A new clinical guideline for primary stroke prevention from the American Stroke Association, a division of the American Heart Association (AHA), was recently published in the journal Stroke. This is the first update in over a decade, and the “2024 Guideline for the Primary Prevention of Stroke” replaces the “2014 Guidelines for the Primary Prevention of Stroke.”

The panel of experts noted that this updated guideline is intended to be a helpful resource for clinicians to guide in implementing various prevention strategies for individuals with no history of stroke. The updates align with the AHA’s Life’s Essential 8.

Health experts conducted a comprehensive search of literature published since the 2014 guideline, derived from research involving human participants published in English and indexed in MEDLINE, PubMed, Cochrane Library, and other selected and relevant databases. The search was conducted between May 2023 and November 2023, and other documents on related subject matter previously published by the AHA were also reviewed.

The new guideline provides clinical evidence–based recommendations for strategies for supporting brain health and thwarting stroke throughout a person’s lifespan by improving healthy lifestyle behaviors and getting preventive care. The new primary prevention of stroke guideline urges clinicians to screen patients for stroke risk factors, including hypertension, hyperlipidemia, diabetes, and obesity.

In a press release on the AHA website, chair of the guideline writing group, Cheryl D. Bushnell, MD, MHS, FAHA, professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, stated, “The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention.”

Dr. Bushnell added, “Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.

“This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke,” stated Dr. Bushnell.

The updated guidelines included the adoption of the Mediterranean diet, which has been shown to significantly diminish stroke risk, especially when supplemented with nuts and olive oil. The updated guidelines highlight essential stroke prevention recommendations, including regular health screening, identifying and managing risk factors, lifestyle interventions, and medications based on individual patient needs.

The updated guidelines accentuated the importance of physical activity for cardiovascular health and stroke prevention. The authors also emphasized and provide a new recommendation to screen for sedentary behavior and advise patients to avoid inactivity and engage in regular moderate to vigorous physical activity.

Another new recommendation is based on “robust” data that glucagon-like peptide-1 receptor agonists (GLP-1s) significantly improve the management of type 2 diabetes and weight loss and lower the risk for cardiovascular disease. As a result, guideline authors recommend using GLP-1s in patients with diabetes and high cardiovascular risk or established cardiovascular disease. Another drug class introduced since the 2014 guidelines were published, proprotein convertase subtilisin/kexin type 9 inhibitors, have proven to be highly effective in lowering low-density lipoprotein cholesterol. These medications have also been shown to reduce the risk of stroke.

New to the guideline is an emphasis on social determinants of health and their impact on stroke risk, and it also includes some new gender-specific recommendations for women based on conditions such as a history of migraine, early menopause, and endometriosis.

Finally, Dr. Bushnell added, “Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain.”

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