations to help prevent a first-time stroke, they say.
“Stroke remains a major health care problem,” Larry B. Goldstein, MD, chairman of the statement writing committee and director of the Duke Stroke Center in Durham, N.C., and his colleagues write in Stroke: Journal of the American Heart Association. “Its human and economic toll is staggering.”
The guidelines, last updated in 2006, now focus heavily on primary prevention. For the first time, the guidelines address stroke as a continuum of related events rather than a single isolated episode. These related events can include ischemic stroke, which accounts for 87% of all strokes, non-ischemic stroke, and transient ischemic attack, which in many cases is considered a warning sign of a possible impending stroke.
In the United States, stroke death rates have declined by more than a third between 1999 and 2006; however, stroke remains the third leading cause of death after cardiovascular disease and cancer. The authors note that although stroke was once considered to be a condition of the elderly, the number of pediatric stroke cases has risen in recent years. More than 77% of the 795,000 strokes in the U.S. are first-time events; there are 6.4 million stroke survivors in the U.S. Twenty percent of stroke survivors are so functionally impaired that they require institutional care.
Adopting healthy lifestyle habits is one of the best ways to reduce the risk for stroke;
Emergency room physicians have an opportunity to identify patients at risk for stroke and recommend screenings, referrals, or prevention therapies to reduce their risk.
Physicians need to take a complete family medical history of patients; genetic screening for stroke may be appropriate for some patients with certain disorders that predispose them to stroke, such as Fabry’s disease. Genetic screening for stroke is not recommended for the general population.
Carotid endarterectomy (surgery to repair a narrowing in the carotid artery) and carotid artery stenting may benefit some select patients who are at high risk for stroke. Doctors should decide on the utility of these procedures on a case-by-case basis.
Aspirin doesn’t prevent stroke among patients at low risk or patients with diabetes or asymptomatic peripheral artery disease, but it may offer some benefit to patients who are at high risk.
Women who use oral contraceptives and who smoke, have high blood pressure, high cholesterol, diabetes, who are obese, or have thrombotic mutations, which could affect blood clotting, may be at greater risk for stroke.