New Stroke Prevention Guidelines: A Quick and Easy Guide

Helmi L. Lutsep, MD; Bret S. Stetka, MD


January 16, 2015

In This Article


On October 28, 2014, new guidelines[1] for the primary prevention of stroke were released by the American Heart Association (AHA)/American Stroke Association (ASA), updating the previous guidelines from 2011. The report points out that "76% of stroke are first events"—emphasizing the importance of primary prevention—and also that in a 6000-person case/control study, "10 potentially modifiable risk factors explained 90% of the risk of stroke."

With this in mind, writing group members performed a thorough review of relevant literature, guidelines, personal files, and expert opinion to formulate the new document. What follows is a quick reference guide to the new guidelines.

Assessing the Risk for First Stroke

The Basics

Risk assessment tools are useful, but have limitations...

...however, a treatment plan based on their results should consider the patient's overall risk profile.

The Bottom Line: As the authors point out, stroke risk assessment tools aren't perfect; no one of them considers all possible factors potentially contributing to stroke. But they are useful at quantifying stroke risk. As mentioned in the guidelines, the AHA/ACC CV Risk Calculator is reasonable to consider.

In patients who have had strokes or have multiple stroke risk factors, risk assessment tools might not be necessary, because this population often falls into the most aggressive medical management category. If the patient has atrial fibrillation (AF), the CHADS2 or CHA2DS2-VASc risk calculators can be helpful.


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