2024 Guideline for the Primary Prevention of Stroke

2024 guidelines on the primary prevention of stroke

This guideline delves into the details of what we should be doing in order to prevent the very first stroke in patients. Overall, the recommendations agree with the American Heart Association's Life's Essential 8 recommendations that were published before for the prevention of cardiovascular disease.

However, this guideline has a few specific recommendations for stroke prevention, and some of those are listed below:

• The Mediterranean diet is recommended for people who are at intermediate or high risk of stroke.
• Sedentary behavior increases the risk of stroke; hence, avoiding sitting. Engaging in moderate to vigorous physical activity is recommended.
• GLP-1 receptor agonists should be used to help with diabetes and weight management in order to reduce the risk of cardiovascular events, specifically stroke. This is recommended for patients with diabetes and high cardiovascular risk or those with established cardiovascular disease.
• Blood pressure (BP) management remains critical, but studies show that only 30% of the participants achieved control with one agent; hence, we will need to use two or more agents in order to control BP for the primary prevention of stroke.
• Antiplatelet therapy is recommended in patients with antiphospholipid syndrome or systemic lupus erythematous without a history of stroke or a venous thrombosis event. For patients with antiphospholipid syndrome who have experienced a prior venous thrombosis event, a vitamin K antagonist with an international normalized ratio between 2 and 3 is preferred over direct oral anticoagulants.
• In pregnant women, we should treat hypertension when systolic BP is ≥160 mm Hg or diastolic BP is ≥110 mm Hg in order to reduce the risk of intracranial bleeding, and we should manage all other vascular risk factors as well.
• Patients with endometriosis, premature ovarian failure, or menopause before 40 years of age are at an increased risk for stroke; hence, their cardiovascular risk factors need to be managed.
• Transgender patients who are taking estrogen are at an increased risk for stroke; hence, their cardiovascular risk factors need to be managed.

The hope is that, with these new guidelines, we can prevent the occurrence of the very first stroke in patients.