Healthy habits and appropriate treatments help prevent stroke, according to graded, evidenced-based recommendations issued by the American Heart Association and it's division, the American Stroke Association.
These "primary prevention" guidelines are published in the rapid access issue of Stroke: Journal of the American Heart Association.
Stroke is the third leading cause of death and a major source of disability in the United States. Every year about 700,000 people in the United States suffer a stroke, resulting in nearly 158,000 deaths. From 1993-2003, the stroke death rate fell 18.5 percent, but the actual number of stroke deaths declined only 0.7 percent, according to 2006 association statistics.
"Stroke remains a major public health problem. Its human and economic toll is staggering," said Larry B. Goldstein, M.D., the guidelines' lead author and chair of the association's Stroke Council.
The estimated direct and indirect cost of stroke in 2006 is $57.9 billion.
"Stroke can be prevented and we are learning more about ways of accomplishing that," said Goldstein, professor of medicine (neurology) and director of the Duke Center for Cerebrovascular Disease at Duke University Medical Center in Durham, N.C. The guidelines addressed risks that can't be altered and those that can be influenced.
Non-modifiable risk factors
Risk factors that can't be changed include age, gender, race/ethnicity and family history. Older people, men, African Americans, and people with a family history of stroke are generally at greater risk than others.
The writing committee also cited low birth weight as a potential non-modifiable risk factor. Some studies have found that adults who weighed about 5.5 pounds (2,500 grams) or less at birth have double the risk of stroke as adults who weighed about 8 pounds (4,000 grams) or more at birth. However, the reason for this relationship remains uncertain.
"We are facing potential cutbacks in maternal health and nutrition programs. In addition to their public health benefits, it makes sense to invest in programs aimed at improving the health of women during pregnancy," Goldstein said. "Dividends may pay off decades later by potentially reducing the chances of stroke - and all the health costs that go with it - later in life."
Modifiable risk factors
In the guidelines, modifiable risk factors are categorized as "well-documented" or "less well-documented or potentially modifiable."
The guidelines reiterate some well-known prevention measures such as controlling high blood pressure, not smoking, avoiding exposure to secondhand smoke, being physically active and treating disorders that increase the risk of stroke such as atrial fibrillation (a type of irregular heartbeat), carotid artery disease and heart failure.
The guidelines suggest physicians consider using a risk assessment tool such as the Framingham Stroke Profile to assess patients' risk.
"It is important to identify patients at high risk of stroke because research shows that many strokes can be prevented if those individuals modify their risk factors," Goldstein said.
Some new recommendations for "well-documented" stroke risk factors include: