Stroke survivors should control their blood pressure, cholesterol and weight and do moderate physical activity regularly to avoid having another stroke, according to new guidelines from the American Heart Association and American Stroke Association.

In addition, survivors should receive proven therapies like aspirin or procedures to keep neck arteries open, depending on their individual medical needs.

The guidelines — released on May 1, 2014 — update the 2011 version. They apply to adults who have had an ischemic stroke , caused by blood clots in or near the brain, or a transient ischemic attack , which raises survivors’ risk for a future stroke.

“A vast amount of new research is revealing new and improved ways to protect patients with an ischemic stroke or transient ischemic attack from having recurrent events and further brain damage,” said Walter Kernan, M.D., lead author and chair of the guideline writing group and professor of medicine at Yale University School of Medicine in New Haven, Conn.

Treating high blood pressure is possibly the most important way to prevent another ischemic stroke, according to the guidelines. About 70 percent of people who have had a recent ischemic stroke also have high blood pressure.

Intensive cholesterol-lowering therapy is also important for those who survive strokes caused by hardened arteries. However, the association no longer recommends niacin or fibrate drugs to raise HDL, the “good” cholesterol, due to a lack of evidence showing they prevent recurrent strokes.

The guidelines recommend physically capable survivors do moderate to vigorous aerobic exercise for about 40 minutes, three to four times week. Activities may include brisk walking, riding an exercise bike or jogging.

There are new sections on nutrition, sleep apnea and pre-diabetes. There are new recommendations that involve:

  • Diabetes and obesity screening;
  • Possible screening for sleep apnea;
  • Possible nutritional assessment;
  • 30-day monitoring for atrial fibrillation for survivors of strokes with unknown causes;
  • Using anticoagulants in specific situations;
  • Following a Mediterranean-type diet that emphasizes vegetables, fruits, whole grains and includes low-fat dairy, poultry, fish, legumes and nuts, and limits sweets and red meat.

“The key to staying healthy after an ischemic stroke or TIA is careful and rapid assessment of the cause of the event and identification of stroke risk factors so that appropriate preventive interventions can be quickly provided,” Kernan said. “Then, patients must work with their doctors regularly to stay on their prevention program. With this approach, every patient can look forward to a healthier future.”

Every year, more than 690,000 U.S. adults have an ischemic stroke and another 240,000 have a transient ischemic attack.

The “Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack” were published in the American Heart Association journal Stroke.

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