Updated Stroke Prevention Guidelines

Updated Stroke Prevention Guidelines

The American Heart Association and American Stroke Association (AHA/ASA) have updated guidelines on primary stroke prevention based on comprehensive and timely evidence from clinical investigations and research trials. Recommendations are included for controlling risk factors, using interventional approaches to atherosclerotic disease, and antithrombotic treatments for preventing stroke. The guidelines were published in Stroke and are available for free online at “One of the most important changes in the AHA/ASA guidelines is that newer anticoagulants can be used as alternatives to warfarin to prevent stroke in patients with atrial fibrillation (AF),” says James F. Meschia, MD, FAHA, who chaired the AHA/ASA committee that developed the recommendations. The guidelines note that although some of the new AF drugs are more expensive, they require less ongoing monitoring and therefore represent reasonable options for patients. Another key recommendation from the guidelines is that clinicians are urged to use of statins, along with diet and exercise, to help lower the stroke risk in patients at high risk for experiencing a stroke within the next 10 years. “In addition, the CHA2DS2-VASc is recommended for stratifying the risk for stroke,” says Dr. Meschia. “Patients with a score of 0 on the CHA2DS2-VASc do not require anticoagulants, but those with a score of 2 or higher should receive these therapies.” He adds that patients with a score of 1 on CHA2DS2-VASc can be considered for anticoagulants.   Women & Stroke According to the AHA/ASA, women have higher stroke risks if they are pregnant, use oral contraceptives, use hormone replacement therapy, have migraines, and/or have depression. The guidelines recognize the different risk factors women face throughout their...

An Update on Diagnosing & Treating PAD

Peripheral arterial disease (PAD) is a common and dangerous condition that affects millions of Americans, especially those with a history of diabetes or smoking. Despite efforts to increase awareness in the medical community, the disease remains largely underdiagnosed. For many patients, PAD is asymptomatic and may not lead to recognizable symptoms. In turn, a diagnosis may be delayed. If left untreated, PAD has been shown in published research to be predictive of heart attack, stroke, leg amputations, and death. In 2005, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), along with collaborating societies, released guidelines for the management of PAD. In 2011, the ACCF/AHA updated these guidelines to reflect new data in the diagnosis and treatment of the condition. “The 2011 guideline includes new information for diagnosing PAD, smoking cessation, the use of antiplatelet therapy, and interventions for treating severely ischemic limbs and abdominal aortic aneurysms (AAAs),” says Thom W. Rooke, MD, FACC, who chaired the committee that developed the 2011 guidelines. “The update can assist primary care clinicians, cardiologists, pulmonologists, interventional radiologists, vascular surgeons, and vascular medicine specialists in improving patient care.” Diagnosing Peripheral Arterial Disease The 2011 ACCF/AHA guideline includes a recommendation to lower the age at which anklebrachial index (ABI) diagnostic testing should be performed in the practice setting. “Previously, the recommendation was for patients aged 70 or older to receive an ABI,” says Dr. Rooke. “That threshold has been lowered to age 65 or older based on mounting evidence demonstrating that people in this age range have a 20% chance of having either symptomatic or asymptomatic PAD.” Furthermore, ABI diagnostic...