Podcasts about stroke prevention

Dr. Gillian L. Gordon Perue discusses asundexian and the OCEANIC-STROKE trial. Show citation:  Sharma M, Dong Q, Hirano T, et al. Asundexian for Secondary Stroke Prevention. N Engl J Med. 2026;394(15):1467-1479. doi:10.1056/NEJMoa2513880 

Primary stroke prevention is a critical opportunity for neurologists, with most stroke risk driven by modifiable factors such as hypertension and lifestyle behaviors. This episode highlights practical tools and strategies, including Life's Essential 8 and contemporary risk calculators, while also exploring evolving approaches to shared decision making and secondary prevention. In this episode, Katie Grouse, MD, FAAN, speaks with Mitchell S. Elkind, MD, MS, FAAN, author of the article "Stroke Prevention" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Elkind is the Chief Science Officer for Brain Health and Stroke at the American Heart Association in Dallas, Texas, and a professor of neurology and epidemiology at Columbia University in New York, New York. Additional Resources Read the article: Stroke Prevention Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @MitchElkind Full episode transcript available here Dr Grouse: Neurologists have generally been more involved in secondary stroke prevention, but primary stroke prevention is increasingly recognized as an important topic of discussion for neurologists. Today, I have the opportunity to interview Dr. Mitchell Elkind, who wrote the article on stroke prevention in the newest Continuum issue on cerebrovascular disease.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to the audience.  Dr Elkind: Thank you so much, Katie. So, my name is Mitch Elkind, and I'm the Chief Science Officer for Brain Health and Stroke at the American Heart Association and a stroke neurologist by background.  Dr Grouse: Well, I just want to start by saying that I really enjoyed reading this article. I think this is just a really wonderful article I recommend strongly. Such a high yield, an important topic for a lot of us who see patients who are interested in learning about their stroke risks or need help with, uh, stroke prevention after having a stroke. So, I wanted to start. What's changed in the last couple of years? You know, what are some big highlights that you really want to stress that are different from maybe the last time we reviewed this topic?  Dr Elkind: Sure. Well, there's been a lot of development in the field of secondary stroke prevention, for one thing. But even beyond that, I think we increasingly appreciate how important it is to control what we call the social drivers of health on the earlier side, primordial or primary prevention. And that has been a big advance, I'd say. And I would also say, I think it's really important for neurologists to understand some of those questions about primordial and primary prevention. You know, we tend to get involved with patients after they've had a stroke or maybe a TIA, some kind of event. But sometimes we find people who are following for, you know, non-stroke related conditions who have risk factors also. And we can really play an important role in identifying those risk factors and helping to prevent a first stroke or vascular event as well. So, I think it's real important for us to be doctors even before we're neurologists. So, you know, Katie, about ninety percent of stroke risk is modifiable, so we can do a great job as neurologists in preventing stroke. And one of the most important things that we can do is to identify and treat high blood pressure. And recently, actually, the American Heart Association, American College of Cardiology guidelines on the management of hypertension have said that treatment of high blood pressure not only prevents stroke, but it can also help to prevent cognitive decline and dementia. And this is the first time that we've had a class of recommendation one and level of evidence A, the highest level of recommendation we give for the use of blood pressure treatment to prevent dementia. And that's largely based on the results of some large trials that have come out recently showing that you can prevent dementia with blood pressure control. So that's a really exciting link, I think, between cardiovascular risk factor control and subsequent brain health. It just illustrates the role that neurologists can play in, so many conditions outside of stroke as well.  Dr Grouse: That's a really great point, and I want to get a little more into the idea of primordial stroke prevention. Can you tell us a little bit more about what that might be?  Dr Elkind: So primordial prevention refers to addressing how we can prevent risk factors from occurring in the first place, and how can we improve the environments in which people live. You know, we know that only about twenty percent of health outcomes is dependent on what happens between the patient and their doctor in the office. About eighty percent of it is due to what happens in the environments in which we live, work, pray, and play. And so that's what we mean when we refer to the social drivers of health. What is the neighborhood like where somebody lives? Do they have access to healthy food? Do they have places where they can go to exercise? Is there air pollution in the area that may affect their health? You know, one really interesting fact that's become apparent in the last few years is that air pollution is a major risk factor for stroke. Something like a sixth of all strokes can be attributed to the quality of air. And so, what are the things we can do at the broader public policy, community level to reduce the risk of risk factors like high blood pressure and diabetes even before somebody has an event that brings them to the attention of the doctor? So that's what we're thinking about with regard to primordial prevention. It's the earliest stage in prevention.  Dr Grouse: And that's really fascinating. You know, I think an area that we haven't, as neurologists, really put a lot of our time thinking about, but clearly a very important thing. I really appreciated reading your article about how you incorporated the fact that, you know, a lot of these risk factors overlap very, very closely with all the risk factors for various types of cardiovascular events. And I would imagine that the work you've done as the Chief Clinical Science Officer for the American Heart Association has informed a lot of the way you've thought about-Trying to bring all these risks together and think a little bit more holistically about the whole thing. Could you tell us a little bit more about that and the work that you've done on the American Heart Association's Life's Essential 8 score?  