AHA/ASA update guidelines to reduce first-time stroke risk

Each year, around 610,000 Americans experience a first-time stroke. But new guidelines from the American Heart Association (AHA)/American Stroke Association (ASA) highlight a number of interventions that may significantly lower the risk of a new stroke.

The new guidelines recommend following a Mediterranean- or DASH-style diet with extra nuts to reduce the risk of first-time stroke.

The researchers at the Mayo Clinic in Jacksonville, FL reached their recommendations by analyzing existing guidelines and a number of randomized clinical trials and observational studies.

The updated guidelines are published in the journal Stroke.

Stroke is the fourth leading cause of death in the US, killing almost 130,000 Americans every year. 

It occurs when a blood clot blocks an artery or vessel, restricting blood flow to the brain.

Age is an important risk factor for stroke; it is more likely to occur in people over the age of 55. It is also more common among men and those with a family history of stroke or transient ischemic attack, known as a "mini stroke."

Although these risk factors are not controllable, there are many that are. Major risk factors for stroke include high blood pressure, high cholesterol, diabetes, atherosclerosis, obesity, smoking and alcohol use. These controllable risk factors account for around 90% of stroke cases.

In the new American Heart Association/American Stroke Association (AHA/ASA) guidelines, the authors set out a number of strategies that they believe can significantly reduce the risk of new strokes by tackling these risk factors.

What do the AHA/ASA recommend to reduce first-time stroke risk?

Follow a Mediterranean- or DASH-style diet supplemented with nuts

The Mediterranean diet is frequently hailed for its health benefits. Only recently, researchers reported on a study claiming the diet - when supplemented with nuts or olive oil - may reverse metabolic syndrome.

But above all, the Mediterranean diet has been associated with better heart health. Last year, we reported on a study suggesting the diet can reduce genetic stroke risk, while other research claimed it can reduce heart attack and stroke in high-risk patients.

Based on the overwhelming evidence, the new AHA/ASA guidelines recommend following a Mediterranean-style diet or a diet similar to the Dietary Approaches to Stop Hypertension (DASH) diet, an eating plan developed by the National Heart, Lung and Blood Institute. The diets should be supplemented with nuts.

Both diets consist of lots of fruits, vegetables, whole grains, legumes, nuts, seeds, poultry and fish. The diets also limit red meat consumption and incorporate foods low in saturated fats.

In addition, the authors say individuals should lower their intake of sodium. The DASH eating plan is typically lower in sodium than the traditional Western diet.

Increasing physical activity and quitting smoking

The guidelines state that adopting regular physical activity can significantly lower blood pressure. Last year, researchers reported on a study revealing that individuals who participated in more than 4 hours of exercise a week in their leisure time had a 19% lower risk of high blood pressure.

The AHA/ASA state that adults should take part in at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise every week.

The authors note that smoking significantly raises the risk of stroke - particularly for women. A 2012 study from the association found that female smokers are at higher risk of hemorrhagic stroke - the most dangerous form of stroke.

As such, the new guidelines state that individuals should quit smoking to reduce the risk of stroke. They also recommend avoiding secondhand smoke, which has been linked to increased risk of stroke and heart attack.

The AHA website provides some tips on how to quit smoking.

Home monitoring and regular blood pressure checks

The new guidelines state that individuals should visit their health care providers once a year for a blood pressure evaluation.

They also recommend home blood pressure monitoring - in combination with an annual blood pressure check - to ensure blood pressure is kept under control.

For patients who are already using medication to lower blood pressure, they recommend talking to a health care provider if the medication is not working or promotes serious side effects. They add that patients should talk to their health care provider to find a medication regime that suits them.

Commenting on these new guidelines:

"We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled - especially high blood pressure - account for 90% of strokes.

Talking about stroke prevention is worthwhile. In many instances, stroke isn't fatal, but it leads to years of physical, emotional and mental impairment that could be avoided."