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Diet and exercise counseling may help prevent recurrent strokes

Treating patients with metabolic syndrome and counseling them on diet, exercise and weight loss might help prevent a recurrent stroke or a transient ischemic attack, according to new recommendations by the American Heart Assn. and the American Stroke Assn. The secondary stroke prevention guidelines were published online Oct. 21 in the AHA's journal Stroke. The recommendations, updated from 2006, aim to prevent recurrent incidents in stroke survivors and patients who had transient ischemic attacks. Suggestions for metabolic syndrome are among the key updates for primary care physicians, said AHA President Ralph Sacco, MD. Metabolic syndrome is characterized by a group of risk factors, including abdominal obesity, elevated blood pressure and insulin resistance. The syndrome increases patients' risk for vascular disease and affects about half of those who have an ischemic stroke, according to the guidelines. "We want clinicians to begin to recognize [metabolic syndrome], to know its components and to control" those risks, said Dr. Sacco, chair of neurology at the University of Miami Miller School of Medicine. "When doctors [adhere to guidelines], we improve the quality of care and improve the lives of our patients. We're focusing on getting specialists and primary care physicians to know the guidelines and implement them." The American Academy of Neurology supports the new recommendations as an educational tool for neurologists. An estimated 795,000 Americans have a stroke each year, according to the Centers for Disease Control and Prevention. Nearly a quarter of those cases are recurrent events. To help prevent secondary strokes, the guidelines say medication for hypertensive patients should be tailored to individual blood pressure control needs (www.ncbi.nlm.nih.gov/pubmed/20966421/). Physicians are encouraged to reduce low-density lipoprotein cholesterol levels to less than 70 mg/dL in patients who had an atherosclerotic ischemic stroke or a transient ischemic attack and do not have coronary heart disease. For diabetic patients who had a stroke or transient ischemic attack, doctors should follow existing guidelines for glycemic control and blood pressure targets. The American Diabetes Assn. recommends that adult diabetics' hemoglobin A1c be less than 7% and their blood pressure less than 130/80 mmHg. Additionally, the guidelines say angioplasty and stenting might be alternatives to surgery among stroke survivors who have severe blockage of the carotid artery. As in previous years, the guidelines continue to stress advising stroke patients to quit smoking, engage in at least 30 minutes of physical activity one to three times a week and eliminate or reduce alcohol consumption. They are set to be revised in three years, with additional updates at varying intervals to reflect changing information on the approaches to prevent stroke. "We need to recognize that a good proportion of people who [have a stroke] have a recurrent [incident]," Dr. Sacco said. "To our patients, stroke recurrence is one of the most feared complications. Some fear recurrent stroke more than death." The full and original article can be found here: http://www.ama-assn.org/amednews/2010/11/08/prse1110.htm
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