Secondary Stroke Prevention Guidance Updated
Written by Editor   
Tuesday, May 06, 2014 04:41 PM

The American Heart Association/American Stroke Association have updated the guidelines for secondary prevention in patients with stroke or transient ischemic attack (TIA).  The document includes new sections on nutrition and sleep apnea and revisions of several other sections, including those dealing with hypertension, dyslipidemia, diabetes, carotid stenosis, and atrial fibrillation.

Greater emphasis was placed in the updated guidelines on lifestyle factors, including diet, exercise, and weight management.

The importance of what people put into their bodies was underscored with a new nutrition section, which included the following recommendations:

  • It is reasonable to conduct a nutritional assessment to look for signs of overnutrition or undernutrition; those with signs of undernutrition should be referred for nutritional counseling.
  • The use of routine supplementation with a single vitamin or vitamin combinations is not recommended.
  • It is reasonable to recommend reduction of sodium intake to less than 2.4 grams per day, or even lower to less than 1.5 grams per day.
  • It also is reasonable to recommend adherence to a Mediterranean-type diet that includes vegetables, fruits, whole grains, low-fat dairy, poultry, fish, legumes, olive oil, and nuts, and limits sweets and red meats.

Hypertension leads the list of major risk factors, and clarifications were made to that section regarding when to initiate or resume antihypertensive therapy in these patients.  The dyslipidemia section also was revised to be consistent with the cholesterol guideline that was part of the suite of prevention guidelines released by the American College of Cardiology and American Heart Association last fall. 

Some of the other changes found in the document include the following:

  • A recommendation stating that all patients should probably be screened for diabetes with tests of fasting plasma glucose, glycated hemoglobin (HbA1c), or oral glucose tolerance.
  • An expansion of the section on diabetes to include information on pre-diabetes.
  • A recommendation to screen all patients for obesity using body mass index.
  • A recommendation stating that a sleep study might be considered to detect sleep apnea because of the high prevalence of the disorder in patients with stroke or TIA.
  • A recommendation that 30-day monitoring for atrial fibrillation in patients who had a stroke of unknown cause is reasonable within 6 months of the event.