Enhancing Stroke Prevention Guidelines Through Diverse Evidence and Inclusive Care: Cheryl D. Bushnell, MD, MHS, FAHA

WATCH TIME: 4 minutes

"We are really trying to ‘hone in’ on the populations, the data that is stroke-free to the extent that we can, and acknowledge the challenges our patients face. It makes us better doctors, better able to understand why they couldn’t make it to the appointment or didn’t take their medicines."

Prior studies have shown that a stroke occurs when cerebral blood flow is disrupted because of either the occlusion of a blood vessel by a thrombus or embolus, or by vessel rupture which then results in hemorrhage. This interruption can lead to cerebral hypoxia, impairing neuronal function and potentially causing irreversible brain injury. Continued research has revealed that stroke is a leading cause of morbidity and often causes significant cognitive impairment, dysphasia, motor deficits, and limitations in daily functional activities. In the United States, the condition is known as the fifth leading cause of mortality, with approximately 160,000 deaths annually. Notably, it is estimated that up to 80% of the more than 600,000 first-time strokes each year are preventable with appropriate interventions.

The American Stroke Association’s recently updated clinical guideline, superseding the 2014 version, provided evidence-based recommendations for stroke prevention strategies. Designed as a resource for healthcare providers, this guideline specifically targets patients without a prior history of stroke, offering strategies to reduce incident stroke risk. A volunteer writing group conducted an extensive literature review across multiple databases, examining existing research and relevant documents. Based on the evidence gathered by the group of experts, the guideline included key recommendations such as regular health screenings, identification of risk factors, lifestyle interventions, and pharmacologic therapies where appropriate to support effective primary stroke prevention.

Chair of the guideline writing group Cheryl D. Bushnell, MD, MHS, FAHA, sat down with NeurologyLive^® to dive deeper into the clinical implications of this updated guideline. In the interview, she talked about the strategies that are being implemented to increase diversity in randomized controlled trials for stroke prevention. Bushnell, professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine, also spoke about how social determinants of health impact the ability of minoritized populations to participate in stroke prevention trials. Toward the end of the conversation, she shared the ways that can broaden clinical trial representation improve overall recommendations for stroke and brain health.

REFERENCES
1. Bushnell C, Kernan WN, Sharrief AZ, et al. 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. Published online October 21, 2024. doi:10.1161/STR.0000000000000475
2. New guideline: Preventing a first stroke may be possible with screening, lifestyle changes. News Release. American Heart Association. Published October 21, 2024. Accessed October 22, 2024. https://newsroom.heart.org/news/new-guideline-preventing-a-first-stroke-may-be-possible-with-screening-lifestyle-changes