ALTHOUGH the basic advice for preventing a first-time stroke remains the same, more finely tuned stroke prevention strategies have recently been set forth by the American Heart Association and the American Stroke Association for specific groups of individuals and certain situations than did the Associations’ previous report in 2006, says the July 2011 issue of the Johns Hopkins’ Health After 50.

The guidelines for preventing a first-time stroke are offered and remain:

• Keep blood pressure under 140/90

• Eat a diet low in saturated fat and high in fruits, vegetables and low-fat dairy products

• Cut the sodium; increase potassium

• Drink alcohol only in moderation — no more than one drink a day for women and two drinks a day for men

• Quit smoking if you currently light up

• Exercise regularly

• Maintain a normal body weight

While doctors used to believe that such strategies could reduce the risk of only one type of stroke — ischemic stroke, in which a blood clot blocks blood flow to the brain — the guidelines reveal that these measures can also help prevent hemorrhagic strokes, which are caused by ruptures or tears in blood vessels, and transient ischemic attacks (TIAs), whose short-lived stroke symptoms are often a precursor to an ischemic stroke.

Stroke is the fourth most common cause of death after heart disease, cancer and chronic lower respiratory disease.

About 2,000 less Americans died of stroke in 2008 than in 2007, according to the Centers for Disease Control and Prevention, and experts cite lifestyle-related prevention strategies as a major factor in the decline of stroke-related deaths.

Nevertheless, about 795,000 individuals in the United States have a stroke each year and most of these strokes are a first attack.

The importance of preventing a first stroke cannot be overemphasized because, of the roughly 6 million Americans who are stroke survivors: 20 percent remain in an institution three months after the stroke, and 15 to 30 percent become permanently disabled.

Whereas the updated guidelines provide new advice pertaining to individuals with specific health conditions, other recommendations, such as avoiding secondhand smoke, apply to everyone:

• Secondhand smoke — Studies suggest that being around a lot of smoke may increase your risk of stroke, although evidence regarding secondhand smoke isn’t as strong as that pertaining to smokers themselves. Still, avoiding secondhand smoke is a reasonable strategy for reducing strokes, according to  the guidelines.

• Aspirin therapy — While taking an aspirin a day has become a popular preventive care strategy for stroke, the guidelines emphasize that it won’t reduce your risk if you’re unlikely to have a stroke in the first place. Consult your physician before choosing this means of preventive care because the routine use of aspirin may cause side effects, such as stomach bleeding and even hemorrhagic stroke. The American Heart Association recommends you should take a daily aspirin only if your 10-year risk of heart attack or stroke is 10 percent or more. Similarly, the U.S. Preventive Services Task Force guidelines recommend aspirin only if your five-year risk of heart disease is at least 3 percent.

• Carotid artery stenosis — If you have symptoms of carotid artery stenosis (which is a narrowing of the arteries that supply blood from your neck to your brain), your doctor may recommend an interventional procedure — either carotid endarterectomy or stenting — to open up your arteries. However, if you have carotid artery stenosis without symptoms, the guidelines now recommend these interventional procedures if your carotid arteries are more than 60 percent closed on an angiogram or more than 70 percent closed on an ultrasound. Discuss with your doctor the risks and benefits of interventional procedures, as well as, possible alternatives, such as lifestyle changes or medication.

• Atrial fibrillation — If you have atrial fibrillation (which is an abnormal heart rhythm that causes the upper two chambers of your heart to quiver) you’re at increased risk for stroke. Your doctor will probably put you on the blood thinner warfarin (Coumadin, Jantoven), if you have additional risk factors, such as being older than age 75 or having high blood pressure. Warfarin is prescribed to prevent the formation of blood clots, which can cause a stroke. Aspirin over warfarin will probably be recommended by your doctor if you have few additional risk factors. The Food and Drug Administration recently approved a new anticoagulant called dabigatran (Pradaxa) for atrial fibrillation. Although the drug appears to work as well as warfarin at preventing stroke, with lower risk of bleeding, the guidelines don’t make specific recommendations on Pradaxa, and it isn’t considered a replacement for warfarin at this time.

• Diabetes — If you have diabetes, controlling your blood pressure is still key to lowering your overall cardiovascular risk. The guidelines recommend an ACE inhibitor or Angiotensin II receptor blocker in those cases. In addition, a cholesterol-lowering statin medication may reduce your risk of a first stroke, especially if you have additional risk factors.

Since your risk of stroke increases as you get older, ask your doctor which prevention strategies are right for you, including those recommended by the American Heart Association and the American Stroke Association, concludes the health letter.

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