Our Take: New stroke guidelines emphasize prevention through lifestyle changes

Dr. Jose Luis Lopez, Medical Director, Beacon Stroke Program

The American Heart Association and American Stroke Association in October released new guidelines – their first in a decade. These updated recommendations represent a significant shift in stroke prevention strategy, emphasizing lifestyle changes and early intervention that could prevent up to 80 percent of strokes.

The guidelines take a fresh look at stroke prevention across all stages of life, with notable new focus areas including women’s unique health risks and the impact of social and environmental factors on stroke risk. The recommendations aim to transform how healthcare providers approach stroke prevention, from enhanced screening protocols to innovative strategies for helping patients make sustainable lifestyle changes.

To understand what these pivotal changes mean for our community, we spoke with Dr. Jose Luis Lopez, Medical Director of Beacon Health System’s Stroke Program. Dr. Lopez offers his perspective on the most significant updates and shares insights on how these guidelines will shape stroke prevention and care in our region.

Q: The new guidelines suggest up to 80% of strokes are preventable. As our stroke program medical director, what do you see as the most impactful changes in these first new guidelines in a decade, particularly regarding early intervention and screening?

A: The American Heart Association’s “Life’s Essential 8” represents a significant step forward in stroke prevention. This framework simplifies and enhances opportunities for individuals to self-manage their health through four ideal health behaviors and four ideal health factors. The components include healthy diet, physical activity, healthy sleep, and avoidance of tobacco products, along with maintaining healthy levels of blood lipids, blood glucose, blood pressure and weight. The inclusion of sleep as a new recognized cardiovascular health component marks an important advancement in our understanding. This construct serves to motivate both individual and population health improvement by providing clear focus on vascular risk factors that are measurable, modifiable, and easily monitored. Importantly, research shows that having a greater number of these eight cardiovascular health metrics at ideal levels early in life correlates with better cognition in midlife.

Q: Women’s unique stroke risks are receiving new emphasis in these guidelines, including factors like pregnancy complications, endometriosis, and early-onset menopause. How should this change our approach to stroke prevention for women in our community?

A: Medical literature has clearly established that women face more adverse effects from stroke than men. Women are more likely to be living alone and widowed before stroke, are more often institutionalized after stroke, and experience poorer recovery than men. This reality underscores the critical importance of identifying women at higher risk and implementing effective prevention strategies.

Pregnant and postpartum individuals face approximately triple the risk of stroke compared with young adults of similar age, making blood pressure control before, during, and after pregnancy crucial for preventing both fatal and nonfatal stroke. Women with a history of hypertensive disorders of pregnancy, adverse pregnancy outcomes, endometriosis, and early menopause face increased risk and earlier onset of cerebrovascular disease, necessitating careful screening and management of vascular risk factors.

The widespread use of hormonal contraception among women aged 15 to 49 years in the U.S. – approximately 65% – makes education about stroke risk particularly important. There’s a direct relationship between higher estrogen dosing and increased stroke risk, especially for women who also have hypertension, migraine, or smoking habits that can synergistically increase their risk.

Courtesy of American Heart Association.

Q: Research shows these prevention strategies could reduce both stroke and dementia risk. From your experience leading our stroke program, how do you see these interconnected brain health issues affecting patients?

A: Sustaining a healthy brain over a lifetime is fundamental to maximizing overall ability and independence. The evidence increasingly shows that cumulative exposure to vascular risk factors throughout life affects not only the risk of symptomatic stroke but also of silent brain lesions that can diminish optimal brain function. This connection between vascular health and brain function offers hope – since many vascular risks are modifiable, we have the opportunity to actively maintain brain health and potentially prevent dementia later in life.

Q: The new guidelines point out that some populations have an elevated stroke risk due to various factors including genetics, lifestyle, and social determinants of health. How does our stroke program address these disparities in our community?

A: Community education remains a critical domain within our Beacon Stroke System of Care. Our approach encompasses not only primordial and primary prevention of stroke but also emphasizes the impact of timely recognition and action for stroke victims. Through our Beacon Stroke Patient Advocacy Internship, we’ve developed community stroke education projects targeting diverse populations. These include high school students for primary prevention, agricultural workers for primary prevention, Spanish-speaking community members for stroke awareness, and even elementary school children for primordial prevention, recognizing the significance of developing healthy habits early in life. In each case, we ensure that education is provided at appropriate educational levels and in the necessary language.

We continuously explore new platforms to reach and educate community members who are most vulnerable to stroke. This ongoing effort reflects our commitment to addressing health disparities and ensuring that potentially life-saving information reaches all segments of our community.

Q: While lifestyle modifications like the Mediterranean diet and regular exercise are key recommendations, many patients find these changes challenging in today’s world. How do we help patients navigate these challenges while still making meaningful changes to reduce their stroke risk?

A: The key is to remember the framework of “Life’s Simple 8” – the four ideal health behaviors (Diet, Physical activity, Nicotine exposure, Sleep health) and the four ideal health factors (weight, blood lipids, blood glucose, and blood pressure). Each of these health metrics can be optimized individually to reduce stroke risk. I encourage patients to adopt a motivating motto like “one day at a time,” “one step at a time,” “baby steps,” or any phrase that helps celebrate their achievements in this lifetime endeavor of sustaining brain health. This approach acknowledges that while the changes may be challenging, every small step toward better health matters in reducing stroke risk.

Learn more about Beacon’s stroke team

When a stroke occurs, time matters. How quickly a blood clot is removed or blood vessels are repaired is critical. Our emergency services — including a specialized stroke team — are here 24 hours a day. A neurologist and other experts will act immediately to evaluate and treat you. Our outpatient and in-hospital rehabilitation for heart and stroke patients and other services are also here to help. Learn more about the Beacon Health System Stroke Program.