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New guidelines describe how to prevent second strokes

Sunday May 4, 2014
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Stroke survivors should control their blood pressure, cholesterol and weight and regularly perform moderate physical activity to avoid having another stroke, according to an American Heart Association/American Stroke Association scientific statement.

They also should receive other evidence-based therapy specific to their individual health, which may include aspirin therapy or carotid artery surgery, according to the statement, which was published May 1 on the website of the journal 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,” Walter Kernan, MD, lead author and chair of the guideline writing group and professor of medicine at Yale University School of Medicine in New Haven, Conn., said in a news release.

Treating hypertension possibly is most important for secondary prevention of ischemic stroke, according to the statement. About 70% of people who have had a recent ischemic stroke also have hypertension.

The statement notes that intensive cholesterol-lowering therapy also is important for survivors whose stroke was caused by atherosclerosis. However, the association no longer recommends niacin or fibrate drugs to raise HDL cholesterol, due to sparse data establishing their effectiveness at reducing secondary stroke risk.

Stroke or TIA survivors who are capable of engaging in physical activity should participate in three to four sessions per week of aerobic exercise of moderate to vigorous intensity, such as walking briskly or riding a bike, according to the statement.

Since the last update in 2011, the association added sections on nutrition, sleep apnea, aortic arch atherosclerosis and prediabetes.

New recommendations include:

• Screening stroke and TIA survivors for diabetes and obesity;

• Possible screening for sleep apnea;

• Possible nutritional assessment;

• 30-day monitoring for atrial fibrillation for those who had a stroke of unknown cause;

• Anticoagulants in specific situations;

• Following a Mediterranean-type diet that emphasizes vegetables, fruits, whole grains and includes low-fat dairy, poultry, fish, legumes and nuts and limits sweets and red meat.

Clinical trials have not proven the benefits of a Mediterranean diet after ischemic stroke or TIA, so statement recommendations are based on compelling but lower levels of research.

Each year in the U.S., more than 690,000 adults have an ischemic stroke and about another 240,000 experience a TIA, which leaves no immediate impairment but puts survivors at high risk for future stroke.

On average, the annual risk for a future ischemic stroke after an initial ischemic stroke or TIA is about 3% to 4%.

“The key to staying healthy after an ischemic stroke or TIA is careful and rapid assessment of the cause of the event and identification of stroke risk factors so that appropriate preventive interventions can be quickly provided,” Kernan said. “Then, patients must work with their doctors regularly to stay on their prevention program. With this approach, every patient can look forward to a healthier future.”

Guidelines: http://bit.ly/1mjcZX0

To see what else is trending in Stroke, visit www.Nurse.com/Stroke.


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