Lifestyle modifications, including eating a Mediterranean or DASH-style diet, should be encouraged to lower an individual’s risk of first-time stroke, according to new guidelines for the primary prevention of stroke from the American Heart Association and American Stroke Association.
Mediterranean and DASH (Dietary Approaches to Stop Hypertension) dietary plans are characterized by their emphasis on fruits, vegetables, whole grains, legumes, nuts, seeds, poultry, and fish, while limiting red meats, sweets, and any foods with saturated fats. This new guidelines – which have been endorsed by the American Academy of Neurology, American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Preventive Cardiovascular Nurses Association – suggest that adopting either of these diets in addition to a few other healthy living habits can dramatically reduce an individual’s odds of suffering a stroke (Stroke 2014;45 [doi: 10.1161/STR.0000000000000046]).
“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled – especially high blood pressure – account for 90% of strokes,” said Dr. James Meschia, chair of the writing committee and chairman of neurology at the Mayo Clinic in Jacksonville, Fla., in a statement. The last such guidelines were released 3 years ago (Stroke 2011;42:517-84)
The writing committee gathered data pertaining to the age, birth weight, race/ethnicity, and genetic factors, among several others. Studies examined included a U.S. Nationwide Inpatient Sample, which showed that stroke hospitalizations increased between 1998 and 2007 for individuals aged 25-34 years and 35-44 years; the Framingham Heart Study, which estimated that the odds of a middle-aged adult suffering a stroke are 1 in 6; an analysis of South Carolina Medicaid beneficiaries under age 50, which revealed that individuals born weighing less than 2,500 g were twice as likely to have a stroke as those born heavier; and an Atherosclerosis Risk in Communities (ARIC) study that showed Latino and African American populations being at higher risk for stroke due to hypertension, obesity, and diabetes.
Because blood pressure, hypertension, diabetes, and obesity are so commonly linked to stroke risk, the new American Heart Association/American Stroke Association (AHA/ASA) guidelines highly recommend a Mediterranean or DASH-style diet supplemented with nuts. Additionally, the guidelines advise health care professionals to advise patients to cut down on sodium intake, regularly monitor their blood pressure, talk to their physicians immediately if any medication does not do what it is intended to or creates negative side effects, and quit smoking, and, for women, consider an alternative to oral birth control pills.
Hypertension, “the most important, well-documented, modifiable stroke risk factor,” should be treated with antihypertensive medication to a target blood pressure of less than 140/90 mm Hg, the guidelines state.
Furthermore, the ASA/AHA guidelines continue to recommend regular physical exercise and acute monitoring of individuals’ cholesterol levels, such as LDL, HDL, and triglycerides, as failure to keep these numbers in check can easily lead to a serious stroke. The guidelines also state that although heavy alcohol consumption can increase the chance of stroke, “light to moderate” alcohol consumption can actually decrease the odds of suffering a stroke.
The AHA/ASA guidelines also examine factors such as migraines, which are associated with stroke in women under age 55, and hyperhomocysteinemia, which is also associated with an increased risk of stroke. Other factors like hypercoagulability and sleep apnea were not shown to have any identifiable relationship with an increased risk of stroke.
“As health professionals, we must ensure that progress in preventing stroke does not lead to complacency,” say the guidelines. “We must acknowledge that several recommendations remain vague because of suboptimal clinical trial evidence or, even more concerning, may be out of date and therefore irrelevant.”
Dr. Meschia and his associates warn that although medications are helpful, the best way to safeguard against a stroke is to change a person’s lifestyle into one of healthy eating and exercise habits. Unfortunately, say the authors, “it is easier to convince a patient to take a pill than to radically change his or her lifestyle, [but] we must expect the same standards of evidence for lifestyle interventions.”
Dr. Meschia disclosed that his research grant comes from the National Institute of Neurological Disorders and Stroke. He had no other relevant financial disclosures of interest. Several of the guidelines’ coauthors had disclosures of their own, which are listed in the statement.