Updated Guidelines: Primary Stroke Prevention

In the February 1, 2011 issue of Stroke, the American Heart Association/American Stroke Association (AHA/ASA) released new guidelines for the primary prevention of stroke. The guideline reviews evidence on established and emerging risk factors for stroke. A significant change in these guidelines, which update a previous statement from 2006, is that clinicians are urged to address primary prevention of both ischemic and hemorrhagic stroke because the risk factors and prevention strategies for these events largely overlap. The critical role of a healthy lifestyle in the prevention of stroke is also emphasized. Areas of particular interest include emergency department (ED) screening, aspirin use among low-risk patients, asymptomatic carotid artery stenosis, and atrial fibrillation (AF), among other updates. ED screening for stroke risk represents an entirely new recommendation. Due to a lack of resources, there has been a surge in the number of people who receive care through the ED. This setting represents a unique opportunity to capture individuals at high risk of stroke and to offer information on smoking cessation programs, referrals for alcohol/drug abuse programs, screening for hypertension, and identification of AF. Aspirin Update A notable point in the AHA/ASA scientific statement is that aspirin is not recommended for preventing a first stroke in people at low risk or in those with diabetes or diabetes plus asymptomatic peripheral artery disease. Use of aspirin to prevent cardiovascular events—including but not limited to stroke—is recommended for those at sufficiently high risk. However, it’s important to weigh the risks, primarily bleeding, associated with treatment. Managing Asymptomatic Carotid Artery Stenosis Population screening for asymptomatic carotid artery stenosis is not recommended. An area that has...