Dr Elkind: Sure. I can't take credit for it. It's really work that was done by others at the Heart Association, particularly a cardiologist and epidemiologist named Don Lloyd-Jones. But many other volunteers participated. Life's Essential 8 is our approach to primary stroke prevention and cardiovascular prevention more broadly. We say Life's Essential 8 because it includes four health behaviors and four health factors that people can observe to reduce their risk of cardiovascular disease. The four factors are kind of things like know your numbers, your blood pressure, your blood sugar, your body mass index, right, which is a combination of weight and height, and your cholesterol level. So, know those numbers and keep them within the recommended ranges, and talk to your doctor if they're not. And then four lifestyle behaviors. So, one of them is to eat a healthy diet, and typically that means the Mediterranean diet. It means getting regular exercise, and we recommend 150 minutes a week of moderate to vigorous physical activity. Of course, it means abstinence from smoking or other tobacco products. And the last one, the eighth one, which I was so excited about when we added this, is sleep, recommending at least seven hours of sleep a night. So, I was really excited about this because we used to talk about Life's Simple 7, and then the last iteration of our recommendations included this recommendation for adequate sleep because of the mounting evidence of the importance of sleep to cardiovascular health. But sleep is really a brain function, right? And so, it was really the first, in a way, specific brain function that was added to our recommendations. So that's Life's Essential 8. People can read about it online at heart.org and recommend it to your patients as a simple way for people to understand the best approach to reducing their risk of cardiovascular disease, including stroke.  Dr Grouse: I checked it out myself after reading the article. It's very accessible to patients. It's a great education tool. And they can, you know, see their own score and use that in their own way to, to think about what their risks are and how they can help mitigate and then rescore themselves down the line. There's also, though, on the kind of more the clinician side, the PREVENT calculator as well. Could you tell us a little bit more about how we could use that in approaching this patient population?  Dr Elkind: Yeah. So, I think of Life's Essential 8 as being a patient-focused tool that people can use. PREVENT is really more for clinicians. Anybody can look it up online and enter your data into it. There's a risk calculator online. But the basic idea behind PREVENT and other similar risk calculators is that it's a way to estimate somebody's risk of having a cardiovascular event like stroke or a heart attack or even heart failure by entering information about your health. And we used to think, we used to use something called the ASCVD, atherosclerotic cardiovascular disease risk calculator, or the Framingham score. Framingham Heart Score, for example, was another one. PREVENT is the latest version, and it has several advantages over those earlier types of risk predictors. For one thing, it predicts risk at younger ages as well. It goes down to age 30. It predicts risk over a longer duration of time, so over 30, 10 or 30 years. It eliminates the use of race as an item to put into the calculator and substitutes for that socioeconomic status, so it's not a race base, but a measure of social disadvantage. And it also includes kidney elements, kidney measures. It includes renal function, for example, that weren't included in prior measures, and it can also be used to predict heart failure, which was not part of the original calculators. Another major advantage of the PREVENT study is that it was based on real-world data from about three million patients, many, many more than the 50,000 or so that the earlier risk calculators were based on. So, it has a much more robust data set and therefore allows a bit more precision in the ability to predict future risk of events. And typically, primary care doctors would enter their patient's data, calculate a risk, and then based on the results of the risk calculator, they can make recommendations about what type of medications a person should take or what other strategies they could use to reduce their risk. And so that's the role that PREVENT plays, is really being focused more for the clinician than the patient.  Dr Grouse: Really great tool for us to be aware of. You earlier alluded to the fact that neurologists are in the situation where we sometimes are helping patients with this primary prevention. But you also make a case for why it's in the patient's best interest for us to be involved in, in these conversations when we can, when we have the opportunity. Can you tell us more about that?  Dr Elkind: Shared decision-making is really important because we know that people aren't going to lead the healthiest possible lives if they're not invested in their care. And so, a doctor telling somebody what to do if the patient doesn't want to do it is gonna have limited benefit.So we emphasize the importance of shared decision-making as much as possible. And I think that where this comes up a lot is actually in the situation of, for example, atrial fibrillation, where patients will often be put on a blood thinner. And many people are fearful of blood thinners. They worry about the risk of bleeding. Maybe they know a relative who's had a bleeding complication from a blood thinner, and so they may be disinclined to try it. And so, it's really important to have these discussions about the risks and the benefits of medication and engage the patient in thinking about this. And there are even tools and visual aids that people can look to to help explain some of these complicated concepts to patients. So, these are the kinds of things that reflect implementation science as a way to improve adherence. We know what works in a clinical trial setting often, but the challenge is translating that into the real world and getting our patients to use the medications that we believe scientifically have been shown to be of benefit. I've actually been surprised sometimes at conversations I've had with people, in some cases, healthcare professionals who resist going on blood thinners because of their fear of the complications. And I feel like the evidence is there. Why don't they believe me? And that's why it's really important to have the conversation. Even our peers and colleagues can sometimes question the evidence, and it's important for us to be aware of that.  Dr Grouse: Absolutely. I think that sounds very reasonable to me, and hopefully these tools will help us with making some of these decisions with our patients. Now, turning our attention a little bit to secondary prevention. So, you know, someone's already had a stroke or a TIA, sort of thinking about what we can do to optimize their risk factors for further strokes. You know, I think there has been some changes that have happened, I think, in the last few years that might be affecting some of the decisions we're making and some of the advice we're giving our patients. I wanted to talk a little bit about GLP-1 receptor agonist medications. Is the data there to support use of this either in secondary prevention or even in primary prevention in the case of stroke?  