on May 4, 2006
Published online before print May 4, 2006, doi: 10.1161/01.STR.0000223048.70103.F1
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.
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
Larry B. Goldstein MD, FAAN, FAHA, Chair;
Key words: AHA Scientific Statements • stroke • risk factors • primary prevention
Find additional patient-related information at:
Related Internet Resources:
This article has been cited by other articles:
 |
|
 |
|
  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. 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] [PDF]
|
|
|
|
|
|
R. L. Sacco The 2006 William Feinberg Lecture: Shifting the Paradigm From Stroke to Global Vascular Risk Estimation Stroke, June 1, 2007; 38(6): 1980 - 1987. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Combining Aspirin With Oral Anticoagulant Therapy: Is This a Safe and Effective Practice in Patients With Atrial Fibrillation? Stroke, May 1, 2007; 38(5): 1652 - 1654. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Mosca, C. L. Banka, E. J. Benjamin, K. Berra, C. Bushnell, R. J. Dolor, T. G. Ganiats, A. S. Gomes, H. L. Gornik, C. Gracia, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1230 - 1250. [Full Text] [PDF]
|
|
|
|
|
|
L. Mosca, C. L. Banka, E. J. Benjamin, K. Berra, C. Bushnell, R. J. Dolor, T. G. Ganiats, A. S. Gomes, H. L. Gornik, C. Gracia, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update Circulation, March 20, 2007; 115(11): 1481 - 1501. [Full Text] [PDF]
|
|
|
|
|
|
O. Y. Bang, J. L. Saver, D. S. Liebeskind, S. Starkman, P. Villablanca, N. Salamon, B. Buck, L. Ali, L. Restrepo, F. Vinuela, et al. Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis Neurology, March 6, 2007; 68(10): 737 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Nandalur, A. D. Hardie, P. Raghavan, M. J. Schipper, E. Baskurt, and C. M. Kramer Composition of the Stable Carotid Plaque: Insights From a Multidetector Computed Tomography Study of Plaque Volume Stroke, March 1, 2007; 38(3): 935 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kettunen, T. Lanki, P. Tiittanen, P. P. Aalto, T. Koskentalo, M. Kulmala, V. Salomaa, and J. Pekkanen Associations of Fine and Ultrafine Particulate Air Pollution With Stroke Mortality in an Area of Low Air Pollution Levels Stroke, March 1, 2007; 38(3): 918 - 922. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. Smith, A. R. Abdullah, H. Amirfarzan, and L. H. Schwamm Serum lipid profile on admission for ischemic stroke: Failure to meet National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) guidelines Neurology, February 27, 2007; 68(9): 660 - 665. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kurth, B. M. Everett, J. E. Buring, C. S. Kase, P. M. Ridker, and J. M. Gaziano Lipid levels and the risk of ischemic stroke in women Neurology, February 20, 2007; 68(8): 556 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein and P. M. Rothwell Primary Prevention and Health Services Delivery Stroke, February 1, 2007; 38(2): 222 - 224. [Full Text] [PDF]
|
|
|
|
|
|
C. Osmond, E. Kajantie, T. J. Forsen, J. G. Eriksson, and D. J.P. Barker Infant Growth and Stroke in Adult Life: The Helsinki Birth Cohort Study Stroke, February 1, 2007; 38(2): 264 - 270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein and J. L. Saver Thrombolysis in Stroke: a Medicolegal Quagmire Stroke, November 1, 2006; 37(11): 2663 - 2663. [Full Text] [PDF]
|
|
|
|
 |
|
 V Caso and M Paciaroni MTHFR 677 TT genotype and hyperhomocysteinaemia: an underestimated risk TANDEM for patients with stroke J. Neurol. Neurosurg. Psychiatry, October 1, 2006; 77(10): 1103 - 1103. [Full Text] [PDF]
|
|
|
|
|
|
B. B. Worrall and J. C. Mychaleckyj PDE4D and Stroke: A Real Advance or a Case of the Emperor's New Clothes? Stroke, August 1, 2006; 37(8): 1955 - 1957. [Full Text] [PDF]
|
|