Introduction

Stroke is a leading cause of disability and the fifth leading cause of death in the United States, with over 600,000 people experiencing their first stroke each year.

Up to 80% of these strokes may be preventable through lifestyle changes, routine screenings, and proper management of risk factors.

The 2024 guidelines for primary stroke prevention, released by the American Stroke Association (ASA), offer updated, evidence-based recommendations to help healthcare professionals and the general public take proactive steps toward reducing stroke risk.

Key Messages:

• Prevention Focus: Preventing a first stroke is critical, as it significantly reduces stroke-related deaths and disabilities.
• Risk Factor Screening: Regular screenings for high blood pressure, elevated cholesterol, blood sugar levels, and obesity are essential to identify individuals at high risk for stroke.
• Healthy Lifestyle Changes: Promoting lifestyle changes such as healthy eating, physical activity, smoking cessation, and adequate sleep are key to stroke prevention.
• Social Determinants of Health: The guidelines emphasize the need to address social determinants, including education, income, and access to healthcare, which affect stroke risk.

Recommendations:

1. Identifying and Managing Risk Factors

Primary care professionals should regularly screen patients for common stroke risk factors, including:

• High Blood Pressure: Antihypertensive medications can help reduce the risk of stroke in individuals with elevated blood pressure.
• Cholesterol: Statins should be prescribed to lower cholesterol and reduce stroke risk.
• Blood Sugar: Elevated blood sugar levels should be controlled, especially in individuals with Type 2 diabetes.
• Overweight and Obesity: Weight management through diet and exercise, and in some cases medications like GLP-1 receptor agonists, can reduce stroke risk.

2. Promoting Healthy Lifestyle Behaviors

The American Stroke Association’s Life’s Essential 8 metrics highlight essential lifestyle factors for stroke prevention, including:

• Healthy nutrition (e.g., Mediterranean diet)
• Regular physical activity (at least 150 minutes of moderate-intensity exercise per week)
• Avoiding tobacco use
• Getting sufficient sleep (7-9 hours per night)
• Managing cholesterol, blood sugar, and blood pressure

3. Health Equity and Social Determinants of Health

Health professionals should consider the impact of social factors such as education, economic stability, and access to healthcare in stroke prevention strategies. Providing resources for those facing challenges like food insecurity or inadequate housing is essential to ensure equitable stroke prevention efforts.

4. Sex- and Gender-Specific Recommendations

Special attention should be given to the unique stroke risks in women and gender-diverse individuals. These include:

• Pregnancy-Related Risks: High blood pressure during pregnancy or shortly after delivery increases stroke risk.
• Oral Contraceptives: Women using hormonal contraceptives should be counseled about their stroke risk, especially if they experience migraines.
• Transgender Individuals: Those undergoing hormone therapy may be at elevated risk for stroke and should receive tailored prevention strategies.

5. Medications for High-Risk Individuals

In addition to lifestyle interventions, medications such as antihypertensives, statins, and newer options like GLP-1 receptor agonists are recommended for individuals at high risk of cardiovascular events, including stroke.