Dr Elkind: There is evidence that supports the use of GLP-1s for stroke prevention. We need more data, though. We need trials that focus only on patients with stroke, for example, there have been studies in patients with cardiovascular disease broadly that include stroke patients. But if you look at the subcategory just of stroke patients alone, the data in that subgroup alone don't always show a benefit. And so, we need more data that's focused on stroke patients alone. So, I think the data are continuing to emerge, but we need more still.  Dr Grouse: Is there any development in the thought about whether we should be putting patients on antiplatelet therapies for incidental, incidentally identified strokes? For instance, if you got an MRI for migraine or for other reasons and you found one, no history of any stroke-like symptoms. Should we be putting these patients on aspirin or any other types of therapies?  Dr Elkind: That's a really great question. And again, it's an area where there's some controversy and really, there's really no definitive data that would support using antiplatelet therapy in people with incidentally discovered infarcts or what we call, you know, whispering strokes or silent strokes. Many stroke neurologists will use antiplatelet agents. This is one of those areas where it's so important to identify the risk factors. As we were saying before, patients who have other neurological disorders like migraine or epilepsy may turn out to have cardiovascular risk factors like diabetes and high blood pressure. That's why it's so important for neurologists to be able to treat those patients or refer them to specialists who can. Patients who have incidentally discovered lesions similarly are a group where we should be looking for risk factors. So, I don't think of it only in terms of do we put them on an antiplatelet or not, but really more holistically, can we identify their other risk factors and address those? Should the patient's information be entered into a risk calculator like PREVENT, for example, so that we can come up with a more global or holistic measure of their cardiovascular risk and address that as appropriate? Because if they are at risk for stroke, they're also at risk for cardiac events, including heart attack, heart failure, sudden cardiac arrest, and so forth. So, I think of it as a, as a great kind of teachable moment or an opportunity to catch somebody and bring them into the healthcare system more broadly and address those other potential risk factors.  Dr Grouse: Speaking of, of risk factors that we often like to think about and work up when possible, in cases where it seems certainly possible the patient had an embolic stroke, but perhaps we've done a few weeks or four weeks of cardiac monitoring, have not found any evidence of atrial fibrillation. What's new and what's the current recommendations for doing further monitoring when there's high suspicion for cardioembolic stroke?  Dr Elkind: This is a really active area of investigation, and guidelines suggest that we should do some cardiac monitoring for atrial fibrillation after an unexplained stroke, but it's not clear how much we should do. Studies generally show that the longer you follow somebody on a cardiac monitor after stroke, the more likely you are to detect atrial fibrillation. It could be as high as thirty percent after a few years. And that's great. And if you detect atrial fibrillation, people usually end up being recommended for a blood thinner. But how extensively we should monitor remains unknown. And I think a lot of the investigation recently has been around the question of, are there other ways to get that information rather than waiting six months or a year for the person to develop atrial fibrillation?It's a little bit funny logically to think a person has a stroke today, a year later you discover atrial fibrillation on the monitor, and you say, "Oh, now I know what caused your stroke a year ago." Right? The temporality, the causality perhaps is off in that case. And so, wouldn't it be better if we could tell what somebody's risk of having another cardioembolic stroke is, or the likelihood that they have atrial fibrillation is at the time that you first see them for the stroke, you know, in the hospital, for example. And so, there's some really new technologies that have evolved like AI or artificial intelligence interpretation of EKGs that can give a really good indication of which people are gonna go on to develop atrial fibrillation. And so, I think we need some more trials in that area to demonstrate that we can detect the risk of AFib and treat that even before it appears on one of those delayed monitors. That's an area that I think is very exciting right now. There's also a further question with regard to how to treat these patients, which is that sometimes atrial fibrillation is a consequence of the stroke itself. So, we can think about what people call known AF, meaning atrial fibrillation that's known about before the stroke even occurs, versus AF that's detected after a stroke, or AF-DAS, people will say. Those may have very different implications for the risk of recurrence and what the person's cardiovascular status is. So, I think what we've learned over the last few years is that atrial fibrillation, it used to be like the slam dunk for a stroke neurologist. It was the easy thing. You know, you had a stroke, you have AFib, you should be on a blood thinner. Now we know that there's lots of different kinds of AFib. There's AFib before stroke, there's AFib after stroke, there's burden of atrial fibrillation. So, some people may have 30 seconds of AFib, some people may have several hours, some people may be in it continuously. It comes and goes, and that can make it challenging to manage. So, we have a lot more work to do to understand this problem better.  Dr Grouse: That also gets me into some other interesting areas that I think there's still some question, you know, how aggressive should you be? How often is it a case of is this correlated or is this causative? For instance, when a patent foramen ovale is, is discovered in patients with cryptogenic stroke. Are there any tools or new developments to help us understand whether these PFOs should be closed in these cases?  