Monday, December 06, 2010

AHA / ASA GUIDELINES 2010 FOR THE PRIMARY PREVENTION OF STROKE

Undoubtedly, stroke is one of the major catastrophic diseases that we must all avoid. Striking adults at the prime of life or fifties, and sixties, incapacitates them, make them lose their independence and self belief, and make them ( in some cases ) totally dependent on others at the phase of their life when they wish to be independent to enjoy life in their twilight years.
In 1999, the American Heart Association ( AHA ) and the American Stroke Association ( ASA ), decided to set a target to reduce stroke by 25% by year 2010. They managed to achieve their target of 25% reduction by year 2008.
They have just released their Stroke primary prevention guidelines 2010, in a document published in STROKE Dec 2. The last such document was published in 2006.
In this present document, they again emphasize the importance of lifestyle modification, in the prevention of strokes. Stop smoking, lose weight, exercise, eat less salt, moderate alcohol consumption, low fat diet, green vegetables and fruits, ideal body weight. It is reported that these measures, if properly taken can reduce the risk of stroke by 80%, much better then any medication that we can prescribe to our patients. A few other key interesting areas from the guidelines should be highlighted.
1. Secondary smoke : the data here is incomplete although the conventional wisdom is to have a smoke free environment.
2. Screening of stroke risk factors by GPs and emergency room physicians ( or anywhere where a patient comes into contact with a medical personnel. There should be a universal awareness by all medical personnel, to screen for stroke risk factors and take lifestyle modification measures.
3. Assymptomatic carotid artery stenosis. The guidelines seemed to suggest that medical therapy is the way to go. All the scary carotid enarterectomy procedures, and carotid stenting, should be for thsoe with symptoms.
4. Low dose aspirin should be for those with moderate risk for strokes and not for everybody, or those with low risk of strokes.
5. Atrial fibrillation is becoming an important risk factor for strokes. The guidelines still recommend the use of warfarin. It should be noted that the guidelines were drawn up, before the important clinical trials which seem to suggest that new factor 10 inhibitors may provide an alternative to warfarin. Perhaps these will be highlighted in future guidelines.
I personally feel that we must do our utmost to prevent strokes, as it is a very debilitating disease. I saw my mother suffer 3 years with it, and it is terrible. If you are one of those who feel like me, then please lead a healthy lifestyle ( you can still have a life ), particularly, no added salt in food, and good control of blood pressure.
Perhaps the AHA/ASA should work towards reducing strokes by a further 50% by 2015?

1 comment:

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