Guidelines for the Primary Prevention of Stroke

The American Heart Association (AHA), together with the American Stroke Association (ASA), has issued an updated statement on the primary prevention of stroke. This guideline is an update of the AHA statement published in 2011 [1]. It aims to provide comprehensive and timely evidence-based recommendations for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke.

Risk assessment strategies to assess the influence of both modifiable and unmodifiable risk factors are discussed, to be able to estimate risk for a first stroke for an individual patient. Recommendations are also provided for genetic and pharmacogenetic testing. Both prevention of haemorrhagic and ischaemic stroke are addressed. In the case of ischaemic stroke, whenever permitted by available evidence, the new tissue-based definition is adopted.

Differences in stroke risk among men and women are well recognised. Since AHA has recently issued a guideline specifically on the prevention of stroke in women [2], the current statement limits gender-specific issues to a summary of key recommendations on management of risk specific to women.

New or revised recommendations with respect to the earlier 2011 guideline included instructions on lifestyle. Following a Mediterranean diet supplemented with nuts is now advised to lower the risk of stroke. New recommendations also focus on the benefit of successfully reducing blood pressure, for which an individualised approach in choosing the right agent should be followed to obtain success. The guideline thus stresses the importance of a healthy diet, physical activity and BP control as key components of effective prevention of stroke.

Guidance is furthermore given on what type of antithrombotics or anticoagulation patients might need in the case of atrial fibrillation (valvular and non-valvular), with different CHA2DS2-VASc scores and for the prevention of stroke in a variety of other specific clinical scenario and conditions.

Find this guideline online

1. Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–584.
2. Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1545–1588.