Stroke prevention guidelines focus more on patient
Last Updated: 2006-05-04 16:00:36 -0400 (Reuters Health)
NEW YORK (Reuters Health) - New stroke prevention guidelines place a greater focus on an individual patient-oriented approach to stroke prevention, in contrast with the population-based approach discussed in the 2001 guidelines.
The guidelines were released by the American Heart Association and the American Stroke Association and are published in the online issue of Stroke: Journal of the American Heart Association. To formulate the guidelines, lead author Dr. Larry B. Goldstein, from Duke University in Durham, North Carolina, and his associates conducted a systematic review of clinical trials published between 2001 and January 2005.
Some important risk factors that are not subject to modification include age, gender, race or ethnicity, genetic factors and low birth weight. Armed with the knowledge of such risk factors in their patients, physicians can identify those who would benefit more from therapeutic interventions that address modifiable risk factors.
Some well-documented, modifiable or treatable risk factors include high blood pressure, exposure to tobacco smoke, blockage of the carotid arteries in the neck, irregular heart rhythm, sickle cell disease, high cholesterol, excessive sodium intake, obesity, physical inactivity and postmenopausal hormone therapy.
For diabetics, the guidelines recommend tight control over blood pressure and blood sugar, and possibly the use of a cholesterol-lowering drug or high blood pressure medication.
The physicians also suggest that patients with sickle cell disease undergo ultrasound imaging of the brain, starting at 2 years of age. Transfusion therapy is likely to be of benefit for children who are found to have a high stroke risk.
The guidelines also include advice for "less-well-documented or potentially modifiable risk factors," such as the metabolic syndrome (a cluster of risk factors such as high blood pressure, obesity and high blood sugar); alcohol abuse; and abuse of drugs such as cocaine, amphetamines and heroin. The researchers also note that oral contraceptives should probably be avoided by women with stroke risk factors.
There is also some evidence that sleep apnea (interruption of breathing during sleep), migraine, high blood levels of specific types of fats, excessive coagulation of the blood, infection and inflammation, and postmenopausal hormone therapy, are associated with increased risk of stroke.
Aspirin is not recommended for preventing a first stroke in men, although it may benefit men with a high risk of cardiovascular events. There is some evidence that aspirin treatment can reduce the risk of stroke in women. In either case, the researchers say, aspirin should be used only if the benefits outweigh the risks.
SOURCE: Stroke 2006.
