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American Heart Association says Blood pressure control, lifestyle changes key to preventing subsequent Strokes

Saint Thomas and Vanderbilt support healthy lifestyle as key part of stroke prevention

American Heart AssociationDallas, TX – Stroke survivors should control their blood pressure, cholesterol and weight and do moderate physical activity regularly to avoid having another stroke, according to an American Heart Association/American Stroke Association scientific statement.

They should also receive other evidence-based therapy specific to their individual health, which may include aspirin therapy or a surgical procedure to keep neck arteries open.

Blood Pressure Check. (American Heart Association)
Blood Pressure Check. (American Heart Association)

The statement, “Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (TIA),” is published in the American Heart Association journal Stroke.

“A vast amount of new research is revealing new and improved ways to protect patients with an ischemic stroke or transient ischemic attack from having recurrent events and further brain damage,” said Walter Kernan, M.D., lead author and chair of the guideline writing group and professor of medicine at Yale University School of Medicine in New Haven, CT.

Treating high blood pressure is possibly most important for secondary prevention of ischemic stroke, according to the statement. About 70 percent of people who have had a recent ischemic stroke also have high blood pressure.

About one-third of adult Tennesseans have been diagnosed with high blood pressure and many more have it but remain undiagnosed. Stroke is the 5th leading cause of death in the state, killing about 3200 Tennesseans per year, one of the worst rates in the nation.

“Stroke is not just an ‘accident’ (as in the old term ‘cerebrovascular accident’), it occurs for a reason,” says Howard Kirshner, M.D., director of the Vanderbilt Stroke Center. “High blood pressure is the most common risk factor for stroke, occurring in 1/3 of the U.S. population, and it confers a 6-fold increase in the risk of stroke. Studies have shown that treatment for high blood pressure can prevent 40-50% of first strokes. After a stroke, up to 70% of patients have high blood pressure, and control of blood pressure is very effective in preventing second strokes.”

The statement notes that intensive cholesterol-lowering therapy is also important for survivors whose stroke was caused by hardened arteries. However, the association no longer recommends niacin or fibrate drugs to raise good cholesterol, due to sparse data establishing their effectiveness at reducing secondary stroke risk.

It’s also good for stroke/TIA survivors capable of engaging in physical activity to have three to four sessions per week of moderate-vigorous intensity aerobic physical exercise such as walking briskly or riding a bike, according to the statement.

“Recent scientific research supports prior study results showing that the risk of a first stroke or recurring stroke is significantly reduced in people who adopt simple but effective lifestyle changes,” says E. Frank Lafranchise, M.D., a neuro hospitalist with Saint Thomas Neurology Specialists at Saint Thomas West Hospital. “Healthy eating, exercise, not smoking, weight management, and knowing your numbers are all key. Additional strategies are also effective in specific patient populations. Work with your doctor or other healthcare professional to identify your specific risk factors and to develop a personalized risk-reduction program.  Taking all recommended medications, as prescribed, is also critical to help reduce stroke risk.”

Since the last update in 2011, the association added sections on nutrition, sleep apnea, aortic arch atherosclerosis and pre-diabetes.

New recommendations include:

  • Screening stroke and TIA survivors for diabetes and obesity
  • Possible screening for sleep apnea
  • Possible nutritional assessment
  • 30-day monitoring for irregular heart beat (atrial fibrillation) for those who had a stroke of unknown cause
  • Anticoagulants in specific situations
  • Following a Mediterranean-type diet that emphasizes vegetables, fruits, whole grains and includes low-fat dairy, poultry, fish, legumes and nuts and limits sweets and red meat

Clinical trials haven’t proven the benefits of a Mediterranean diet after ischemic stroke or TIA, so statement recommendations are based on compelling but lower levels of research.

Each year in the United States, more than 690,000 adults have an ischemic stroke, which originate from blood clots that block blood flow in the brain or in a vessel leading to the brain.

Another 240,000 Americans will experience a TIA. Although TIA leaves no immediate impairment, survivors are at high risk for a future stroke.

On average, the annual risk for a future ischemic stroke after an initial ischemic stroke or TIA is about 3 percent to 4 percent.

“The key to staying healthy after an ischemic stroke or TIA is careful and rapid assessment of the cause of the event and identification of stroke risk factors so that appropriate preventive interventions can be quickly provided,” Kernan said. “Then, patients must work with their doctors regularly to stay on their prevention program. With this approach, every patient can look forward to a healthier future.”

Co-authors of the statement are: Bruce Ovbiagele, M.D., M.Sc., M.A.S., vice-chair; Henry R. Black, M.D.; Dawn M. Bravata, M.D.; Marc I. Chimowitz, MB.Ch.B.; Michael D. Ezekowitz, MB.Ch.B., Ph.D.; Margaret C. Fang, M.D., M.P.H.; Marc Fisher, M.D.; Karen L. Furie, M.D., M.P.H.; Donald V. Heck, M.D.; S. Claiborne (Clay) Johnston, M.D., Ph.D.; Scott E. Kasner, M.D.; Steven J. Kittner, M.D., M.P.H.; Pamela H. Mitchell, Ph.D., R.N.; Michael W. Rich, M.D.; DeJuran Richardson, Ph.D.; Lee H. Schwamm, M.D.; and  John A. Wilson, M.D.


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