• Posted November 25, 2024

Stroke Guidelines Updated, With Focus on Women and GLP-1s

Women, especially those who had high blood pressure during pregnancy or entered menopause before age 45, are among those with a greater risk for stroke.

They and other high-risk groups are the focus of new stroke prevention guidelines from the American Heart Association and American Stroke Association. 

The guidelines also suggest new GLP-1 weight-loss drugs as an option for patients with diabetes, because this group has a greater risk for heart disease.

"The goal of these guidelines is to promote brain health and reduce individual risk of stroke, so that we are all living healthy lives with a great quality of life as we age," said Dr. Alexis Simpkins, an associate professor of neurology at Cedars-Sinai. 

The guidelines are aimed at guiding discussions between patients and healthcare providers to help prevent a primary stroke.

They emphasize the importance of getting high blood pressure under control, Simpkins noted.

"Blood pressure goals now are a little bit more aggressive than they were previously," she said in a Cedars-Sinai news release. "Maintaining a healthy weight and reducing salt intake are important, but many people need the help of medication to meet these goals. And if one medication does not work, providers and patients should not hesitate to add another."

The updated guidelines encourage people to follow the Mediterranean diet, Simpkins said. It emphasizes fruits, vegetables, whole grains, seafood and healthy fats like olive oil.

Simpkins said the new guidelines also highlight several groups at increased risk. They include women with endometriosis, those whose ovaries stop functioning before age 40, and women during and after pregnancy, especially those who developed high blood pressure while pregnant. 

Transgender women receiving gender-affirming hormone therapy also have an increased risk, the guidelines noted.

"We don't yet fully understand the reasons behind this elevated risk, especially in cases of endometriosis and early menopause," Simpkins said, adding that further study is needed. 

"In the meantime," she added, "these patients and their healthcare providers should be having specific conversations about stroke risk and making plans to manage it."

The guidelines urge providers to consider so-called social determinants of health in gauging patients' stroke risk. These factors include race, income, access to healthy food and medical care and opportunities for physical activity.

Each year, more than 140,000 Americans die of stroke, according to neurologist Dr. Shlee Song, co-director of the Comprehensive Stroke Program at Cedars-Sinai. 

She said the American Heart Association's Life's Essential 8 has stroke-prevention strategies everyone can follow.

"The Essential 8 and social relationships keep us healthy and aging well," Song said.

"By staying connected and engaged in our social bonds, avoiding tobacco use, and paying attention to what we eat, physical activity, sleep, waist measurement, cholesterol, blood sugar and blood pressure, everyone can improve brain health and resiliency," she said. "This helps maintain quality of life and lower risk of stroke, cardiovascular disease and other major health problems."

More information

The U.S. Center for Disease Control and Prevention has more about stroke.

SOURCE: Cedars-Sinai, news release, Nov. 20, 2024