In this edition of our Guidelines Timeline series, we will explore the recently released 2024 Guideline for the Primary Prevention of Stroke by the American Heart Association (AHA) and American Stroke Association (ASA). This updated guideline supersedes the previous version from 2014, providing clinicians with a comprehensive resource to aid in the implementation of prevention strategies for individuals with no history of stroke.
The authors of the guideline emphasize that ischemic and hemorrhagic strokes are largely preventable, and closing the prevention gap is crucial for the well-being of United States (US) residents. Annually, 600,000 US residents experience a first stroke, with 200,000 facing a recurrent event. Tragically, nearly 160,000 individuals will lose their lives due to stroke, making it the fifth leading cause of death in the US. Clinicians have the ability to take the lead in implementing preventive measures to close this gap.
While we will compare and contrast the two guidelines, as well as highlight key points and updates, please note that we cannot cover every detail outlined in these guidelines. We do recommend reviewing the full guideline provided in each link below. Without further delay, let’s get to it!
AHA/ASA Stroke Prevention Guidelines
- Primary Prevention of Stroke
- Published: October 2024
- Primary Prevention of Stroke
- Published: December 2014
Major Changes & Key Takeaways: 2024 vs 2014
Overview
| 2024 Guideline | 2014 Guideline | |
|---|---|---|
| Updated Recommendations | Includes new evidence-based recommendations reflecting advancements in medical research | Provided foundational recommendations based on evidence available at the time |
| Life’s Essential 8 | Aligns with AHA’s Life’s Essential 8 health metrics | Not mentioned |
| Sex-Specific Recommendations | New recommendations specific to women, including social determinants of health | No specific recommendations for women or social determinants of health |
| Medication Updates | Guidance on using GLP-1 receptor agonists for diabetes management and PCSK9 inhibitors for lowering LDL cholesterol | Focus on managing modifiable risk factors through lifestyle changes and medications like statins |
| Sedentary Behavior | Emphasizes avoiding sedentary behavior during waking hours | Recommended physical activity: 150 minutes of moderate or 75 minutes of vigorous activity per week |
| Pregnancy-Related Stroke | Specific recommendations for managing high blood pressure and screening for pregnancy complications | Not specifically addressed |
- Modifiable Risk Factors:
- The 2024 guidelines are in accordance with the AHA’s Life’s Essential 8 for optimizing cardiovascular and brain health, as well as preventing stroke. The authors outline the 8 strategies as follows: improve dietary habits, increase physical activity, quit smoking, prioritize quality sleep, maintain a healthy weight, manage cholesterol levels, regulate blood sugar, and control blood pressure.
- While the 2014 guideline does include a robust list of modifiable risk factors, Life’s Essential 8 provides a clearer starting point for clinicians and their patients.
- Sex Specific Recommendations:
- One of the notable changes in the 2024 guidelines is the increased focus on women’s health. This update highlights several key points
- Prevention of pregnancy-related stroke is primarily achieved through the management of hypertension.
- Conditions such as endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all linked to an increased risk of stroke. Screening for these conditions is an important step in evaluating and managing vascular risk factors to reduce the risk of stroke.
- Transgender women who take estrogens are at a higher risk of stroke, thus evaluating and modifying risk factors can be beneficial in reducing the risk of stroke.
- One of the notable changes in the 2024 guidelines is the increased focus on women’s health. This update highlights several key points
- Medication Updates:
- One of the significant updates in the 2024 guideline pertains to the introduction of groundbreaking medications that have been approved since the 2014 guideline. Notably, the recommendation of glucagon-like peptide 1 receptor agonists (GLP-1s) stands out as they have demonstrated effectiveness in not only improving the management of type 2 diabetes but also aiding in weight loss and reducing the risk of cardiovascular disease and stroke.
- Additionally, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been recognized for their efficacy in managing hyperlipidemia in adults, potentially decreasing the risk of stroke. These advancements in medication offer new and promising treatment options for patients with these conditions.
| Medication Type | 2024 Guideline | 2014 Guideline |
|---|---|---|
| Antihypertensives | ACE inhibitors, ARBs, calcium channel blockers, thiazide and thiazide-like diuretics | ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics |
| Statin Therapy | High-intensity statins for high-risk patients, moderate-intensity for others | High-intensity statins for high-risk patients, moderate-intensity for others |
| GLP-1 Receptor Agonists | Recommended for patients with diabetes and high stroke risk | Not included |
| PCSK9 Inhibitors | Recommended for patients with high LDL cholesterol and high stroke risk | Not included |
- Dietary Recommendations:
- Both guidelines incorporate the Mediterranean diet; however, the 2024 guideline places a greater emphasis on the significance of adopting this diet, particularly when supplemented with nuts and olive oil, to reduce the risk of stroke. The 2024 guideline specifically recommends that adults without a history of cardiovascular disease, as well as those with high or intermediate risk, adhere to the Mediterranean diet.
Thank you for taking the time to read our latest article in the Guidelines Timelines series. These updates showcase the most recent advancements in stroke prevention, with the American Heart Association (AHA) and American Stroke Association (ASA) leading the way in advancing research and knowledge in this field.
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