With approximately 795,000 cases occurring each year, stroke is one of the leading causes of death and disability in the United States. However, there is some good news: Due to increased research on prevention, the number of strokes has decreased by 42 percent over the last 40 years. As part of its ongoing stroke prevention initiative, the American Heart Association (AHA) has released its new guidelines for the primary and secondary prevention of strokes.
Although many of the recommendations have remained the same, the nutrition, management of hypertension, smoking cessation, heart conditions and migraine recommendations have been updated. These changes can further reduce the number of new strokes and the risk of cardiovascular events in patients with existing cardiovascular disease.
For the first time, the AHA has specifically advocated a Mediterranean diet supplemented with nuts as a way to reduce risk. Also, as a public health measure, they recommend banning smoking in public places to reduce exposure to secondhand smoke.
These new guidelines from the American Heart Association mean that physicians need to be informed of the newest evidence that can positively affect patient outcomes. For example, recommendations for managing high blood pressure now encourage patients to monitor their numbers at home. Patients who are considered prehypertensive — with systolic readings from 120-139 mm Hg and diastolic readings of 80-89 mm Hg — should be counseled about lifestyle interventions and checked annually. The new guidelines also encourage physicians to focus on reducing blood pressure by choosing the pharmacological agent that works best for the individual patient's physiology.
Some of the most important changes to the guidelines are in the area of cardiac conditions. Atrial fibrillation, a major contributor, is now approached with a new contingent of medications that reduce the formation of clots in the blood. This prevents clots from reaching the brain, which causes ischemia, the restriction of blood supply to tissue. Recommendations on when to avoid anticoagulation therapy are also discussed. Again, pharmacological agents should be chosen with the specific characteristics of the patient in mind.
Evidence shows that treatment with aspirin and cilostazol is an appropriate first-line therapy for reducing the likelihood of an initial cerebrovascular event. Aspirin is also useful for stroke prevention in patients with chronic, but not yet severe, kidney disease.
Migraine sufferers who smoke should be encouraged to quit smoking as soon as possible. The guidelines also recommend eliminating the use of estrogen-based contraceptives in women with migraines associated with aura.
New guidelines, new tools
New guidelines for stroke prevention mean that new pharmacological agents are pushed to the front of the physician's toolbox, serving as helpful adjuncts to established treatments. Also, the new guidelines emphasize the individualization of patient care, taking into account the patient's preferences, interactions with other medications, cost, tolerability and individual risk factors.
Research into stroke prevention and treatment continues at institutions like the award-winning UCLA Comprehensive Stroke Center at Ronald Reagan UCLA Medical Center. Students at the David Geffen School of Medicine at UCLA are educated in a climate of research and innovation, where they have the opportunity to work closely with the physicians at UCLA medical centers and initiatives. Though medical school is just the beginning of a physician's career, the emphasis on seeking the best evidence-based practice creates practitioners who are the frontrunners in the ever-changing world of patient care.