By Christopher St. Clair, PharmD, ORISE Fellow; Sarah Prowitt, MPH, ORISE Fellow; and Richard Olson, MD, MPH, Director, Division of Prevention Science, ODPHP
Stroke takes a serious toll on the health of Americans: Every 40 seconds, someone in the United States has a stroke. Every 4 minutes, someone dies of a stroke. All health care providers — physicians, nurses, pharmacists, and others — play an important role in preventing this deadly disease. And May, as National Stroke Awareness Month, is the perfect time to reflect on what each of us can do to prevent, detect, and treat stroke.
The ABCS of Heart Health
Prevention is the best defense against stroke. That’s why the U.S. Department of Health and Human Services (HHS) created Million Hearts® — a national initiative to prevent 1 million heart attacks and strokes in 5 years. Million Hearts® aims to meet these goals using the ABCS: aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation:
- Aspirin when appropriate: Once-daily low-dose aspirin may be appropriate for certain patients with known risk factors for cardiovascular disease (CVD). For information on appropriate aspirin use, consider the U.S. Preventive Services Task Force (USPSTF) recommendations for aspirin use to prevent CVD.
- Blood pressure control: Hypertension is a significant preventable risk factor for stroke, yet nearly 35 million adults in the U.S. have uncontrolled hypertension, and approximately a third of these individuals are not aware that they have it. Million Hearts® offers tools to help health care providers identify patients with undiagnosed hypertension, and sponsors an annual Hypertension Control Challenge for medical practices to achieve blood pressure control in at least 70% of their patients. Success stories from the Hypertension Control Challenge may provide ideas for how you can improve blood pressure control in your patients.
- Cholesterol management: Patients with known risk factors for CVD may benefit from preventive statin therapy. For information on appropriate statin use, consider the USPSTF recommendations for statin use for primary prevention of CVD.
- Smoking cessation: The harmful effects of smoking are well documented, but patients need a great deal of support from family, friends, and their health care team to successfully stop smoking. Encourage patients who smoke to develop a quit plan and offer resources that can help them succeed. For more information on how to treat tobacco dependence, use the Resources for Professionals from smokefree.gov.
Help Your Patients Develop Healthy Habits
Healthy eating and increased physical activity play key roles in controlling blood pressure and cholesterol levels — and a healthy lifestyle is associated with a decreased risk of stroke. Counsel all of your patients on lifestyle factors and encourage them to adopt healthy habits that can decrease their risk of CVD and other chronic diseases. The Dietary Guidelines for Americans and Physical Activity Guidelines for Americans provide evidence-based recommendations:
- The Dietary Guidelines for Americans recommends healthy eating patterns that include a variety of fruits, vegetables, grains, fat-free and low-fat dairy, and protein foods — while limiting saturated fats and trans fats, added sugars, and sodium. ODPHP offers a free toolkit with patient handouts to help health care providers start conversations about nutrition and teach important concepts about building and maintaining healthy eating patterns.
- The Physical Activity Guidelines for Americans recommends that individuals get 150 minutes of moderate-intensity physical activity each week to reduce the risk of chronic diseases, including stroke. Encourage your patients to find a physical activity they enjoy and can stick with over time — remind them that even a brisk 10-minute walk counts toward meeting the recommendations and has a positive effect on heart health. ODPHP has free resources to help health care providers share physical activity recommendations with adults and youth.
Teach Your Patients to Act FAST
Stroke can happen at nearly any time or in any place, and quick recognition and treatment is essential to prevent significant brain damage or death. Patients need to know the signs and symptoms so they can react immediately if they — or a friend, family member, or bystander — may be experiencing a stroke.
An easy way to teach the signs and symptoms of stroke is with the acronym FAST, which stands for face, arms, speech, and time:
- Face: Ask the person to smile. Is one side of their face drooping or numb?
- Arms: Ask the person to raise both arms. Is one arm weak or numb?
- Speech: Ask the person to repeat a simple sentence. Is their speech slurred or are they unable to repeat the sentence correctly?
- Time: If the person shows any of these signs, call 911 immediately and note the time when the signs first appeared. This information can help emergency responders make important decisions about treatment.
For additional resources on stroke prevention — and to view a summary of scientific research in this field — visit MindYourRisks.NIH.gov.