Dr Elkind: PFO and stroke is a great story that's been going on for decades. And again, we've made tremendous progress in the last several years. So, it's true that about 20% or so of people have a PFO, and because of that, it can be really hard to say with any certainty whether an individual patient sitting in front of you, that the PFO was the cause of their stroke. Rarely we can have a really high degree of certainty. You know, if somebody has, uh, a DVT, for example, and shortly after that maybe they have pulmonary embolism and then a stroke, and we can say, "Oh, clearly this was a paradoxical embolism," went to the lungs and then some crossed over and went to the brain. That happens really infrequently. Most of the time you're faced with a patient who has a PFO and a stroke, and they may have some other risk factors. There are some tools that we can use to help figure out the likelihood that a PFO is related to a stroke. One of those is called the ROPE score or the risk of paradoxical embolism score that was developed by David Thaler and, uh, David Kent from Tufts and a group of other investigators as well. That score allows one to say what the likelihood is that the PFO was causative of the stroke, and it's based on a person's risk factors such that the younger you are, the more likely it is the PFO caused the stroke. And the absence of risk factors make it more likely that the PFO caused the stroke. So, the higher your ROPE score indicating the fewer other reasons you have a stroke, the more likely the PFO is to be causative. So that can be helpful in identifying patients who may have had a stroke due to their PFO. There are other features that are identified in something called the PASCAL score, which is a way of assessing the degree of shunting and whether or not there's an atrial septal aneurysm that can be used as additional factors that lead to the likelihood that a PFO was causative rather than just incidental. So, by putting this kind of information together, we can kind of do precision neurology or precision prevention by identifying which patients with a PFO are really the ones we need to worry about and do procedures like closure.  Dr Grouse: I look forward to hearing more and learning more as more advances are made in these areas. Dr Elkind: Thank you.   Dr Grouse: And thank you so much for joining us today to talk about your article.   Dr Elkind: Oh, I appreciate it. Thank you for giving me the opportunity. I really enjoyed it.  Dr Grouse: Again, today I've been interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Learn more about the ACTION learning network at this link.About our Guest: Tanya Perry, DO, is the director of the VAD Program at Cohen Children's Medical Center. She earned her medical degree from Nova Southeastern University and completed her pediatric critical care fellowship training at Cohen Children's Medical Center, followed by pediatric cardiology fellowship at Cincinnati Children's Hospital, where she subsequently practiced for 3 years as a cardiac intensivist. Dr. Perry's clinical and research efforts are focused on improving outcomes in children supported with mechanical circulatory support. Selected References: Ventricular Assist Device Therapy - ClinicalKeyBerlin Heart EXCOR and ACTION post-approval surveillance study report - PubMedABCs of Stroke Prevention | Circulation: Cardiovascular Quality and OutcomesQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Social determinants of health, including housing, food access, insurance status, and structural inequities, significantly influence stroke prevention, recovery, and long term outcomes. These factors affect biological risk, treatment adherence, and disparities in care, even when traditional clinical measures are addressed. This episode highlights practical strategies for integrating screening, leveraging multidisciplinary teams, and identifying opportunities for advocacy to improve patient outcomes. In this episode, Teshamae Monteith, MD, FAAN, speaks with Nneka L. Ifejika, MD, MPH, author of the article "Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Ifejika is an adjunct professor of physical medicine and rehabilitation at UT Southwestern Medical Center in Dallas, Texas, and the chief scientific officer of the Division of Academics at Ochsner Health System in New Orleans, Louisiana. Additional Resources Read the article: Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Monteith: Two patients have the same stroke, but when they return, they have very different outcomes. We can look into some of their comorbidities, but something we don't spend enough time talking about is the social determinants of health. Stay tuned to this discussion. I promise you, you'll become a better neurologist. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr. Teshamae Monteith. Today I'm interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. How are you? Welcome to our podcast. Dr Ifejika: Thanks for having me. I'm doing great. Dr Monteith: Great. So, can you introduce yourself to our audience? Dr Ifejika: Sure. I'm Dr. Nneka Ifejika. I am the Chief Scientific Officer of Ochsner Health System in New Orleans, Louisiana. But I'm also a cerebrovascular rehabilitation doctor. I've been practicing for about nineteen years, and am happy and honored to be a contributor to this Continuum Neurology article. It's a really important topic. Dr Monteith: Great. So, what got you into this field, first of all? Dr Ifejika: Well, I was deciding between PM&R and neurology, and I was putting in both match lists. And I thought about it and I leaned toward PM&R, but stroke still had a grasp on my heart and my mind. And so, after I finished my residency, I joined the UT Houston stroke team, and I did a, thankfully did a two-year fellowship and became cross-trained in stroke as well as physical medicine rehab. So, I am a jack of both trades. Dr Monteith: So, you got your way in a way. Dr Ifejika: I did. Dr Monteith: You know, we have a lot of learners that are listening, so it's always, uh, nice for them to be inspired, I think, by people's career paths. So why don't we talk about the objectives of your article? Dr Ifejika: Sure. So, one of the most important things that we wanted to do was make sure that medical students, residents, faculty, and fellows understood the impact of social determinants of health on stroke recovery and stroke rehabilitation. It's not as simple as you have hypertension, hyperlipidemia, we're going to manage your stroke risk factors. Oh, you had an ischemic stroke. You presented in time for the window. We're going to give you endovascular therapy and then modified Rankin scale at hospital discharge in ninety days. No, no, no. The stroke survivor and their caregivers and their family have a lot more to deal with outside of what we look at during the acute stroke hospitalization and post-acute rehabilitation. Things like, can they afford the medication that we're prescribing? Antiplatelet agents or anticoagulation can be extremely expensive. Do they have housing insecurity? Is there food insecurity? What's going on behind the scenes that we are not addressing that can directly impact the admission rate and the readmission rate after we take care of a stroke survivor? Dr Monteith: I love the article because you took a real deep dive into social determinants of health, what they are, why they matter, and what we can do about them. And so why don't we talk a little bit about the NINDS framework for social determinants of health? I think many of us might not be familiar with the framework per se. Dr Ifejika: So, the framework consists of multiple domains specifically that relate to social determinants of health that were published in Neurology a couple of years ago. So, I