The American Heart Association has issued new evidence-based recommendations for primary prevention of ischemic stroke, publishing the guidelines online May 4 in the journal Stroke.

Risk factors for a first stroke are classified according to their potential for modification (non-modifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented).

Non-modifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution.

Less well-documented or potentially modifiable risk factors include metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection.

The guidelines suggest physicians consider using a risk assessment tool such as the Framingham Stroke Profile to assess patient’s risk.

“It is important to identify patients at high risk of stroke because research shows that many strokes can be prevented if those individuals modify their risk factors,” said Larry B. Goldstein, MD, the guidelines’ lead author and chair of the association’s Stroke Council.

Some new recommendations for “well-documented” stroke risk factors include the following: Patients with rare genetic causes of stroke should be referred for genetic counseling. High-risk individuals with diabetes should be treated with statins, and people with hypertension should increase potassium intake and limit sodium intake.

A new recommendation among potentially modifiable risk factors is evaluating people for sleep apnea. This disorder is marked by extremely loud snoring, daytime sleepiness and is associated with an increased risk of stroke.