Top Things to Know: Guidelines for the Prevention of Stroke in Patients With Stroke and TIA
Published: May 01, 2014
- Initiation of treatment for hypertension in those not previously treated is critical to prevention of a second stroke and it is important that stroke patients who were previously treated for HTN be restarted on appropriate anti-hypertension medication for secondary prevention.
- Goals for target BP level or reduction from pretreatment baseline are not clear and they should be individualized, but it is reasonable to achieve a systolic pressure <140 mmHg and a diastolic pressure <90 mmHg.
- Intensive lipid-lowering effects from statin therapy is recommended to reduce risk of stroke and cardiovascular events in patients with ischemic stroke or TIA of atherosclerotic origin and an LDL-C level ≥100 mg/dL with or without evidence for other clinical ASCVD.
- Patients with ischemic stroke or TIA and other comorbid atherosclerotic cardiovascular disease (ASCVD) should also be managed using to the ACC/AHA 2013 guidelines, including lifestyle modification, dietary recommendations, and medication recommendations.
- Obesity is associated with increased risk for incident stroke and therefore all patients with TIA or stroke should be screened for obesity with measurement of body mass index (BMI).
- Patients with ischemic stroke or TIA who can engage in physical activity at a minimum 3 to 4, 40 minute sessions per week of moderate-vigorous intensity aerobic physical exercise is recommended to reduce stroke risk factors.
- Cigarette smoking is an independent risk factor for first ischemic stroke. Cigarette smoking is also a contributor for silent brain infarction.
- Heavy alcohol use is a major risk for ischemic stroke, TIA, or hemorrhagic stroke. This guideline advises for heavy alcohol users, it should be eliminated or reduced to reduce the risk of recurrent stroke.
- Persons with stroke of atherosclerotic origin (non-cardioembolic) should receive antiplatelet therapy for prevention of recurrent stroke.
- This guideline recommends monitoring achievement of nationally-accepted, evidence based guidelines to identifying areas to target for quality improvement interventions.
Citation
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [published online ahead of print May 1, 2014]. Stroke. doi: 10.1161/STR.0000000000000024.