Migraine, endometriosis – key risk factors

• Each year, thousands of people in the United States experience a stroke. Strokes can lead to death and long-term disability.
• The American Heart Association and the American Stroke Association have just released updated guidelines for primary stroke prevention.
• The guidelines highlight gender-specific updates on screening and prevention, as well as recommendations for a healthy lifestyle.
• People can work with their doctors to take steps toward a healthy lifestyle that reduces the risk of stroke.

Stroke prevention is a key focus of health promotion. It’s over in the United States 795,000 strokes happen every year.

Doctors are interested in helping people with prevention strokes wherever possible, and to this end they must benefit from accurate guidance and research updates.

The article updates the 2014 guidelines and is intended to support the efforts of physicians and health groups to prevent stroke.

These new guidelines are intended to add information and make appropriate changes based on new data. To write the new guidelines, researchers conducted a review of literature published after 2014 in several databases. The authors also reviewed previous AHA and ASA documents on stroke prevention.

The guidelines also discuss social determinants of health that may influence stroke risk, but it is important to note that they focus primarily on individual changes rather than systemic interventions.

The authors also recommend screening for factors such as access to healthy foods, health insurance, and neighborhood safety, as this may help identify barriers to stroke prevention efforts.

When it comes to evaluation, they recommend screening adults for stroke-related risk factors, such as diet, diabetes, high blood pressure (hypertension)body weight, smoking, substance abuse and physical inactivity.

The new guidelines also identify emerging evidence of surprising medical conditions that increase the risk of stroke. One of them is migraine. For people with migraine, guidelines recommend assessment and modification of vascular risk factors and avoidance of combined hormonal contraception when appropriate.

They then discuss concerns during pregnancy and the early postpartum period, with experts recommending treatment for severe hypertension and noting that it is prudent to use antihypertensive medications to treat hypertensive disorders of pregnancy to reduce the risk of stroke.

Additional screening for adverse pregnancy outcomes later may also be helpful.

Another risk factor identified was endometriosisand appropriate screening tests can help determine your risk of stroke.

The guidelines also discuss the effects of certain hormones contraceptives – such as those with high levels estrogen — may increase the risk of stroke.

Doctor Haris Kamala vascular neurologist at Memorial Hermann Mischer Neuroscience Associates in Shenandoah, Texas, who was not involved in developing the new stroke guidelines, said Medical news today This:

“These guidelines identify and highlight certain groups in the general population who are at higher risk of stroke; careful monitoring and counseling of such patients can help prevent stroke. One such group is pregnant women or women who have given birth in the last 6 weeks – they should be asked to monitor their blood pressure closely and ensure it stays below 160/110 to reduce the risk of intracerebral hemorrhage.”

“Screening for premature ovarian failure, endometriosis and a history of early menopause is important because such patients are at increased risk of stroke,” he also explained. “Lower doses of estrogen are recommended for people (women) considering oral contraception because it may increase the risk of stroke by making the blood thicker than usual.”

Finally, the guidelines also emphasize that some people – such as transgender women – taking estrogen may benefit from having their doctors assess their risk factors and modify their risk factors to reduce their risk of stroke.

The guidelines outline practical actions that can help prevent stroke, with particular emphasis on ‘Life is essential 8” AHA recommendations for heart health. These include things like diet, physical activity, blood pressure and smoking.

For example, the guidelines highlight the benefits of Mediterranean diet in reducing the risk of stroke and suggest that salt replacement may be helpful in some older adults with uncontrolled blood pressure.

When it comes to physical activity, they note that doctors should recommend about 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity exercise, or a combination of these exercises, to reduce the risk of stroke.

Doctors should also encourage people to avoid excessive sedentary behavior to help people reduce their risk of stroke.

To help control diabetes, guidelines recommend screening for certain people pre-diabetes and diabetes. Evidence also supports the use of GLP-1 receptor agonists such as Ozempicin people with diabetes to reduce the risk of stroke.

Controlling blood pressure is also important in preventing stroke. The guidelines recommend blood pressure screening, lifestyle improvements and medications to help some people with high blood pressure.

Additionally, evidence supports that taking two or more antihypertensive medications helps prevent stroke.

The next element discussed was tobacco smoking. The updated guidelines recommend that doctors screen for tobacco use, that nonsmokers continue this pattern, and that smokers stop smoking to reduce the risk of stroke.

Cheng-Han Chen, MDboard-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California, also not involved in the development of the new guidelines, commented:

“It’s great to see updated, evidence-based recommendations for preventing such a common and devastating cardiovascular disease. It incorporates many new discoveries in our understanding of stroke risk factors. Over the past decade, we have gained a greater understanding of the need to manage lifestyle-related cardiometabolic risk factors such as hypertension, overweight/obesity, cholesteroland blood sugar levels.”

However, the authors of the updated stroke guidelines noted some areas that still require additional research to draw firm conclusions.

For example, they admitted that there had been no research examining the benefits of screening for social determinants of health.

Further research is also needed on aspects of the relationship between stroke and hormonal contraception, endometriosis and menopause. Additional research may also be helpful in better understanding the unique risk of stroke in transgender people, as data on this topic is limited.

Further research may help determine how often blood pressure should be monitored to prevent stroke and understand the relationship between migraine, stroke risk and the use of hormone therapy.

The authors further acknowledged that the guidelines do not address the risk of stroke associated with certain social and systemic problems.

They also stressed that the evidence cited to support new guidelines is not always the strongest. The cited studies have their own limitations, including limitations on included and excluded participants and a lack of data on some subpopulations.

Still, the updated guidance highlights how people can take control of important modifiable risk factors to reduce their risk of stroke and improve their health, and brings new evidence on stroke prevention to the fore.

“The 2024 Primary Prevention of Stroke Guidelines are a much-needed and long-awaited update to the previous 2014 Primary Prevention of Stroke Guidelines. Over the past decade, our knowledge and understanding of stroke risk factors and (the impact of) lifestyle changes on stroke prevention has advanced. cerebrovascular disease has increased by leaps and bounds, and these guidelines are in line with that knowledge. With better implementation of known risk factor management strategies, more than half of the stroke cases occurring in the U.S., as well as the associated disability and cognitive decline, could likely be prevented.”

“Additionally, this guideline addresses and identifies specific patient populations and social determinants of health that have a direct correlation with an increased risk of stroke. Overall, these new guidelines represent a fairly comprehensive assessment to assist clinicians from a primary prevention perspective and to help target treatment to specific groups and high-risk factors,” he concluded.