AHA/ASA Primary Stroke Prevention Guidelines 2024 - Guideline Summary - Guideline Central
Patient Assessment
Management
5. Atherosclerotic and Nonatherosclerotic Risk Factors
6. Specific Populations
7. Heart Disease
8. Antiplatelet Use for Primary Prevention
Document Overview

Primary Prevention of Stroke

American Heart Association

American Stroke Association


Publication Date: Oct 20, 2024

Page Last Updated: May 5, 2026

Class of Recommendations and Level of Evidence

Class (Strength) of Recommendation
CLASS I (STRONG)Benefit >>> Risk
Suggested phrases for writing recommendations:
  • Is recommended
  • Is indicated/useful/effective/beneficial
  • Should be performed/administered/other
  • Comparative-Effectiveness Phrases†:
    • Treatment/strategy A is recommended/indicated in preference to treatment B
    • Treatment A should be chosen over treatment B
CLASS IIa (MODERATE) Benefit >> Risk
Suggested phrases for writing recommendations:
  • Is reasonable
  • Can be useful/effective/beneficial
  • Comparative-Effectiveness Phrases†:
    • Treatment/strategy A is probably recommended/indicated in preference to treatment B
    • It is reasonable to choose treatment A over treatment B
CLASS IIb (WEAK) Benefit ≥ Risk
Suggested phrases for writing recommendations:
  • May/might be reasonable
  • May/might be considered
  • Usefulness/effectiveness is unknown/unclear/uncertain or not well established
CLASS III: No Benefit (MODERATE)
(Generally, LOE A or B use only) Benefit = Risk
Suggested phrases for writing recommendations:
  • Is not recommended
  • Is not indicated/useful/effective/beneficial
  • Should not be performed/administered/other
CLASS III: Harm (STRONG) Risk > Benefit
Suggested phrases for writing recommendations:
  • Potentially harmful
  • Causes harm
  • Associated with excess morbidity/mortality
  • Should not be performed/administered/other
Level (Quality) of Evidence‡
LEVEL A
  • High-quality evidence‡ from more than 1 RCT
  • Meta-analyses of high-quality RCTs
  • One or more RCTs corroborated by high-quality registry studies
LEVEL B-R (Randomized)
  • Moderate-quality evidence‡ from 1 or more RCTs
  • Meta-analyses of moderate-quality RCTs
LEVEL B-NR (Nonrandomized)
  • Moderate-quality evidence‡ from 1 or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies
  • Meta-analyses of such studies
LEVEL C-LD (Limited Data)
  • Randomized or nonrandomized observational or registry studies with limitations of design or execution
  • Meta-analyses of such studies
  • Physiological or mechanistic studies in human subjects
LEVEL C-EO (Expert Opinion)
  • Consensus of expert opinion based on clinical experience

COR and LOE are determined independently (any COR may be paired with any LOE).

A recommendation with LOE C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although RCTs are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.

* The outcome or result of the intervention should be specified (an improved clinical outcome or increased diagnostic accuracy or incremental prognostic information).
† For comparative-effectiveness recommendations (COR I and IIa; LOE A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated.
‡ The method of assessing quality is evolving, including the application of standardized, widely used, and preferably validated evidence grading tools; and for systematic reviews, the incorporation of an Evidence Review Committee.

COR indicates Class of Recommendation; EO, expert opinion; LD, limited data; LOE, Level of Evidence; NR, nonrandomized; R, randomized; RCT, randomized controlled trial.

Document Overview

Document Title
Primary Prevention of Stroke
Authoring Societies

American Heart Association

American Stroke Association

Document Publication Date
Oct 20, 2024
Page Last Reviewed/Updated
May 5, 2026
Document Type
Guideline
Country of Publication
United States
Full Text Freely Available
Yes
Full Text Guideline
www.ahajournals.org/doi/10.1161/STR.0000000000000475
Source Citation

Bushnell C, Kernan WN, Sharrief AZ, Chaturvedi S, Cole JW, Cornwell WK, Cosby Gaither C, Doyle S, Goldstein LB, Lennon O, Levine DA, Love M, Miller E, Nguyen Huynh M, Rasmussen-Winkler J, Rexrode KM, Rosendale N, Sarma S, Shimbo D, Simpkins AN, Spatz ES, Sun LR, Tangpricha V, Turnage D, Velazquez G, Whelton P. 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2024;55:e00–e00. doi: 10.1161/STR.0000000000000475.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives

The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 “Guidelines for the Primary Prevention of Stroke.” This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals with no history of stroke. The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Scope
Prevention
Diseases/Conditions (MeSH)

D020521 - Stroke

D011322 - Primary Prevention

D020521 - Stroke

D011322 - Primary Prevention

Keywords
Ischemic Attack, Stroke Prevention, primary prevention, stroke
Target Patient Population
individuals who have not previously experienced a stroke or transient ischemic attack
Inclusion Criteria
Male, Female, Adult, Older Adult
Health Care Settings
Ambulatory, Long Term Care
Intended Users
Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources
Hub Data Supplement
Number of Source Documents
735
Literature Search Start Date
Saturday, April 1, 2023
Literature Search End Date
Friday, March 1, 2024
Includes peer/external review process?
Yes
Includes public comment process?
No
Methodologist involvement?
Yes
Patient involvement?
No
Includes multi-disciplinary group?
Yes
Includes systematic review?
Yes
Grades quality of strength of evidence?
Yes
Grades quality of strength of recommendation?
Yes
Discloses funding source?
Yes
Discloses conflicts of interest?
Yes
Includes benefits/harms analysis with recommendations?
Yes
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