do hope that people who are hearing this recording actually read them. There are interpersonal domains, there are classic medical domains, there are indeterminate domains, and there are six total domains. And health domains are the last domain. So, things like when it comes to housing insecurity, food insecurity, that's a domain of social determinants of health. When it comes to chronic racism, when it comes to biases that patients experience, those actually impact outcomes. So, there are six separate indices that we're going to get into in detail and how we address them as clinicians, whether it be at the medical student level, resident level, faculty level, to integrate the social determinants of health in our care plans, because we could be doing a much better job. And I think it'll be really important from the interpersonal perspective when we really relate to our patients and their families that we ask these questions. For example, if we're prescribing someone to have treatment for their diabetes mellitus and ha- and, and be taking insulin, if they have housing insecurity and they're in a homeless shelter, they have to leave the homeless shelter during the day. So, what happens to the insulin that we prescribe? These are variables that we are not considering on a regular basis, but they directly relate to compliance. Dr Monteith: Great. So that was one thing I wanted to bring up. We're very good at measuring blood pressure and trying to determine, uh, the association between stroke outcomes and things that we can measure, glucose, lipids, blood pressure. What is the evidence for social determinants of health and stroke outcome? Dr Ifejika: The evidence is growing, and there have been many publications that have come out that are, are going to be highlighted in this article related to structural determinants of health inequities, like structural racism, as well as disparities related to ethnicity and race. There's geographical disparities. For example, a lot of patients are, are primarily concerned about rural versus urban, whether you have access to different post-acute rehabilitation, whether you have access to secondary stroke prevention because you simply don't have the transportation from a, a rural area to get to a drugstore to get things available to you. Social status. There are actually publication related to socioeconomic status and the concerns when it comes to air pollution. So particulate matter 2.5, we know that that has a direct impact on stroke outcomes and health overall, but we don't really think about it as a structural determinant of health inequity. There's several multiple layers of research that have gone on specifically that have been cited in the literature that relate directly to social determinants of health and how we can address them moving forward. Dr Monteith: And what I found interesting in your article in that you gave at least a few examples where social factors like income, education were controlled for, and maybe in large part it is, but even when you control for some of these very obvious social risk factors, you still have inequities. Dr Ifejika: Absolutely. And I think it was really important to show that we had strong peer review evidence behind this, as it wasn't just something that we were creating or hypothesizing about. There have been studies that have been done over this over decades of time, showing the impacts of social determinants of health on outcomes. But the question and concern that we have is we know this growing body of literature continues to expand. What are we doing about it when it comes to education of the future generations of providers who will be caring for this population? Dr Monteith: Before we get into how, you know, what we're going to do about that, let's just kind of put that link, cause the evidence is there. How does it drive biology? Dr Ifejika: It's a great question. So, for example, particulate matter 2.5 in air pollution has been shown to have an existing impact on hypertension, raising your blood pressure. So that's a direct effect of a social determinant of health related to socioeconomic status because people who live in areas with higher air pollution are... They're not green spaces. They live near highways. Those are areas that unfortunately are also impacted by food deserts. Food deserts, if you're not able to get fresh fruits, vegetables, whole foods, increases your risk of developing diabetes, hyperlipidemia, also increases your sodium intake, again, increasing hypertension. These things are all connected to biological determinants. It's just that we're not asking about them necessarily within the social history when we're taking people into the hospital, but they have direct effects. Dr Monteith: Great. Neurologists tend to be busy and, you know, we're... have all of these things that we're being asked to do and chart and click and all of that stuff. And so how can we more readily integrate screening for social determinants of health and that conversation into the work we do? We recognize it's important. We recognize it's an important risk factor. There's a lot of these determinants. So, what is a good way to do so? And I, I know that in the paper you've, you've given different roles to different team players, so I want you to talk about that too, but just kind of even a regular routine office visit. Walk us through a way we can more easily integrate that kind of conversation. Dr Ifejika: It's an excellent question, and what I've recommended that we do in a standard office visit is utilize the time before the visit to send out screeners. So, for example, usually with an electronic medical record, you can send documents before the visit even starts, where people can check off whether they have any concerns regarding housing, food insecurity. They can check out their location of where they live, whether they live near a highway or not near a highway. It's specifically related to socioeconomic status. We can ask about insurance status, whether they have insurance, insured versus uninsured, but then also types of insurance, whether they have Medicaid insurance versus Medicare insurance. Then even drilling even further, type of Medicare insurance, Medicare Advantage versus traditional Medicare, cause all of those things actually play a role in this. Dr Ifejika: And evaluate these things and don't take time during your office visit. Send these screeners out beforehand. Have them be assimilated by your medical staff. Make sure you're utilizing every resource that you have at your disposal to help streamline things, so by the time the person comes in for the visit, you've primed the pump. You have this information already in your hands at your fingertips cause it was sent out in advance, and you have your medical staff already have an understanding of. If they didn't fill it out electronically, give it to them in the lobby. Make sure they have a handwritten copy in the lobby so that when they come into the office visit, you have the information at your