What are the guidelines for stroke prevention?

From the Guidelines

To prevent strokes, it is crucial to focus on controlling modifiable risk factors through lifestyle changes and medication when necessary, as recommended by the 2024 guideline for the primary prevention of stroke 1. The key aspects of stroke prevention include:

• Maintaining a healthy blood pressure (below 130/80 mmHg) through lifestyle changes and medication, with the use of ≥ 2 antihypertensive medications recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension 1
• Managing cholesterol with a heart-healthy diet and, when indicated, statins such as atorvastatin or rosuvastatin
• Using anticoagulants like warfarin, apixaban, or rivaroxaban for those with atrial fibrillation
• Implementing antiplatelet therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole for those who have had a previous stroke or TIA
• Controlling diabetes with a target HbA1c below 7%
• Quitting smoking completely and limiting alcohol to moderate levels
• Exercising regularly (150 minutes of moderate activity weekly) and maintaining a healthy weight
• Following a Mediterranean or DASH diet rich in fruits, vegetables, whole grains, and lean proteins, with the Mediterranean diet being specifically recommended for its proven benefits in reducing stroke risk 1 Additionally, screening for and addressing adverse social determinants of health, as well as screening for sedentary behavior and counseling patients to avoid being sedentary, are important aspects of stroke prevention 1. The use of glucagon-like protein-1 receptor agonists is also recommended for patients with diabetes and high cardiovascular risk or established cardiovascular disease, due to their effectiveness in improving management of type 2 diabetes, weight loss, and lowering the risk of cardiovascular disease and stroke 1.

From the Research

Stroke Prevention Guidelines

The guidelines for stroke prevention involve a combination of medical and lifestyle measures.

• Medical measures include:
  • Controlling hypertension, which is the most important modifiable risk factor for stroke 2
  • Treating dyslipidemia with statins 2, 3
  • Anticoagulation therapy in atrial fibrillation 2, 3, 4, 5
  • Carotid endarterectomy in symptomatic high-grade carotid stenosis 2
• Lifestyle modifications include:
  • Reducing salt intake 2
  • Eliminating smoking 2, 6
  • Performing regular physical activity 2, 6
  • Maintaining a normal body weight 2, 6

High-Risk Patients

For patients with atrial fibrillation, stroke prevention strategies include:

• Oral anticoagulation (OAC) with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants (NOACs) 4, 5
• Left atrial appendage occlusion, sometimes used in combination with catheter ablation for the treatment of atrial fibrillation 4, 5
• Non-pharmacological, percutaneous therapies for stroke prevention 4

Primary Prevention

Primary prevention of stroke involves assessing and managing modifiable risk factors, including:

• Cigarette smoking 6
• Physical inactivity 6
• Overweight and obesity 6
• Dyslipidemia 6
• Hypertension 6
• Diabetes 6
• Obstructive sleep apnea (OSA) 6
• Atrial fibrillation (AF) 6