Stroke. 2006;37:1583-1633
Published online before print May 4, 2006, doi: 10.1161/01.STR.0000223048.70103.F1
Published online before print May 4, 2006, doi: 10.1161/01.STR.0000223048.70103.F1
(Stroke. 2006;37:1583.)
© 2006 American Heart Association, Inc.
AHA/ASA Guideline |
Primary Prevention of Ischemic Stroke
A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Abstract
Background and Purpose— This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk.
Methods— Writing group members were nominated by the committee chair on the basis of each writer’s previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The writers used systematic literature reviews (covering the time period since the last review published in 2001 up to January 2005), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations based on standard American Heart Association criteria. All members of the writing group had numerous opportunities to comment in writing on the recommendations and approved the final version of this document. The guideline underwent extensive peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.
Results— Schemes for assessing a person’s risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed.
Conclusion— Extensive evidence is available identifying a variety of specific factors that increase the risk of a first stroke and providing strategies for reducing that risk.
Key Words: AHA Scientific Statements • stroke • risk factors • primary prevention
This article has been cited by other articles:
 |
|
 |
|
  P. Armario and A. de la Sierra Antihypertensive treatment and stroke prevention: are angiotensin receptor blockers superior to other antihypertensive agents? Therapeutic Advances in Cardiovascular Disease, June 1, 2009; 3(3): 197 - 204. [Abstract] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein The Cart and The Horse: The Advancing Technology of Carotid Artery Stenting Circ Cardiovasc Intervent, June 1, 2009; 2(3): 153 - 155. [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein and P. M. Rothwell Advances in Primary Prevention and Health Services Delivery Stroke, May 1, 2009; 40(5): e295 - e297. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Armstrong-Wells, B. Grimes, S. Sidney, D. Kronish, S. C. Shiboski, R. J. Adams, and H. J. Fullerton Utilization of TCD screening for primary stroke prevention in children with sickle cell disease Neurology, April 14, 2009; 72(15): 1316 - 1321. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Johannsen, P. R. Kamstrup, R. V. Andersen, G. B. Jensen, H. Sillesen, A. Tybjaerg-Hansen, and B. G. Nordestgaard Hepatic Lipase, Genetically Elevated High-Density Lipoprotein, and Risk of Ischemic Cardiovascular Disease J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1264 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Appelros, B. Stegmayr, and A. Terent Sex Differences in Stroke Epidemiology: A Systematic Review Stroke, April 1, 2009; 40(4): 1082 - 1090. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. J. Howard, J. H. Voeks, H. L. Lutsep, A. Mackey, G. Milot, A. D. Sam II, M. Tom, S. E. Hughes, A. J. Sheffet, M. Longbottom, et al. Does Sex Matter? Thirty-Day Stroke and Death Rates After Carotid Artery Stenting in Women Versus Men: Results From the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) Lead-in Phase Stroke, April 1, 2009; 40(4): 1140 - 1147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Kajantie, J. G. Eriksson, C. Osmond, K. Thornburg, and D. J.P. Barker Pre-Eclampsia Is Associated With Increased Risk of Stroke in the Adult Offspring: The Helsinki Birth Cohort Study Stroke, April 1, 2009; 40(4): 1176 - 