Stroke prevention starts with adopting healthy habits and managing risk factors before a first stroke occurs. The 2024 guidelines for primary stroke prevention build on the American Heart Association’s (AHA) Life’s Essential 8 recommendations for overall cardiovascular health and include additional specific strategies to reduce stroke risk.
A critical recommendation is following a Mediterranean diet, which emphasizes fruits, vegetables, whole grains, lean proteins, and healthy fats. This diet helps lower stroke risk by promoting better heart and brain health. Eating better is one of the AHA’s Life’s Essential 8, and it aligns with the guideline’s focus on healthier dietary choices for those at moderate to high stroke risk.
Engaging in regular physical activity is another cornerstone of stroke prevention. Avoiding prolonged sitting and participating in moderate-to-vigorous exercise are strongly recommended. This complements the AHA’s recommendation to aim for at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week to maintain cardiovascular health.
For patients with diabetes and high cardiovascular risk, medications such as GLP-1 receptor agonists can aid in managing blood sugar and weight, further reducing stroke risk. Maintaining blood sugar levels within a healthy range is vital, as outlined in Life’s Essential 8, and supports the prevention of diabetes-related cardiovascular complications.
Controlling blood pressure is another critical factor. High blood pressure is one of the leading causes of stroke, and many patients require two or more medications to achieve effective control. The AHA highlights keeping blood pressure below 120/80 mm Hg as an essential goal for overall heart health.
In certain cases, medications play a key role. Antiplatelet therapy is advised for individuals with autoimmune conditions like antiphospholipid syndrome or lupus, depending on their medical history. For pregnant women, managing high blood pressure (systolic ≥160 mm Hg or diastolic ≥110 mm Hg) is crucial to avoid complications such as bleeding in the brain. In the average risk patient with no history of vascular disease daily aspirin therapy has not been found to be beneficial.
Other groups at heightened risk of stroke include women with endometriosis, early menopause, or premature ovarian failure, and transgender individuals using estrogen therapy. Managing cholesterol and addressing other cardiovascular risk factors in these populations is vital to reduce their stroke risk, as emphasized by the AHA’s guidelines.
Two additional components of Life’s Essential 8 are quitting tobacco and achieving healthy sleep patterns. These are fundamental for stroke prevention. Smoking cessation eliminates a significant risk factor for stroke, while getting 7-9 hours of quality sleep each night helps maintain cardiovascular health.
Finally, the guidelines stress the importance of maintaining a healthy weight, which is another AHA priority. Excess weight is a major risk factor for stroke and achieving a healthy body mass index (BMI) can significantly lower the risk of cardiovascular events.
The 2024 guidelines, combined with the AHA’s Life’s Essential 8, emphasize that preventing a first stroke requires healthy lifestyle choices, targeted medical treatments, and management of unique risks in specific populations. By following these comprehensive strategies, we can reduce the likelihood of stroke and promote overall cardiovascular health.