fingertips. Dr Monteith: Are there any particular resources that you recommend for those types of screeners? Dr Ifejika: What I've used in the past, if you have patient-reported outcomes, so the PROMIS instruments, that's a good start. It doesn't get into the details of housing insecurity, food insecurity, but it's a good start to help prime questions and to start the conversation during your office visit. In my clinics, I do a PROMIS 27 on every patient, as well as a PHQ-9 for depression on everyone. And then I collect data longitudinally, and I can always drill down on factors that I noticed that could become a problem moving forward. Dr Monteith: Yeah. And then also in your article, you spoke a bit about this impact from the acute presentation in the hospital to rehab. Dr Ifejika: Yeah. Dr Monteith: So why don't you talk about these different entry points where we can really engage our patients and try and help reduce their burden? Dr Ifejika: Sure. So, healthcare can be quite fragmented, and the stroke patient, stroke survivor, and their family member have no grasp of that. They've had a stroke, and they may be going from the ER to the ICU to the stroke unit to the floor to the rehab unit, and we see it as multiple levels of care, multiple types of providers. They see it as one hospital. And the concern that we have is, at those branch points, things get dropped, and we have the opportunity to pick things up at those branch points. So, during the acute care hospitalization-Primarily, that's the establishment of what has happened, how we're gonna treat it, what are the variables that we can control for right now to address those determinants of health moving forward, and to specifically looking at whether they were taking medications before, whether they could afford medications before, what that looks like at hospital discharge. Is there any duplication of medications? If a person is taking Coreg and you prescribe metoprolol, but they still have the Coreg at home, should we have really prescribed the metoprolol? We're just spending money that they may have concerns when it comes to access to care and the cost of these prescriptions. So, it's the responsibility of the acute care physician to kind of look at that. Those are subtle things that we think are subtle, but they add up quickly for the family when it comes to having one group of medications that's the same class and having to buy another type. When it comes to post-acute rehabilitation, it's really an important time to screen for whether the caregiver can handle what's occurring. So specifically, if the caregiver is already burning out and the average length of stay for a stroke patient is five days and they've come to rehab for two weeks, what's gonna happen in the next two years or the next four years? So, during the post-acute rehabilitation phase, it's time to kind of look at that and drill down on those kind of questions. Also, the levels of care, Dr Ifejika: it's really important to look at other levels of rehabilitation, so skilled nursing facilities, making sure people have access to that if they need to, if the caregiver is burned out and they don't have the ability to go straight home. Because acute inpatient rehab, the goal of it afterwards, is to go straight home. It's not to go to another facility. So, you need to have that screener in place when it comes to whether the family can take care of this person, and whether the family can do it in an effective way to prevent them being readmitted. Dr Monteith: Great. I also like that you spoke about kind of the team approach and different roles, both for screening and for intervention, both being very important, especially the intervention. And so why don't you give us a few examples how the team could break up the responsibility and how also for the intervention component that can be done. Dr Ifejika: Sure. So, I broke up the team into several levels. So, the team medically is the medical student, resident, and faculty physician. However, the team also includes the support staff, so your case manager, your social worker, the therapist, physical therapy, occupational therapy, speech therapy, the pastoral services, all these members of the team. You know, sometimes as physicians, we don't read those notes. There's a lot of information in the notes from social work, care coordination, and the therapist. They get down to subtleties cause they're asking questions, for example, "What kind of equipment do you have at home? How many stairs do you have at home? What level of house do you have, one story, two story? If you live in an apartment, do you have an elevator access?" That's important for someone with hemiparesis. When it comes to medications, when it comes to insurance status, when it comes to your ability to have the mechanisms to pay for care as an outpatient, social workers are required to ask these questions cause they have to figure out resources for the patient and their family to help facilitate improved outcomes. So, they have to ask questions regarding these tasks. The concerns are, do we read what they're saying? So, it's really important to interact with them, and if it's not something that you're looking at in the chart, cause we're all so tied to our computers, find where they are in the hospital. Walk by their office and have a chat. Run your list with them, especially for people who you're concerned have vulnerabilities, and make sure that you're setting an example for your medical students with your faculty doing so. If you're looking at it from the medical student, resident, faculty perspective, medical students, listen. This is your opportunity to really contribute to the team as well as learn about social determinants of health and research in their fields. You are the boots on the ground for the medical team. You are the ones who should be priming the pump and asking these questions of the family members. We're sending you into the rooms to do a history and physical. Social determinants of health should be a part of your history and physical, and you should be taking what we're saying in this article and asking these questions and tying it into your resident. Now, the resident is the work person of the hospital. We all know this. Things run through the resident. Things run through the fellow. It's really important that they have this information in a manner that is negotiable. The list keeps getting longer, and a resident doesn't need to be overburdened. It needs to be synthesized in a manner that can help facilitate the resident being able to act as well as communicate any concerns to the faculty. And at the faculty level, we are the voices that can affect change. So, if there's any concerns when it comes to advocacy, research, making sure that people are accessing care in a way that makes sense, particularly when it comes to the ability for us to galvanize change on a national level, that's kind of our job. Dr Monteith: Great, and so let's talk about intervention. What are things that, let's say, the neurologist