Primary Prevention of Stroke

JAMA, 9 August 2016

This JAMA Clinical Guidelines Synopsis summarizes the American Heart Association/American Stroke Association (AHA/ASA) 2014 guidelines on primary prevention of stroke. …

Major recommendations

  • Assess the risk of first stroke in adults using a risk assessment tool such as the American College of Cardiology (ACC)/AHA Cardiovascular Risk Calculator (class IIa; level of evidence B).
  • Encourage lifestyle habits that promote physical activity (class I; level of evidence B), a diet low in sodium and rich in fruits and vegetables (class I; level of evidence A), and smoking cessation using counseling and drug therapy (class I; level of evidence A).
  • Treat patients estimated to have a ≥7.5% 10-year risk of cardiovascular events as recommended in the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (class I; level of evidence A).
  • In patients with nonvalvular atrial fibrillation (AF) and a CHA2DS2-VASc score of ≥2 and acceptably low risk of complications, anticoagulation with either warfarin (class I; level of evidence A), dabigatran, apixaban, or rivaroxaban (class I; level of evidence B) is recommended.
  • Use of aspirin for cardiovascular disease (CVD) prophylaxis is reasonable for people who have a 10-year risk of a cardiovascular event >10% (class IIa; level of evidence A).
  • Aspirin is not useful in preventing stroke in people at low risk (class III; level of evidence A).

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