(i) Oral contraceptives
Oral contraceptives may be harmful in women with other stroke risk factors (e.g., smoking, history of thromboembolism) (Class III/Grade C).
For women taking oral contraceptives at risk, aggressive treatment of stroke risk factors may be justified (Class IIb/Grade C).
(ii) Diet and nutrition
(i) To lower blood pressure, reduce sodium intake (<2.3 g/day) and increase potassium intake (≥4.7 g/day) as recommended in the Dietary Guidelines for Americans (Class I/Level A).
Recommending more fruits and vegetables and low-fat dairy products to reduce saturated fatty acid intake, which may lower blood pressure (Class I/Level A).
Diets rich in fruits and vegetables with higher potassium salt content are beneficial in reducing stroke risk (Class I/Level B).
(iii) Lack of physical activity
Recommend increased physical activity, with a lower risk of stroke in those with increased physical activity (Class I/Level B).
Endorse the recommendation of the 2008 Physical Activity Guidelines for Americans that adults should participate in at least 150 minutes of moderate intensity or 75 minutes of high intensity aerobic exercise per week (Class I/Level B).
(iv) Obesity and body fat distribution
As a measure to reduce blood pressure, weight loss is recommended for overweight and obese individuals (Class I/Class A).
For overweight and obese individuals, weight loss is reasonable as a measure to reduce stroke risk (Class IIa/Level B).
Description.
Overweight: body mass index (BMI) 25-29.9
kg/m2.
Obese: BMI ≥30
kg/m2.
Body mass index (BMI) = weight (kg) ÷ height (m)2.
Abdominal obesity: waist circumference >102 cm (men) or >88 cm (women).
I. Risk factors for which the evidence is not yet sufficient and which can be intervened
(i) Migraine
Because of the correlation between the frequency of migraine attacks and the risk of stroke, treatment aimed at reducing the frequency of migraine attacks may be reasonable, but there are no data to confirm that this treatment strategy reduces the incidence of first-time stroke (class IIb/class C).
(ii) Metabolic syndrome
(i) Treatment of various abnormalities of the metabolic syndrome, including lifestyle modification (i.e., exercise, moderate weight loss, healthy diet, etc.) and pharmacologic therapy (i.e., blood pressure lowering, lipid lowering, glycemic control, and antiplatelet therapy) is recommended, as adopted or suggested by NCEPATP III and JNC7, as well as by the relevant sections of this guideline.
The effectiveness of drugs to reduce insulin resistance in reducing the risk of stroke is not known (Class IIb/C).
Note: The metabolic syndrome should have at least 3 of the following abnormalities.
abdominal obesity (abdominal circumference: men > 102 cm; women > 88 cm)
Blood triglycerides ≥ 1.7
mmol/L (150 mg/dl).
High-density lipoprotein (HDL): men <1.03
mmol/L; women >1.28 mmol/L.
Blood pressure: ≥130/≥85
mmHg.
Fasting blood glucose ≥6.11
mmol/L.