Guidelines for the Primary Prevention of Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

American Heart Association/American Stroke Association
Stroke (Impact Factor: 6.02). 02/2011; 42(2):517-84. DOI: 10.1161/STR.0b013e3181fcb238
Source: PubMed

ABSTRACT This guideline provides an overview of the evidence on established and emerging risk factors for stroke to provide evidence-based recommendations for the reduction of risk of a first stroke.
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council Scientific Statement Oversight Committee and the AHA Manuscript Oversight Committee. The writing group used systematic literature reviews (covering the time since the last review was published in 2006 up to April 2009), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations using standard AHA criteria (Tables 1 and 2). All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive peer review by the Stroke Council leadership and the AHA scientific statements oversight committees before consideration and approval by the AHA Science Advisory and Coordinating Committee.
Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic predisposition. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, migraine, hyperhomocysteinemia, elevated lipoprotein(a), hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed.
Extensive evidence identifies a variety of specific factors that increase the risk of a first stroke and that provide strategies for reducing that risk.

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    • "Accordingly, patients with an ischemic complication of atherosclerosis experience a particularly vulnerable disease phase [4]. Currently, prevention and management of cardio-cerebrovascular diseases encompass the control of risk factors, as well as antithrombotic interventions [5] [6]. Additional efforts are directed toward interrupting ongoing oxidative processes in the vessel wall so as to prevent ROS-provoked endothelial impairment [7]. "
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    ABSTRACT: Background and Objectives. Oxidative stress can initiate endothelial dysfunction and atherosclerosis. This study evaluated whether tetramethylpyrazine (TMP), the predominant active ingredient in Rhizoma Ligustici Wallichii (chuanxiong), prevents endothelial dysfunction in a rat model of oxidative stress. Methods. Isolated rat aortic rings were pretreated with various drugs before the induction of endothelial dysfunction by hydrogen peroxide (H2O2). Changes in isometric tension were then measured in acetylcholine- (ACh-) relaxed rings. Endothelial nitric oxide synthase (eNOS) expression was evaluated in the rings by Western blotting, and superoxide anion (O2 (∙-)) content was assessed in primary rat aortic endothelial cells by dihydroethidium- (DHE-) mediated fluorescence microscopy. Results. ACh-induced endothelium-dependent relaxation (EDR) was disrupted by H2O2 in endothelium-intact aortic rings. H2O2-impaired relaxation was ameliorated by acute pretreatment with low concentrations of TMP, as well as by pretreatment with catalase and the NADPH oxidase inhibitors, apocynin and diphenyleneiodonium (DPI). TMP, apocynin, and DPI also reduced O2 (∙-) accumulation in endothelial cells,but TMP failed to alter eNOS expression in aortic rings incubated with H2O2. Conclusions. TMP safeguards against oxidative stress-induced endothelial dysfunction, suggesting that the agent might find therapeutic utility in the management of vascular diseases. However, TMP's role in inhibiting NADPH oxidase and its vascular-protective mechanism of action requires further investigation.
    Evidence-based Complementary and Alternative Medicine 09/2014; 2014:627181. DOI:10.1155/2014/627181 · 1.88 Impact Factor
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    • "Physical activity has shown to be beneficial in primary prevention of stroke (Lee et al., 2003; Wendel-Vos et al., 2004; Goldstein et al., 2011) and may also help reduce the risk of recurrent stroke (Furie et al., 2011). "
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    ABSTRACT: High-intensity aerobic interval training (AIT) has shown to be beneficial in patients with cardiac and pulmonary diseases. Presumably, patients with stroke also benefit from such treatment. However, the feasibility and potential efficacy of high-intensity AIT should be investigated for patients early after stroke. This was a single-group, pre-test-post-test, intervention study. The intervention consisted of a 6-week high-intensity AIT programme, performed twice a week. The AIT comprised 4 × 4-minute intervals, at 85-95% of peak heart rate, interrupted by 3-minute active breaks. Adherence to the protocol, compliance and adverse events were registered to assess feasibility. Cardiorespiratory fitness and functional outcomes were assessed before and after the intervention and at 6 and 12 weeks follow-up. Ten men and five women (mean age 70.0 ± 7.7; range 61-85 years) with mild to moderate stroke were included, 3-9 months after onset. One patient was diagnosed with cancer during follow-up. There were three minor events, but no serious adverse events occurred. All patients accomplished all training sessions and reached the 85% intensity level, except one patient who discontinued the last session. The mean peak oxygen uptake showed no significant improvement from pre-treatment, 28.7 ± 3.8 ml kg(-1) min(-1) , to post-treatment, 29.6 ± 3.6 ml kg(-1) min(-1) , p = 0.189, whereas the mean 6-minute walk test improved from 410.7 ± 101.4 m to 461.0 ± 99.6 m, p = 0.001, and the median (interquartile range) Rivermead Motor Assessment Scale improved from 12.0 (11.0-13.0) to 13.0 (11.0-13.0) points, p = 0.100. These improvements continued after the intervention was concluded. This study has shown that high-intensity AIT is feasible for a selected group of stroke patients. However, the training should be accomplished in line with the American College of Sports Medicine guidelines for high-risk populations to ensure safety. The participants achieved a clinically highly significant improvement in walking distance. This intervention should be tested out in a randomized controlled trial to assess if it is superior to other interventions. Copyright © 2013 John Wiley & Sons, Ltd.
    Physiotherapy Research International 09/2014; 19(3). DOI:10.1002/pri.1573
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    • "While this has demonstrated significant impact on stroke reduction (Kahn et al., 2008), there is still a pressing need to do more to reduce stroke incidence and mortality. Although the precise amounts and type of exercise required to prevent stroke are unclear, meta-analyses conclude that regular PA reduces the risk of stroke by 25–30% when compared with the least active people (Goldstein et al., 2011; Lee, Folsom & Blair, 2003). "
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    ABSTRACT: Background. Physical inactivity is a powerful risk factor for stroke and other chronic diseases. The aim of this study was to explore physical activity habits and preferences in the month leading up to a first-ever stroke, and to determine whether participants were aware of the link between stroke and physical activity. Methods. We undertook an observational study with 81 participants recently admitted to a stroke unit. Participants reported their pre-morbid physical activity preferences and habits and completed the Barriers to Physical Activity and Disability Survey. Data were analysed with summative content analysis and descriptive statistics. Results. Only 31% of participants were aware that physical inactivity was associated with stroke. Most participants defined physical activity with examples of instrumental activities of daily living (IADL) and walking (48% of responses), and IADLs constituted their most frequent regular physical activity (38% of responses). The barriers to physical activity reported by participants most frequently were lack of motivation (52%), lack of interest (50%) and lack of energy (42%). Conclusions. Regular physical activity is important to prevent stroke and other chronic diseases but adults at risk of stroke have little awareness of the risks of physical inactivity and little motivation to undertake regular exercise.
    PeerJ 07/2014; 2:e489. DOI:10.7717/peerj.489 · 2.10 Impact Factor
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