Latest Prevention Guidelines Highlight Sex-specific, Social Risk Factors for Stroke.

More than 600,000 people in the U.S. have a first stroke each year, but up to 80% of these could be preventable. Recently updated prevention guidelines from the American Stroke Association (ASA) aim to help more people avoid a stroke. The guidelines highlight factors that influence risk for women and urge healthcare providers to consider how social factors can affect risk.

There are two main types of stroke:
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• Ischemic stroke: When blood vessels to the brain are clogged or narrow enough to stop blood flow. About 87% of strokes are ischemic.

• Hemorrhagic stroke: When a blood vessel in the brain breaks open and damages the surrounding brain tissue.

Strokes can have serious long-term consequences, including:
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• Challenges with memory, thinking, or spatial awareness

• Changes to the senses

• Difficulty with speech and language

• Paralysis 

• Problems with vision

After their first stroke, about 60% of people have a permanent disability, so prevention is key.

“Stroke is a leading cause of serious long-term disability,” said M. Carter Denny, MD, MPH, a vascular neurologist at MedStar Health. “We want to make sure people live long, healthy, independent lives, so stroke prevention and swift treatment are very important.”

Often, but not always, a stroke occurs after someone has had several risk factors for a long time, such as high blood pressure, diabetes, and high cholesterol.

The ASA’s updated prevention guidelines make it clear that some people have additional risk factors that could make them more likely to experience a stroke, particularly women and birthing individuals. 

Related reading: B.E. F.A.S.T to Recognize the Warning Signs of a Stroke.

Screening for factors that influence women’s stroke risk.

The ASA’s guidelines contain new sex-specific recommendations to help more women prevent stroke. The guidelines encourage providers to talk with their patients about their risk factors for stroke

Some risk factors only impact women or people giving birth. These include:
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• Early onset menopause

• Endometriosis

• High blood pressure during pregnancy

• Premature birth

• Premature ovarian failure

• Use of oral contraceptives

Studies have shown that during pregnancy and the postpartum period, a birthing person’s risk of stroke is about three times higher than for people of the same age who aren’t pregnant.

“We suspect the increased risk of stroke is related to hormonal changes, specifically the high levels of estrogen needed to support pregnancy,” said Dr. Denny. 

The guidelines encourage providers to screen for these risk factors to help get a comprehensive picture of a patient’s stroke risk.  

“Taken individually, risk factors such as high blood pressure, high cholesterol, or obesity increase the risk of clotting and stroke only slightly,” explained Dr. Denny. “But together they do influence risk.”

Related reading: Research Examines Electromagnetic Device to Improve Stroke Recovery.

How non-medical factors influence risk.

To get the fullest assessment of risk, the guidelines recommend providers also ask patients about their social determinants of health, factors outside the doctor’s office that can influence a person’s health. 

These non-medical factors include things such as:
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• Economic stability

• Education quality and access

• Healthcare quality and access

• Neighborhood and built environment

• Social and community context

Studies have shown that people who experience worse social determinants of health are more likely to have a stroke. Black people have a two-fold higher risk for stroke than Whites in part because of disparities in social determinants of health.

“At a health system level, trying to address some of the underlying social determinants of health will hopefully improve future health outcomes,” Dr. Denny explained.

The ASA’s guidelines encourage providers to:
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• Discuss social risk factors with their patients 

• Provide educational materials 

• Connect patients with resources to address social needs

• Choose treatments and medications that are effective and affordable

The new prevention guidelines can help providers get a better picture of an individual’s stroke risk. New treatments can help with prevention, and other therapies allow us to make stroke less devastating.

Related reading: STRIVE Study Centers Patient and Caregiver Outcomes in Stroke Survival Research.

New therapies to help prevent and treat stroke.

Among the exciting recent advances in stroke prevention is the emergence of GLP-1 RA medications. These drugs, approved to treat diabetes and obesity, go by names like Ozempic (semaglutide), Wegovy (semaglutide), Mounjaro (tirzepatide), and Zepbound (tirzepetide). They have been shown in studies to lower the risk of stroke and cardiovascular disease in patients with type 2 diabetes or obesity. 

“These medications aren’t for everyone,” Dr. Denny said. “But for people with obesity, especially if they have diabetes, high blood pressure, or high cholesterol , they may help reduce your risk of heart attack and stroke in the long term.”

Vascular neurologists like Dr. Denny now have more tools to help treat stroke, such as thrombectomy, a procedure to remove blood clots. 

Studies have shown that thrombectomy can be beneficial even for patients who have already suffered brain injury. In some cases involving large clots, thrombectomy can help save brain function when performed up to 24 hours after a stroke starts.

“There appears to be a great benefit of thrombectomy to more people than we originally thought,” Dr. Denny said. “This procedure can help reduce the risk of disability and death, so it can be an important tool in treating severe and disabling strokes caused by large blood vessel clots.”

Another recent advance is a medication called Tenecteplase, which the Food and Drug Administration has approved to treat ischemic stroke. This medication works by breaking down the clot that is blocking blood flow to the brain. It can be given to a patient up to 4 ½ hours after the start of stroke symptoms, busting the clot to restore blood flow and reduce disability from stroke.

Be sure to talk with your doctor about your individual risk for stroke and any steps you can take toward prevention. For patients interested in lowering their risk, Dr. Denny recommends focusing on blood pressure. 

“In terms of all the things we do in stroke prevention, blood pressure is probably the most important,” she said. “I advise patients to monitor their blood pressure and work to keep it in the normal range through a combination of healthy diet, regular exercise, and medication when necessary.”