can do to deal with some of these social factors? Dr Ifejika: From the neurology perspective, I think it's really important to identify missed opportunities and making sure that we address them. For example, the conversations around the ability to have access to care related to insurance versus no insurance. There are many, many ways that neurologists are able to advocate for a person being able to get to Medicare insurance, particularly in the outpatient setting. When we see patients in clinic, it takes two years, them, to qualify for Medicare, two years at a minimum. But there's a gap there that can be filled by us making sure that we document what's happened, contact their providers, facilitate communication with their employers, if they're employees, they can get some short-term disability benefits to help bridge that gap prior to receiving Medicare insurance. It behooves us to do this because if we do not, they fall into the gap and they get readmitted and they're back on service anyway. So, what's important is the outpatient that we really kind of focus on things that we can impact and things like insurance and getting people transitioned from having employer-based insurance versus getting to Medicare is a really important way that we can effect change in a, in a way that's viable and, and replicable. So, in the outpatient setting, neurologists have a wonderful opportunity to effect change in social determinants of health. When it comes to employed persons, who had a stroke transitioning to Medicare, it takes two years to do so. So, in the outpatient clinic, if you have an employed person, make sure that you fill out their short-term disability benefits forms, their long-term disability benefits form. Bridge the gap. Get that information to their employer so they can maintain constant coverage. Because if they do not, if they have to choose between refilling medications and putting food on the table, they're going to choose putting food on the table, and that's going to directly impact their outcomes if they're not taking the medication that we recommend. Dr Monteith: I think that's a great point. I mean, there's a lot that we can do, and in some ways, it may not take that much to document and to be able to ask the questions and to include some of that information into the assessment and plan is really a, a great idea. Dr Ifejika: And you know, if we don't bring these things up and have these conversations, it doesn't get addressed. And that's why I'm very, very thankful that I had the opportunity to do so, cause this is a part of what I do all day. I think that if I wasn't integrating these kind of conversations into my practice, I wouldn't have the ability to share these tips and these abilities to move things forward in a manner that will be constructive for our field overall and for our patients. Dr Monteith: And towards the end of the article, you brought up something I think we don't see in many articles, and that's the role of advocacy and getting involved in health policy. So, can you talk a little bit about that? Dr Ifejika: You know, it's really important to facilitate change when you see that there are things that need to be changed. And the best way to do that is through advocacy at the local or state or federal level. A lot of these variables that we're dealing with can be addressed through legal changes. I'll give you an example. End-stage renal disease, if you have immediate hemodialysis and you have that requirement upon hospital discharge, you qualify for Medicare immediately. Immediately. Before you even leave the hospital. Why wouldn't something be similar for a stroke? Well, the reason why is because there was a level of advocacy that came around end-stage renal disease and a member of Congress's wife had hemodialysis requirements. And so, a law was passed to make sure Medicare covered it immediately after hospital discharge. So, it requires advocacy in some significant ways to get things done, but we have the bandwidth to do this. We take care of a population that has some of the highest rates of preventable disability. That's not going away. We need to make sure that we're effecting change for this group to make sure that they have the best possible outcomes they can experience. Dr Monteith: So, any final messages for our listeners? Dr Ifejika: I look forward to hearing everyone's feedback about our issue. I am thankful for the opportunity to talk about, address, and write about this important topic, and look forward to everyone's feedback. Dr Monteith: Well, thank you so much for being on our podcast. It was a really wonderful summary and we had a very thorough conversation, but you didn't give away too much, so I think they're going to have to read the article. Dr Ifejika: You're going to have to read the article. And we want medical students, residents, fellows, faculty, all of our ancillary staff within the hospitals, please read this article. We really appreciate it. Dr Monteith: Again today, I've been interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Dr. Aleksandra Pikula is quadruple board-certified in Medicine, Neurology, Vascular Neurology, and Lifestyle Medicine… with Neurology and Vascular Neurology Fellowship and postdoctoral training at Boston University, Harvard University, and the Framingham Heart Study.Dr. Pikula holds a status of an Associate Professor of Medicine, a Clinician-Investigator, and Co-Director of the Women's Neurology Fellowship Program at the University of Toronto.Since 2023, she had been appointed as the Inaugural Jay & Sari Sonshine Chair in Stroke Prevention and Cerebrovascular Brain Health at the University of Toronto, University Health Network, and Krembil Brain Institute… and serves as the founding director of the Jay and Sari Sonshine Centre at UHN.Her clinical and research focus is on stroke prevention and outcomes in younger adults, particularly emphasizing women's brain health during midlife. Dr. Pikula advocates for a holistic approach to brain care, targeting stroke and dementia prevention through evidence-based lifestyle medicine programs.Plant-Based Canada was also privileged to feature her as a speaker for our 2026 Conference, where she discussed plant-forward nutrition for the brain across the lifespan. That talk will be available to participants for three months.RESOURCES Through HER Prism Facebook Instagram Linkedin Framingham Heart Study Jay and Sari Sonshine Centre Women's Neurology Fellowship Program at the U of T Support the show

5/27/26 (Co-Host Brian Adams) Resilient Valley's Julia Riseman & Lora Wondolowski: camels through the eye of a needle & other fundraising ideas. Dr. Ethan Chapin, Cooley-Dickinson's Dir of Emergency Medicine: It's Stroke Prevention Month—save yr life & the life of a loved one—BE FAST. Dave Small, Dir of Conservation @ Mount Grace Land Trust: saving the Ebony Bog Haunter (really!), dragon flies and 40,000 acres. Easthampton Mayor Salem Derby: the override vote on June 9 --what happens if it passes; what happens if it doesn't.