1180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Nambi, R. C. Hoogeveen, L. Chambless, Y. Hu, H. Bang, J. Coresh, H. Ni, E. Boerwinkle, T. Mosley, R. Sharrett, et al. Lipoprotein-Associated Phospholipase A2 and High-Sensitivity C-Reactive Protein Improve the Stratification of Ischemic Stroke Risk in the Atherosclerosis Risk in Communities (ARIC) Study Stroke, February 1, 2009; 40(2): 376 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Jones, E. D. Peterson, R. O. Bonow, R. J. Gibbons, B. A. Franklin, R. L. Sacco, D. P. Faxon, V. J. Bufalino, R. F. Redberg, N. M. Metzler, et al. Partnering to Reduce Risks and Improve Cardiovascular Outcomes: American Heart Association Initiatives in Action for Consumers and Patients Circulation, January 20, 2009; 119(2): 340 - 350. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Chertkow, F. Massoud, Z. Nasreddine, S. Belleville, Y. Joanette, C. Bocti, V. Drolet, J. Kirk, M. Freedman, and H. Bergman Diagnosis and Treatment of Dementia: 3. Mild Cognitive Impairment and Cognitive Impairment Without Dementia Focus, January 1, 2009; 7(1): 64 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Cronin and P. J. Kelly Stroke and the Metabolic Syndrome in Populations: The Challenge Ahead Stroke, January 1, 2009; 40(1): 3 - 4. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Lindsay BScN PhD, M. Bayley MD, C. Hellings BScH, M. Hill MSc MD, E. Woodbury BCom MHA, S. Phillips MBBS, and (Canadian Stroke Strategy Best Practices and Stand Canadian best practice recommendations for stroke care (updated 2008) Can. Med. Assoc. J., December 2, 2008; 179(12): S1 - S25. [Full Text] [PDF]
|
|
|
|
|
|
P. Lindsay BScN PhD, M. Bayley MD, C. Hellings BA, M. Hill MSc MD, E. Woodbury BCom MHA, S. Phillips MBBS, and (Groupe de redaction Pratiques optimales et normes Recommandations canadiennes pour les pratiques optimales de soins de l'AVC (mise a jour de 2008) Can. Med. Assoc. J., December 2, 2008; 179(12): SF1 - SF29. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Rose, W. D. Rosamond, S. L. Huston, C. V. Murphy, and C. H. Tegeler Predictors of Time From Hospital Arrival to Initial Brain-Imaging Among Suspected Stroke Patients: The North Carolina Collaborative Stroke Registry Stroke, December 1, 2008; 39(12): 3262 - 3267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sundell, V. Salomaa, E. Vartiainen, K. Poikolainen, and T. Laatikainen Increased Stroke Risk Is Related to a Binge Drinking Habit Stroke, December 1, 2008; 39(12): 3179 - 3184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Buechner, M Moretti, A P Burlina, G Cei, R Manara, R Ricci, R Mignani, R Parini, R Di Vito, G P Giordano, et al. Central nervous system involvement in Anderson-Fabry disease: a clinical and MRI retrospective study J. Neurol. Neurosurg. Psychiatry, November 1, 2008; 79(11): 1249 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Samii and B. Ransom Neurology and Clinical Neuroscience Arch Neurol, October 1, 2008; 65(10): 1392 - 1392. [Full Text] [PDF]
|
|
|
|
|
|
M. Yenari, K. Kitagawa, P. Lyden, and M. Perez-Pinzon Metabolic Downregulation: A Key to Successful Neuroprotection? Stroke, October 1, 2008; 39(10): 2910 - 2917. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein Reducing Death and Disability From Stroke: The Role of Governmental Advocacy Stroke, October 1, 2008; 39(10): 2898 - 2901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Prati, A. Tosetto, D. Vanuzzo, G. Bader, M. Casaroli, L. Canciani, S. Castellani, and P.-J. Touboul Carotid Intima Media Thickness and Plaques Can Predict the Occurrence of Ischemic Cerebrovascular Events Stroke, September 1, 2008; 39(9): 2470 - 2476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. M. Bhat, J. W. Cole, J. D. Sorkin, M. A. Wozniak, A. M. Malarcher, W. H. Giles, B. J. Stern, and S. J. Kittner Dose-Response Relationship Between Cigarette Smoking and Risk of Ischemic Stroke in Young Women Stroke, September 1, 2008; 39(9): 2439 - 2443. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Primary Prevention of Stroke: Impact of Healthy Lifestyle Circulation, August 26, 2008; 118(9): 904 - 906. [Full Text] [PDF]
