Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

Overview

For patients without a prior stroke or known heart disease, these guidelines recommend aspirin for patients with a 10-year projected risk of all cardiovascular events (heart disease and stroke events) of 6% or greater. This threshold identifies a group of people where the benefits of aspirin likely outweigh the harms. The guidelines also recommend aspirin for special situations, including use in some patients with atrial fibrillation (a type of irregular heart beat) and in patients where there is narrowing of the carotid arteries in the neck. The authors conclude that aspirin is not useful in people at low risk of having a first stroke, or in those with diabetes and no established cardiovascular disease.

Methodology

These guidelines were developed to incorporate evidence on established and emerging risk factors for stroke into recommendations for prevention of first strokes. Experts selected by the American Heart Association (AHA) focused on studies published since the last AHA review (2006). The article combines the results of past studies to generate findings about the benefits of aspirin in the prevention of first strokes.

Results

  • For those without a prior stroke or known heart disease, the guidelines recommend the use of aspirin when the 10-year projected risk of all cardiovascular events (heart disease and stroke events) is at least 6%.

  • This threshold of 6% for 10-year risk identifies a group of people where the benefits of aspirin are likely to outweigh the harms.

  • The guidelines also recommend aspirin use in special situations, including in patients with atrial fibrillation (a type of irregular heart beat) at low risk of stroke and in patients where there is narrowing of the carotid arteries in the neck.

Conclusions

  • Daily use of aspirin prevents the risk of first stroke in adults without a prior stroke or known heart disease.

  • The decision to take aspirin depends on a broad range of factors affecting the risk of future stroke. Aspirin can be useful for prevention of a stroke in women without a prior stroke or known heart disease, when the risk of stroke is high enough for aspirin’s benefits to outweigh the harms.

  • Aspirin is not useful in people at low risk of having a first stroke or in persons with diabetes in the absence of established cardiovascular disease.