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JAMA Clinical Guidelines Synopsis |

Primary Prevention of Stroke

Nathaniel Steiger, MD1; Adam S. Cifu, MD1
[+] Author Affiliations
1Department of Medicine, University of Chicago, Chicago, Illinois
JAMA. 2016;316(6):658-659. doi:10.1001/jama.2016.5529.
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Published online

Extract

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

Box Section Ref ID

Guideline title Guidelines for the Primary Prevention of Stroke

Developer American Heart Association (AHA)/American Stroke Association (ASA)

Release dates October 28, 2014 (online); December 11, 2014 (print)

Prior version February 15, 2011

Funding source AHA/ASA

Target population Adults

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).1

  • 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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