|
|
|
|
|
|
S. E. Chiuve, K. M. Rexrode, D. Spiegelman, G. Logroscino, J. E. Manson, and E. B. Rimm Primary Prevention of Stroke by Healthy Lifestyle Circulation, August 26, 2008; 118(9): 947 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Romero, J. Morris, and A. Pikula Review: Stroke prevention: modifying risk factors Therapeutic Advances in Cardiovascular Disease, August 1, 2008; 2(4): 287 - 303. [Abstract] [PDF]
|
|
|
|
|
|
G. Saposnik, R. Cote, S. Phillips, G. Gubitz, N. Bayer, J. Minuk, S. Black, and for the Stroke Outcome Research Canada (SORCan) Wo Stroke Outcome in Those Over 80: A Multicenter Cohort Study Across Canada Stroke, August 1, 2008; 39(8): 2310 - 2317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele Impairment in Glomerular Filtration Rate or Glomerular Filtration Barrier and Occurrence of Stroke Arch Neurol, July 1, 2008; 65(7): 934 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Tanaka, Y. Ishikawa, M. Yokoyama, H. Origasa, M. Matsuzaki, Y. Saito, Y. Matsuzawa, J. Sasaki, S. Oikawa, H. Hishida, et al. Reduction in the Recurrence of Stroke by Eicosapentaenoic Acid for Hypercholesterolemic Patients: Subanalysis of the JELIS Trial Stroke, July 1, 2008; 39(7): 2052 - 2058. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mosca Aspirin Chemoprevention: One Size Does Not Fit All Circulation, June 3, 2008; 117(22): 2844 - 2846. [Full Text] [PDF]
|
|
|
|
|
|
M. Rodriguez-Yanez, J. Agulla, R. Rodriguez-Gonzalez, T. Sobrino, and J. Castillo Review: Statins and stroke Therapeutic Advances in Cardiovascular Disease, June 1, 2008; 2(3): 157 - 166. [Abstract] [PDF]
|
|
|
|
|
|
K. Toyoda, M. Yasaka, K. Iwade, K. Nagata, Y. Koretsune, T. Sakamoto, S. Uchiyama, J. Gotoh, T. Nagao, M. Yamamoto, et al. Dual Antithrombotic Therapy Increases Severe Bleeding Events in Patients With Stroke and Cardiovascular Disease: A Prospective, Multicenter, Observational Study Stroke, June 1, 2008; 39(6): 1740 - 1745. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Chertkow MD, F. Massoud MD, Z. Nasreddine MD, S. Belleville PhD, Y. Joanette PhD, C. Bocti MD, V. Drolet BSc, J. Kirk MD, M. Freedman MD, and H. Bergman MD Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia Can. Med. Assoc. J., May 6, 2008; 178(10): 1273 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Wouts, R. C. O. Voshaar, M. A. Bremmer, J. K. Buitelaar, B. W. J. H. Penninx, and A. T. F. Beekman Cardiac Disease, Depressive Symptoms, and Incident Stroke in an Elderly Population Arch Gen Psychiatry, May 1, 2008; 65(5): 596 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, S. C. Johnston, et al. Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Stroke, May 1, 2008; 39(5): 1647 - 1652. [Full Text] [PDF]
|
|
|
|
|
|
T. Kurth and G. Logroscino The Metabolic Syndrome: More Than the Sum of Its Components? Stroke, April 1, 2008; 39(4): 1068 - 1069. [Full Text] [PDF]
|
|
|
|
|
|
