|
|
 |
 |
|
|
| New guidelines outline stroke prevention strategies |
|
05 May 2006
New guidelines for reducing the risk of stroke have been released by the American Heart Association and the American Stroke Association. They are published in the online issue of Stroke: Journal of the American Heart Association.
The guidelines place a greater focus on an individual patient-oriented approach to stroke prevention, in contrast to the population-based approach discussed in the 2001 guidelines. To formulate the guidelines, lead author Dr Larry B. Goldstein, from Duke University in Durham, North Carolina, and his associates conducted a systematic literature review of trials published between 2001 and January 2005. The team advises using prediction models such as the Framingham Stroke Risk Profile to estimate a patient's risk of stroke.
The authors list important risk factors that are not subject to modification, including age, gender, race or ethnicity, genetic factors, and low birth weight. Armed with knowledge of such risk factors in their patients, physicians can identify those who would benefit more from therapeutic interventions addressing modifiable risk factors.
They then list well-documented and modifiable risk factors, including cardiovascular disease - dilated cardiomyopathy, valvular heart disease, and intracardiac congenital defects. Other treatable conditions listed are hypertension, exposure to tobacco smoke, asymptomatic carotid stenosis, atrial fibrillation, sickle cell disease, dyslipidaemia, excessive sodium intake, obesity, physical inactivity and postmenopausal hormone therapy.
For diabetes, they recommend tight control of hypertension and hyperglycaemia, and possibly use of a statin and an ACE inhibitor or an angiotensin receptor blocker.
They also suggest that for patients with sickle cell disease, transcranial Doppler ultrasound be performed, starting at 2 years of age. Transfusion therapy is likely to be of benefit for children found to be at high stroke risk.
The guidelines also include advice for "less-well-documented or potentially modifiable risk factors," such as metabolic syndrome, alcohol abuse, and drug abuse, including cocaine, amphetamines, and heroin. The researchers say that oral contraceptive use should probably be avoided in women with risk factors for stroke.
Dr Goldstein's team suggests that aspirin should not be recommended for preventing a first stroke in men, although aspirin prophylaxis may be of benefit for men with a high risk of cardiovascular events. There is some evidence that aspirin prophylaxis may reduce the risk of stroke among women. In either case, they say, aspirin should be used only if the benefits outweigh the risks.
Reference:
Stroke 2006 37 (6): 1583-1633.
 Back to selection |
|
 |
|
|
|
