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Over half a million people in the United States have their first stroke each year, according to the American Stroke Association (ASA). To reduce the risk of stroke, the ASA has updated its guidelines with prevention strategies and screening recommendations.
Lowering blood pressure and adopting healthier lifestyles could prevent up to 80% of these initial strokes, according to the ASA, a division of the American Heart Association.
“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention,” Cheryl D. Bushnell, MDchair of the stroke prevention guideline writing group, said in a statement.
A stroke occurs when blood flow to part of the brain is blocked or when a brain blood vessel bursts. Without blood flow, brain cells cannot receive oxygen, and they die.
The revised guidelines, which replace those from a decade ago, reflect insights from research conducted over the past 10 years, Bushnell told Verywell.
They emphasize regular screening for stroke risk factors like high blood pressure, high cholesterol, diabetes, and obesity. The guidelines also outline lifestyle changes using the ASA’s Life’s Essential 8 cardiovascular metricswhich include eating a nutritious diet, staying physically active, getting healthy sleep, and more.
Moreover, the guidelines advocate following the Mediterranean diet, which focuses on whole grains, fish, and an abundance of fruits and vegetables.
A significant update in these guidelines includes considering GLP-1 drugs, such as Wegovy and Ozempic, for patients with diabetes and heart disease. Although studies have not yet confirmed that these drugs prevent strokes, they have been shown to reduce heart attack risk, suggesting potential stroke prevention benefits, according to Anirudh Sreekrishnan, MDdirector of the Outpatient Stroke Clinic at the University of California San Francisco.
Related: Signs and Symptoms of Stroke
Updated Stroke Prevention Guidance for Women
The updated guidelines include specific recommendations for preventing strokes in women, Bushnell noted. The ASA advises healthcare providers to screen women for risk factors such as oral contraceptive use, high blood pressure during pregnancy, and pregnancy-related complications like preterm birth.
Additional risk factors for women include endometriosis, premature ovarian failure (before age 40), and early-onset menopause (before age 45), all of which can elevate stroke risk.
The guidelines also highlight a new concern: transgender women and gender-diverse individuals taking estrogen for gender affirmation may have an increased risk of stroke. The ASA suggests these individuals collaborate closely with their doctors to mitigate stroke risk through healthy lifestyle practices.
High blood pressure is a major risk factor for stroke, particularly in women, according to the ASA. In the United States, over 40% of women have high blood pressure—defined as a reading of 130/80 mm Hg or higher or requiring medication to manage it. However, less than 25% of women with hypertension have their blood pressure adequately controlled to below the recommended threshold of 130/80 mm Hg.
Stroke incidence is also higher in women, largely because stroke risk increases with age. Since women typically live longer than men, more women experience strokes over their lifetimes, according to the CDC.
Racial Disparities in Stroke Risk
Stroke is a leading cause of death among Black women. Almost three in five Black women are diagnosed with high blood pressure, a much higher proportion than among White women (almost two in five). Black women are also diagnosed with higher rates of obesity (nearly three in five) and diabetes (more than one in eight), conditions that increase the risk for stroke.
How to Reduce Stroke Risk
The new guideline recommends at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.
“If there is one fundamental thing I always encourage in my patients—young and old—to help promote cerebrovascular health, it’s movement,” Sreekrishnan said, adding that exercises like walking, hiking, and swimming are vital to cardiovascular maintenance and cognitive health.
“That is why I was thrilled that the guidelines now highlight the importance of screening sedentary behaviors, call for new studies or interventions to help address these behaviors, and recommend the importance of promoting moderate-intensity exercise among all of our patients,” Sreekrishnan added.
Bushnell said the new guideline may offer prevention for brain health as well. “Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke,” Bushnell said. Most strategies for preventing stroke, she added, will also help reduce the risk of dementia.
What This Means For You
The new stroke prevention guidelines emphasize regular screening for high blood pressure, cholesterol, diabetes, and obesity. Healthy lifestyle changes could prevent up to 80% of first strokes. Women and gender-diverse individuals should be aware of unique risk factors, including hormonal birth control use and pregnancy complications. Discussing personalized prevention strategies with your doctor is essential.
