National guidelines on preventing stroke have been updated for the first time in a decade, with a new emphasis on strokes among women, lifestyle changes to reduce risk, and non-medical social determinants of health.
Updates to the guidelines – from the American Heart Association (AHA) and the American Stroke Association (ASA) – reflect new research into stroke since the guidelines were last published in 2014.
“A focus on risk factors in pregnancy is something that’s new” in the guidelines, says University of Colorado School of Medicine faculty member Sharon Poisson, MD. “They also talk about risk factors in postmenopausal women. They even talk about testosterone levels in men. So, there are more sex-specific recommendations for screening and control of risk factors.”
Poisson, a professor in the CU Department of Neurology, co-authored a 2022 study reporting that among adults ages 35 and younger, women are 44% more likely than men to suffer ischemic strokes, where the flow of blood to the brain is obstructed.
“Over the last few decades, while we’re seeing decreasing rates of stroke in the overall population, we’ve seen increasing rates in young people, especially among young women,” she says. “I think we’re behind on young people understanding the risk of stroke, and also on physicians understanding that risk for young people and the importance of risk factor management.”
Across the board
A stroke, Poisson says, “is an injury to the brain that occurs because of some change in blood flow. Ischemic strokes are the most common. They’re related to a lack of blood flow to the brain because of a blood vessel either being narrow because of plaque deposits or being closed from a clot. There are also hemorrhagic strokes that involve bleeding in the brain, such as aneurysms. Those two types share a lot of risk factors.”
As of 2023, stroke was the fourth most common cause of death in the U.S., and Poisson says it is the leading cause of disability among adults.
“There are some people who do very well after a first stroke, and don’t have long-lasting consequences other than an increased risk of stroke going forward,” she says. “Others can have severe consequences, such as weakness, especially on one side of the body. It can affect people’s ability to talk and communicate, vision, swallowing, and walking. It’s across the board.”
Updates to the guidelines
Up to 80% of strokes are considered preventable. The revised AHA-ASA guidelines emphasize the importance of preventing a first stroke, which impacts more than 600,000 people in the United States each year. They offer a new risk-assessment screening tool for clinicians to use.
The guidelines call on health care providers to help prevent first strokes by screening their patients for stroke risk factors, including high blood pressure, elevated cholesterol, high blood sugar, and obesity.
Poisson emphasizes the importance in preventing strokes of “seeing primary care physicians on a regular basis and being screened for risk factors. High blood pressure is probably the most important thing to address to lower the risk of stroke, but if somebody is not regularly seeing a physician, they may not know if they have high blood pressure. Same with things like diabetes and high cholesterol. If we don’t know about them early, we can’t intervene before a stroke happens.”
The guidelines also advise healthy lifestyle changes – such as quitting tobacco, increased physical activity, improved diet, managing weight, and better sleep – as ways for people to reduce risk of stroke and other health threats. They point to the AHA’s “Life’s Essential 8” as a guide.
Also new in the guidelines is a focus on social determinants of health as factors in stroke risk and overall health. These include education, economic stability, access to care, discrimination, structural racism, housing insecurity, and neighborhood limitations, such as lower availability of healthy food.
The sooner the better
To familiarize people with signs of a stroke, Poisson and others use an acronym, “BE FAST”: B for balance, E for eyesight changes, F for face drooping, A for arm or leg weakness, S for speech difficulty, and T for time to call 911.
“Most of the time, stroke symptoms happen all of a sudden,” Poisson says. “One minute, someone’s fine, and the next minute they have new symptoms. Or they go to bed fine and wake up with new symptoms.”
When someone has a stroke and is brought to the hospital, she says, “the first goals are to identify the stroke and stop the damage to the brain. There are clot-busting medicines, but we have a short window of time to be able to use them – about 4-1/2 hours from before the stroke.”
A thrombectomy – a surgical procedure to removes a blood clot – is performed in some cases, but it too must be done as soon as possible after a stroke. “The sooner we can restore blood flow to the brain, the better people do,” Poisson says.
Poisson notes that UCHealth University of Colorado Hospital on the CU Anschutz Medical Campus is a Joint Commission-certified comprehensive stroke center, the highest level of certification, “which means we’re equipped to manage even the most complex strokes. We’ve seen a large amount of growth over the last several years.”
