AHA/ASA Guideline Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Larry B. Goldstein, MD, FAHA, Chair; Cheryl D. Bushnell, MD, MHS, FAHA, Co-Chair; Robert J. Adams, MS, MD, FAHA; Lawrence J. Appel, MD, MPH, FAHA; Lynne T. Braun, PhD, CNP, FAHA; Seemant Chaturvedi, MD, FAHA; Mark A. Creager, MD, FAHA; Antonio Culebras, MD, FAHA; Robert H. Eckel, MD, FAHA; Robert G. Hart, MD, FAHA; Judith A. Hinchey, MD, MS, FAHA; Virginia J. Howard, PhD, FAHA; Edward C. Jauch, MD, MS, FAHA; Steven R. Levine, MD, FAHA; James F. Meschia, MD, FAHA; Wesley S. Moore, MD, FAHA; J.V. (Ian) Nixon, MD, FAHA; Thomas A. Pearson, MD, FAHA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Background and Purpose—This guideline provides an overview of the evidence on established and emerging risk factors for stroke to provide evidence-based recommendations for the reduction of risk of a first stroke. Methods—Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council Scientific Statement Oversight Committee and the AHA Manuscript Oversight Committee. The writing group used systematic literature reviews (covering the time since the last review was published in 2006 up to April 2009), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations using standard AHA criteria (Tables 1 and 2). All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive peer review by the Stroke Council leadership and the AHA scientific statements oversight committees before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results—Schemes for assessing a person’s risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic predisposition. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on August 18, 2010. A copy of the statement is available at http://www.americanheart.org/presenter.jhtml?identifier=3003999 by selecting either the “topic list” link or the “chronological list” link (No. KB-0080). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com. The online-only Data Supplement is available at http://stroke.ahajournals.org/cgi/content/full/STR.0b013e3181fcb238/DC1. The American Heart Association requests that this document be cited as follows: Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–584. Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier=3023366. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml? identifier=4431. A link to the “Permission Request Form” appears on the right side of the page. © 2011 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STR.0b013e3181fcb238 517 by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from by guest on September 1, 2016 http://stroke.ahajournals.org/ Downloaded from