Second stroke not inevitable

Second stroke not inevitable: New guidelines point the way to prevention

May 17, 2014—Stroke survivors today could cut their risk of a second stroke by working with their doctors and making healthy changes such as eating right and exercising.

That’s among the takeaways from updated American Heart Association and American Stroke Association guidelines. The update, published online in Stroke, addresses lifestyle changes and treatments that may be needed after a clot-caused ischemic stroke or a transient ischemic attack (TIA), or warning stroke.

“A vast amount of new research is revealing new and improved ways to protect patients with an ischemic stroke or transient ischemic attack from having recurrent events and further brain damage,” said Walter Kernan, MD, the chair of the writing group that pulled together these guidelines.

Key findings

Ischemic strokes, or brain attacks, occur when blood flow to the brain is disrupted. And they have a high rate of recurrence, according to the statement that accompanied these guidelines. TIAs involve strokelike symptoms that increase the risk of a future stroke, often within days or weeks. But the guidelines emphasize a number of ways people can reduce those risks. Here are some of the highlights:

  • Of all the prevention strategies, regulating high blood pressure with lifestyle changes, medicines or both may be the most crucial. Since about 7 in 10 stroke survivors have high blood pressure, this tip is simply vital.
  • Cholesterol-lowering statins are important for those with strokes caused by artery disease. But niacin or fibrate drugs, which boost levels of HDL, or good cholesterol, are no longer recommended because it’s not clear if they help prevent second strokes.

The update includes a number of new recommendations too. For example, some people may need:

  • Screening for diabetes, obesity and unhealthy eating patterns that might contribute to stroke
  • A sleep study to check for and possibly treat sleep apnea—a condition in which breathing stops briefly during sleep
  • Monthlong monitoring for an irregular heartbeat, called atrial fibrillation
  • Blood-thinning medicines called anticoagulants

Stroke survivors should also try to get active three to four times per week with a doctor’s approval. Brisk walks or bike riding are often recommended.

On the nutrition front, switching to a Mediterranean-style diet may be somewhat beneficial, according to the authors. Such a diet is generally rich in plant-based foods and includes heart-healthy oils, low-fat dairy and limited amounts of red meat.

In addition, some people may need other therapies, depending on their situation. These can include aspirin to help prevent clots or procedures to open clogged neck arteries.

You can read the full guidelines here.

The take-home message
Staying healthy after a stroke or TIA starts with a careful and rapid assessment of the causes and risk factors so that treatment can quickly begin, Dr. Kernan noted.

“Then, patients must work with their doctors regularly to stay on their prevention program,” he said. “With this approach, every patient can look forward to a healthier future.”

You can learn more about your stroke risk factors by taking this assessment.

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