Stroke Prevention Guideline Adds Recs for GLP-1 Drugs, Gender-Affirming Care

The American Heart Association and the American Stroke Association updated guidelines for the primary prevention of stroke, emphasizing primary care screening, lifestyle management, and risk factor control.

The guideline, published in Stroke, replaced the 2014 version to guide management for individuals with no prior history of stroke.

“This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke,” said writing group chair Cheryl Bushnell, MD, MHS, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, in a press release.

For instance, a new recommendation was added for GLP-1 receptor agonists, which received a class 1a recommendation for stroke risk reduction in patients with diabetes and high cardiovascular risk or established cardiovascular disease.

Whether semaglutide (Ozempic, Wegovy) and other GLP-1 drugs as well as new derivatives also reduce stroke risk when used for their indication in weight loss isn’t known and should be tested in trials, Bushnell’s group noted.

Another addition to the guideline is an emphasis on addressing social determinants of health to help mitigate their impact on stroke risk. These non-medical factors, like education, economic stability, access to care, discrimination, structural racism, and neighborhood walkability and healthy food availability contribute to inequities in care and influence overall health.

“Therefore, screening for social determinants of health is recommended in care settings where at-risk stroke patients may be evaluated, with the acknowledgment that evidence-based interventions to address adverse social determinants of health are evolving,” the guideline group wrote.

“Evidence-based approaches for addressing patient-level adverse social determinants of health include ensuring that patient education is provided at the appropriate educational levels and language and building trust to be able to re-educate a patient who has health beliefs that are based on misinformation,” they added. “Other approaches involve advocating for patients, choosing the most efficacious and cost-effective medications, connecting patients to resources that help address health-related social needs such as food and housing insecurity, referring patients to programs that support lifestyle change, and connecting patients with programs that help defray healthcare costs.”

New to the guideline were recommendations specifically for women. The guideline called for screening for stroke risk from use of oral contraceptives, endometriosis, premature ovarian failure, and early-onset menopause. In the context of pregnancy, treatment of hypertensive disorders during pregnancy and within 6 weeks of delivery were recommended to reduce the risk of maternal intracerebral hemorrhage.

Estrogen taken by transgender women and gender-diverse individuals increases risk of stroke, so the guideline gave a class 2a recommendation for evaluation and modification of risk factors to reduce the risk of stroke for these individuals.

“Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain,” Bushnell said.