T. C. Turin, Y. Kita, Y. Murakami, N. Rumana, H. Sugihara, Y. Morita, N. Tomioka, A. Okayama, Y. Nakamura, R. D. Abbott, et al. Higher Stroke Incidence in the Spring Season Regardless of Conventional Risk Factors: Takashima Stroke Registry, Japan, 1988-2001 Stroke, March 1, 2008; 39(3): 745 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. LaBresh, M. J. Reeves, M. R. Frankel, D. Albright, and L. H. Schwamm Hospital Treatment of Patients With Ischemic Stroke or Transient Ischemic Attack Using the "Get With The Guidelines" Program Arch Intern Med, February 25, 2008; 168(4): 411 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Jordan, R. J. Wityk, M. M. Dowling, M. R. DeJong, and A. M. Comi Transcranial Doppler Ultrasound in Children with Sturge-Weber Syndrome J Child Neurol, February 1, 2008; 23(2): 137 - 143. [Abstract] [PDF]
|
|
|
|
|
|
M. Nishimura, Y. Izumiya, A. Higuchi, R. Shibata, J. Qiu, C. Kudo, H. K. Shin, M. A. Moskowitz, and N. Ouchi Adiponectin Prevents Cerebral Ischemic Injury Through Endothelial Nitric Oxide Synthase-Dependent Mechanisms Circulation, January 15, 2008; 117(2): 216 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. Townsend Stroke in Chronic Kidney Disease: Prevention and Management Clin. J. Am. Soc. Nephrol., January 1, 2008; 3(Supplement_1): S11 - S16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U.S. Preventive Services Task Force Screening for Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med, December 18, 2007; 147(12): 854 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Towfighi, J. L. Saver, R. Engelhardt, and B. Ovbiagele A midlife stroke surge among women in the United States Neurology, November 13, 2007; 69(20): 1898 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Wolf and W. B. Kannel Preventing Stroke: Does Race/Ethnicity Matter? Circulation, November 6, 2007; 116(19): 2099 - 2100. [Full Text] [PDF]
|
|
|
|
|
|
R. Cote Cerebrovascular Events in Individuals With Asymptomatic Carotid Disease Stroke, November 1, 2007; 38(11): e148 - e148. [Full Text] [PDF]
|
|
|
|
|
|
T. S. Olsen, R. H. B. Christensen, L. P. Kammersgaard, and K. K. Andersen Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality: Ten-Year Follow-Up of Ischemic Strokes in the Copenhagen Stroke Study Stroke, October 1, 2007; 38(10): 2646 - 2651. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Mazumdar, M. M. Heeney, C. M. Sox, and T. A. Lieu Preventing Stroke Among Children With Sickle Cell Anemia: An Analysis of Strategies That Involve Transcranial Doppler Testing and Chronic Transfusion Pediatrics, October 1, 2007; 120(4): e1107 - e1116. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Harazny, M. Ritt, D. Baleanu, C. Ott, J. Heckmann, M. P. Schlaich, G. Michelson, and R. E. Schmieder Increased Wall:Lumen Ratio of Retinal Arterioles in Male Patients With a History of a Cerebrovascular Event Hypertension, October 1, 2007; 50(4): 623 - 629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein Acute Ischemic Stroke Treatment in 2007 Circulation, September 25, 2007; 116(13): 1504 - 1514. [Full Text] [PDF]
|
|
|
|
 |
|
 Prevalence of Stroke--United States, 2005 JAMA, July 18, 2007; 298(3): 279 - 281. [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Meschia, T. G. Brott, and R. W. Hobson II Diagnosis and Invasive Management of Carotid Atherosclerotic Stenosis Mayo Clin. Proc., July 1, 2007; 82(7): 851 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, M. A. Moro, and A. Davalos The Metabolic Syndrome and Stroke: Potential Treatment Approaches Stroke, July 1, 2007; 38(7): 2196 - 2203. [Full Text] [PDF]
|
|
|
|
|
|
B. Norrving, P. Wester, K. S. Sunnerhagen, A. Terent, A. Sohlberg, F. Berggren, P.-O. Wester, K. Asplund, for the Stroke Guidelines Working Group,, and National Board of Health and Welfare, Stockholm, S Beyond Conventional Stroke Guidelines: Setting Priorities Stroke, July 1, 2007; 38(7): 2185 - 2190. [Abstract] [Full Text] |