Update on Stroke Risk Factor Reduction and Prevention Strategies
By Patrick J. Crowley, MBA

One of the priority goals of Healthy People 2020 is to improve cardiovascular health and quality of life through
prevention, detection, and treatment of risk factors for heart attack and stroke and also prevention of repeat
cardiovascular events (Gupta, 2014).

According to the National Stroke Association, stroke strikes approximately 800,000 Americans every year, killing
nearly 130,000 and forever changing the lives of many who survive. Stroke is a “brain attack,” cutting off vital blood
and oxygen to the brain cells that control functions such as speaking, walking, and breathing (National Stroke Association).

Most strokes occur when arteries are blocked by blood clots or by the gradual buildup of plaque and other fatty
deposits; some strokes can be caused by arteries rupturing when weak spots on the blood vessel wall break. The good
news is that many strokes can be prevented, and new emergency treatments can help stop the brain damage and

But, reducing risk is an important factor in the overall management of people with specific risk factors that can be
controlled. These include elevated cholesterol, hypertension, heart disease, atrial fibrillation, and carotid artery disease.
Additionally, lifestyle stroke risk factors, such as smoking, overweight/obesity, excessive alcohol consumption, and
lack of exercise are also controllable with lifestyle modifications and preventive measures.

Anthony and colleagues reported that current guidelines recommend global risk assessment instruments as the primary
approach for determining risk of coronary heart disease (CHD). The Framingham Risk Score yields a 10-year risk of
CHD, whereas the newer Pooled Cohort Equations yield a 10-year risk of stroke or CHD. Other biomarkers and genetic
tests can be utilized by clinicians to determine cardiovascular risk (Anthony, 2014).

Feigin and Norrving reported on a new paradigm for primary prevention strategy in people with elevated risk of stroke,
suggesting that existing methods of primary stroke prevention are not sufficiently effective. They commented that
based on the recently developed Stroke Riskometer app, a new "mass-elevated risk stroke/cardiovascular disease
prevention" approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention
approach is being advocated (Feigin, 2014). They opined…

  • "We believe this approach is far more appealing to the individuals concerned and could be as efficient as the
    conventional population-based approach because it allows identification and engagement in prevention of all
    individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease"

In February 2014, the American Heart Association/American Stroke Association released their first guideline focused
on stroke prevention in women, which highlights unique risk factors for stroke in women, including oral contraception
and hormone therapy, as well as pregnancy-associated disorders such as preeclampsia. In addition, the guidelines address
hypertension; atrial fibrillation; migraine headache with aura; and the epidemiology of type of stroke (eg, aneurismal
subarachnoid hemorrhage and cerebral vein thrombosis) that are predominant in women (Bushnell, 2014).

Overall, new guidelines for the prevention of stroke in patients with stroke and transient ischemic attack were published
online May 1, 2014, by the AHA/ASA (Kernan, 2014). The guideline is addressed to all clinicians who
manage secondary prevention for these patients.

  • "The aim of this updated guideline is too provide comprehensive and timely evidence-based recommendations
    on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack"
  • Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction,
    antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke
  • Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances,
    including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia,
    hypercoaguable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus
    thrombosis, and pregnancy
  • Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and
    implementation of guidelines


  • Anthony D, George P, Eaton CB. Cardiac risk factors: biomarkers and genetic tests to determine cardiovascular risk.
    FP Essent. 2014;421:11-15.
  • Bushnell C, McCullough L. Stroke prevention in women: synopsis of the 2014 American Heart Association/American
    Stroke Association guideline. Ann Intern Med. 2014;160(12):853-857.
  • Feigin VL, Norrving B. A new paradigm for primary prevention strategy in people with elevated risk of stroke. Int J Stroke.
  • Gupta S. Disparities in multiple risk factors for cardiovascular diseases—Delaware, 2011. Del Med J. 2014;86(3):77-84.
  • Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2014;45(7):2160-2236.
  • National Stroke Association. Reducing risk and recognizing symptoms. www.stroke.org/site/DocServer/ReducingRisk_8-09.pdf?docID=3027. Accessed July 25, 2014.
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