What are the AHA-ASA guidelines on stroke prevention in patients with metabolic syndrome?

Updated: Mar 30, 2020
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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In 2010, the American Heart Association-American Stroke Association (AHA-ASA) updated their guidelines for the primary prevention of stroke. These are described below. [128]


Regular blood pressure screening, lifestyle modification, and drug therapy are recommended. A lower risk of stroke and cardiovascular events are seen when systolic blood pressure levels are less than 140 mm Hg and diastolic blood pressure is less than 90 mm Hg. In patients who have hypertension with diabetes or renal disease, the blood pressure goal is less than 130/80 mm Hg. However, the 2014 JNC-8 guidelines recommend more lenient targets (150/90 mm Hg in patients ≥60 y, and 140/90 mm Hg for most other populations).


Blood pressure control is recommended in types 1 and 2 diabetes. Hypertensive agents that are useful in the diabetic population include ACE inhibitors or ARBs.

Treating adults with diabetes with statin therapy, especially patients with other risk factors, is recommended, and monotherapy with fibrates may also be considered to lower stroke risk. Taking aspirin is reasonable in patients who are at high cardiovascular disease risk. However, the benefit of taking aspirin in diabetic patients for the reduction of stroke risk has not been fully demonstrated.


Statin therapy is recommended in patients with coronary heart disease and certain high-risk conditions for the primary prevention of ischemic stroke. In addition to statin therapy, therapeutic lifestyle changes and LDL-cholesterol goals are also recommended.

Niacin may be used in patients with low HDL cholesterol or elevated lipoprotein (a), but its efficacy in preventing ischemic stroke is not established. Fibric acid derivatives, niacin, bile acid sequestrants, and ezetimibe may be useful in patients who have not achieved the target LDL-C level with statin therapy or who cannot tolerate statins; however, their effectiveness in reducing the risk of stroke has not been established.

Diet and nutrition

A diet that is low in sodium and high in potassium is recommended to reduce blood pressure. Diets that promote the consumption of fruits, vegetables, and low-fat dairy products, such as the DASH (Dietary Approaches to Stop Hypertension)–style diet, help to lower blood pressure and may lower the risk of stroke.

Physical activity

Increases in physical activity are associated with a reduction in the risk of stroke. The goal is to engage in at least 30 minutes of moderate intensity activity on a daily basis

Obesity and body fat distribution

Weight reduction among persons who are overweight or obese is recommended to reduce blood pressure and risk of stroke.

Sleep health

Care should be taken to ensure that patients with metabolic syndrome practice healthy sleep behaviors. Even in patients who do not have sleep apnea or suspected sleep apnea, some studies have suggested a relationship between sleep deprivation or inadequate sleep time and metabolic syndrome. [129] Shift workers, who tend to have poor quality sleep, may also be at higher risk of developing metabolic syndrome. [130]

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