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: 5.72). 02/2011; 42(2):517-84. DOI: 10.1161/STR.0b013e3181fcb238
Source: PubMed


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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    • "In addition, stroke is a major public health concern and considered 1 of the 12 health conditions with the highest burden of disease (Brown and Schultz 2010). Approximately 795,000 people in the US experience a new or recurrent stroke each year, of which about 610,000 are first attacks, and it is estimated that around 6.4 million Americans are stroke survivors (Goldstein et al. 2011). Although the annual stroke incidence and death rates have been decreasing over time as a result of active stroke prevention campaigns and recent advances in acute stroke management, the prevalence of stroke will continue to increase in the future, as the aging population continues to increase and acute stroke management continues to improve (Roger et al. 2011). "
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    ABSTRACT: Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.
    Full-text · Article · Mar 2015 · The Tohoku Journal of Experimental Medicine
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    • "The multifactorial and complex features of stroke impose a considerable challenge for the understanding of the pathology and for the development of new therapies. Multiple environmental factors including co-morbidities increase the risk of stroke [6]. Likewise, stroke severity is dependent on the type of stroke, density of ischemia and duration of vessel occlusion, and is also influenced by several toxic mechanisms, most identified in experimental animal models of stroke [7]. "
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    ABSTRACT: Background In experimental studies, the apolipoprotein D (APOD) and the sigma receptor type 1 (SIGMAR1) have been related to processes of brain damage, repair and plasticity.Methods We examined blood samples from 3081 ischemic stroke (IS) patients and 1595 control subjects regarding 10 single nucleotide polymorphisms (SNPs) in the APOD (chromosomal location 3q29) and SIGMAR1 (chromosomal location 9p13) genes to find possible associations with IS risk, IS severity (NIHSS-score) and recovery after IS (modified Rankin Scale at 90 days). Simple/multiple logistic regression and Spearman¿s rho were utilized for the analyses.ResultsAmong the SNPs analyzed, rs7659 within the APOD gene showed a possible association with stroke risk (OR¿=¿1.12; 95% CI: 1.01-1.25; P¿=¿0.029) and stroke severity (NIHSS¿¿¿16) (OR¿=¿0.70; 95% CI: 0.54-0.92; P¿=¿0.009) when controlling for age, sex and vascular risk factors for stroke. No SNP showed an association with stroke recovery (mRS).Conclusions We conclude that the SNP rs7659 within the APOD gene might be related to risk and severity of ischemic stroke in patients.
    Full-text · Article · Sep 2014 · BMC Neurology
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    • "Diabetes ranks as a leading cause of incident ischemic stroke [1-3]. Epidemiological study confirms that diabetes independently raises the risk of ischemic stroke, the relative risk ranging from 1.8- to nearly 6-fold [3]. A glycated hemoglobin (HbA1c) level of <7.0% is recommended by the American Diabetes Association (ADA) to prevent microvascular complications in type 2 diabetes patients [4,5]. "
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    ABSTRACT: Background Glycemic variation as an independent predictor of ischemic stroke in type 2 diabetic patients remains unclear. This study examined visit-to-visit variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), for predicting ischemic stroke independently, regardless of glycated hemoglobin (HbA1c) and other conventional risk factors in such patients.Methods Type 2 diabetic patients enrolled in the National Diabetes Care Management Program, ¿30 years old and free of ischemic stroke (n¿=¿28,354) in 2002 to 2004 were included, and related factors were analyzed with extended Cox proportional hazards regression models of competing risk data on stroke incidence.ResultsAfter an average 7.5 years of follow-up, there were 2,250 incident cases of ischemic stroke, giving a crude incidence rate of 10.56/1,000 person-years (11.64 for men, 9.63 for women). After multivariate adjustment, hazard ratios for the second, third and fourth versus first FPG-CV quartile were 1.11 (0.98, 1.25), 1.22 (1.08, 1.38) and 1.27 (1.12, 1.43), respectively, without considering HbA1c, and 1.09 (0.96, 1.23), 1.16 (1.03, 1.31) and 1.17 (1.03, 1.32), respectively, after considering HbA1c.Conclusions Besides HbA1c, FPG-CV was a potent predictor of ischemic stroke in type 2 diabetic patients, suggesting that different therapeutic strategies now in use be rated for their potential to (1) minimize glucose fluctuations and (2) reduce HbA1c level in type 2 diabetic patients to prevent ischemic stroke.
    Full-text · Article · Sep 2014 · BMC Medicine
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