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

Larry B. Goldstein, Robert Adams, Mark J. Alberts, Lawrence J. Appel, Lawrence M. Brass, Cheryl D. Bushnell, Antonio Culebras, Thomas J. DeGraba, Philip B. Gorelick, John R. Guyton, Robert G. Hart, George Howard, Margaret Kelly-Hayes, J. V. Nixon, Ralph L Sacco

Research output: Contribution to journalArticle

676 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1583-1633
Number of pages51
JournalStroke
Volume37
Issue number6
DOIs
StatePublished - Jun 1 2006
Externally publishedYes

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Cardiovascular Nursing
Peripheral Vascular Diseases
Primary Prevention
Cardiology
Stroke
Guidelines
Exercise
Body Fat Distribution
Diet Therapy
Hyperhomocysteinemia
Lipoprotein(a)
Peer Review
Thrombophilia
Phospholipases
Carotid Stenosis
Sleep Apnea Syndromes
Expert Testimony
Sickle Cell Anemia
Low Birth Weight Infant
Advisory Committees

Keywords

  • AHA Scientific Statements
  • Primary prevention
  • Risk factors
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

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. / Goldstein, Larry B.; Adams, Robert; Alberts, Mark J.; Appel, Lawrence J.; Brass, Lawrence M.; Bushnell, Cheryl D.; Culebras, Antonio; DeGraba, Thomas J.; Gorelick, Philip B.; Guyton, John R.; Hart, Robert G.; Howard, George; Kelly-Hayes, Margaret; Nixon, J. V.; Sacco, Ralph L.

In: Stroke, Vol. 37, No. 6, 01.06.2006, p. 1583-1633.

Research output: Contribution to journalArticle

Goldstein, Larry B. ; Adams, Robert ; Alberts, Mark J. ; Appel, Lawrence J. ; Brass, Lawrence M. ; Bushnell, Cheryl D. ; Culebras, Antonio ; DeGraba, Thomas J. ; Gorelick, Philip B. ; Guyton, John R. ; Hart, Robert G. ; Howard, George ; Kelly-Hayes, Margaret ; Nixon, J. V. ; Sacco, Ralph L. / 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. In: Stroke. 2006 ; Vol. 37, No. 6. pp. 1583-1633.
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