on May 4, 2006
Stroke. 2006
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
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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
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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]
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L. B. Goldstein and P. M. Rothwell Primary Prevention and Health Services Delivery Stroke, February 1, 2007; 38(2): 222 - 224. [Full Text] [PDF]
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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]
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L. B. Goldstein and J. L. Saver Thrombolysis in Stroke: a Medicolegal Quagmire Stroke, November 1, 2006; 37(11): 2663 - 2663. [Full Text] [PDF]
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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]
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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]
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