profession

Stroke risk lowered 80% by healthy diet, exercise

Revised guidelines stress evaluating patients' lifestyle choices in a primary care setting.

By Marcia Frellick amednews correspondent — Posted Dec. 30, 2010

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Nonsmokers who follow a healthy diet, exercise regularly and drink only in moderation have an 80% lower risk of a first stroke compared with people who don't adopt that lifestyle, according to updated guidelines on stroke prevention.

Because 75% of the 790,000 strokes that occur each year are first-time strokes, the urgency in assessing patients' lifestyle choices and intervening in a primary care setting is clear, said Larry B. Goldstein, MD, professor of medicine at Duke University Medical Center and director of the Duke Stroke Center in Durham, N.C.

"Even though we have a lot to do during those primary care interactions, emphasizing the effect of lifestyle factors and helping patients achieve their goals is one major, major message for primary care providers," Dr. Goldstein said.

The American Heart Assn./American Stroke Assn. guidelines, updated for the first time since 2006, appear in the December issue of the journal Stroke (link).

According to the guidelines, aspirin should not be used to prevent stroke in people who are low-risk. The risk should be sufficiently high for ischemic stroke to offset the hazard of aspirin.

"People should have a 10-year cardiovascular risk in the 6% to 10% range," said Dr. Goldstein, who led the team that revised the guidelines. "Even very low-dose aspirin ... can be associated with an increased risk of major gastrointestinal hemorrhage."

The guidelines address stroke for the first time as a broad spectrum of related events, including ischemic stroke, non-ischemic stroke and transient ischemic attack. Previous recommendations dealt only with ischemic stroke, which accounts for 87% of strokes.

The authors suggest that patients with type 1 or type 2 diabetes undergo blood pressure control to reduce the risk of cardiovascular events. Genetic screening for stroke, although not recommended for the general population, may be appropriate for some, depending on family history and other factors.

Visits to the emergency department offer a critical opportunity to screen for and treat stroke risk factors, as well as making referrals. ED visits are appropriate for cholesterol and blood pressure monitoring, smoking-cessation strategies and atrial fibrillation screening and treatment. This may be particularly important as EDs are often the gateway to the health care system for the uninsured, Dr. Goldstein said.

Screening for high blood pressure in the ED and referral of patients with drug or alcohol problems also are considered reasonable.

It's important for primary care doctors to identify patients with some of the less-known risk factors, such as sleep apnea, Dr. Goldstein said. The condition has been associated with a higher risk of cardiovascular events, in general, and stroke, in particular.

Strokes are the fourth leading cause of U.S. deaths, after decades of being the third most common cause, according to a Dec. 9 report by the Centers for Disease Control and Prevention on mortality data from 2008. The top three causes of death are cardiovascular disease, cancer and chronic lower respiratory diseases, according to the CDC.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story