New Stroke Prevention Guidelines: A Quick and Easy Guide

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

Disclosures

January 16, 2015

In This Article

Obesity and Body Fat Distribution

The Basics

Weight reduction in overweight and obese individuals

The Bottom Line: Although it is difficult to prove that weight reduction directly lowers stroke risk, a large body of evidence supports an association between increased weight and a greater incidence of stroke. The guidelines recommend weight loss in overweight (body mass index, 25-29 kg/m2) and obese (body mass index > 30 kg/m2) individuals, in an effort to lower BP and reduce stroke risk.

Diabetes

The Basics

Type 1 or type 2 diabetes: Control BP, per AHA/ACC/CDC Advisory to target < 140/90 mm Hg

Treat adults with diabetes with a statin, especially in case of additional risk factors

Usefulness of aspirin for primary stroke prevention in those with diabetes but a low 10-year risk for cardiovascular disease is unclear

Add-on fibrate in those with diabetes is not useful in reducing stroke risk

The Bottom Line: In people with diabetes, tight control of hypertension with an ACE inhibitor or angiotensin receptor blocker reduces stroke risk. Although it's unclear whether glycemic control reduces stroke risk in this population, data do suggest that statin therapy decreases the risk for a first stroke in patients with diabetes mellitus.

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