New Guidelines Target Lowering Repeat Stroke Risk

Stroke survivors may reduce chances of another stroke through exercise and other measures

(RxWiki News) At least a quarter of the 795,000 Americans who have a stroke each year will have another stroke within their lifetime. New guidelines, however, may help cut this rate of recurrence.

Within five years of a first stroke, the likelihood of another stroke may rise by more than 40 percent, according to the National Stroke Association.

For American Stroke Month this May, the American Heart Association and the American Stroke Association have updated guidelines that stress controlling blood pressure, weight and cholesterol to decrease the chances of having a repeat stroke.

"Exercise regularly to help cut repeat stroke risk."

Walter Kernan, MD, professor of medicine at Yale University School of Medicine, chaired the group of medical professionals who wrote these new recommendations.

The scientists single out blood pressure control as possibly the most important factor for preventing another stroke. About one in seven patients who have had a stroke resulting from an obstruction within a blood vessel that supplies blood to the brain have also had high blood pressure.

The authors of the recommendations also underscore the role that high cholesterol plays in repeat stroke risk. Clogged arteries can trigger another event, and high cholesterol can contribute to this atherosclerosis. The guidelines recommend statin therapy but no longer suggest taking niacin or fibrates to raise HDL ("good") cholesterol. Researchers cite a lack of data supporting the risk-reduction effects of these medications.

Survivors of stroke and transient ischemic attack (a mini stroke usually lasting only a few minutes and causing no permanent damage) are advised to exercise at least three or four times a week. Regular moderate-to-vigorous aerobic activity, such as riding a bike or taking a brisk walk, can help keep strokes away.

When it comes to nutrition, the panel of medical experts recommends following a Mediterranean-type diet that includes plenty of fresh vegetables, fruits and whole grains, as well as low-fat dairy, poultry, fish, legumes and nuts. The authors suggest putting the brakes on eating sweets and red meat.

The recommendations also encourage stroke survivors to be screened for diabetes, obesity and sleep apnea — all potential risk factors for another stroke.

Those with atrial fibrillation (a common irregular heart beat) are five times more likely to have a stroke. The scientific panel urges monthly monitoring to check for atrial fibrillation among patients who have had a stroke but are uncertain of the cause.

Therapies for stroke patients are tailored to the individual and may include taking aspirin regularly or a surgical procedure to open arteries in the neck.

"The key to staying healthy after an ischemic stroke or transient ischemic attack 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," Dr. Kernan said in a press release. "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."

These guidelines were published May 1 in the American Heart Association journal Stroke.

Review Date: 
May 2, 2014