Georgios Tsivgoulis, MD, PhD, MSc - Navigating the Latest Evidence Surrounding Current and Emerging Strategies for Secondary Stroke Prevention

Georgios Tsivgoulis, MD, PhD, MSc - Navigating the Latest Evidence Surrounding Current and Emerging Strategies for Secondary Stroke Prevention

Georgios Tsivgoulis, MD, PhD, MSc - Navigating the Latest Evidence Surrounding Current and Emerging Strategies for Secondary Stroke Prevention

Georgios Tsivgoulis, MD, PhD, MSc - Navigating the Latest Evidence Surrounding Current and Emerging Strategies for Secondary Stroke Prevention

This activity was supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance. Please go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Link⁠⁠⁠⁠ and complete the evaluation to receive your CE/CME Credit. Credit is available through May 6, 2027.

This segment highlights key insights into diet, lifestyle, and cardiovascular health. #HeartHealth #Nutrition #LifestyleMedicine

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Xin Cheng, MD, PhD - Seeking Solutions in Secondary Stroke Prevention: The Latest Inquiries and Insights on Factor XIa Inhibition

Please visit answersincme.com/860/102701687-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Mike Sharma, MD, MSc; and Richard A. Bernstein, MD, PhD. In this activity, experts in stroke discuss post-stroke care and long-term secondary stroke prevention. Upon completion of this activity, participants should be better able to: Discuss evidence-based strategies for secondary stroke prevention, including risk factor modification; Outline the potential role of FXIa inhibitors in closing current long-term management gaps for patients who have had a non-cardioembolic ischemic stroke or TIA; and Design multidisciplinary, long-term secondary stroke treatment plans that effectively leverage all members of the stroke care team, including cardiologists.

This week, we conclude our 4-part series on Strokes, the #4 cause of death in America.  In this episode, you'll discover:—How the number one thing we can do to prevent Strokes is to not smoke cigarettes.  And the dangers of Vaping which Dr. Prather says "can actually be worse" because of the Heavy Metals that are being inhaled. —Why Dr. Prather says it is "a testament against our government" that  only 2% of a cigarette is required to be composed of tobacco, with the rest being cardboard soaked in addictive chemicals. —The Acupuncture, Auriculotherapy, and Homeopathy treatments offered at Holistic Integration that are incredibly effective in helping people to overcome cigarette and other addictions. —How birth control pills are the leading cause of younger women to have a Stroke because they reduce Copper levels in the body, which leads to a weakening of the arteries.   Plus, the dangers of legal pharmaceutical amphetamines like Ritalin, which are "basically cocaine".—How the ECP (External CounterPulsation) Therapy at Holistic Integration prevents Cardiovascular Disease, will reverse Cardiovascular Disease, and even reverses Stroke effects by duplicating 5 years of marathon training for the heart in just 7 weeks. —The role obesity plays in increasing the risk of a Stroke.  And the Body Composition Analysis at Holistic Integration that measures your Body Fat Percentage more accurate,y than the Body Mass Index measurement. —Why TIA events should be taken seriously because they will make you 10 times more likely to have a Stroke within the next year.  And why Dr. Prather says you need to react to a TIA as if you have had a Stroke. —The amazing amount of information you get from the Autonomic Nervous System ANS Test that is given to every new patient at Holistic Integration and helps Dr. Prather really know if a patient is in trouble. —Why your Cholesterol ratio matters more than just your overall Total Cholesterol number.  And how Cholesterol is actually an antioxidant there to protect you from Free Radical damage.—The importance of proper Chiropractic Care in Stroke Prevention, particularly the Atlas Orthogonal Adjustment.  And why Dr. Prather says you are not going to correct Hypertension caused by a Vagal Nerve issue unless you correct the Atlas first. http://www.TheVoiceOfHealthRadio.com*Receive exclusive bonus content as a member of our Voice Of Health Patreon Community:https://www.patreon.com/cw/VoiceofHealthPodcast

Please visit answersincme.com/860/102620367-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Keith C. Ferdinand, MD; and Henry J. Michtalik, MD, MPH, MHS. IIn this activity, experts in preventive cardiology and hospital medicine discuss secondary stroke prevention strategies for hospitalists and internists. Upon completion of this activity, participants should be better able to: Evaluate guideline-recommended secondary stroke prevention strategies after ischemic stroke or TIA; Describe the clinical rationale for FXIa inhibitors; Discuss the clinical significance of the latest efficacy and safety data for FXIa inhibitors in secondary stroke prevention; and Apply best practices for transitioning patients from inpatient to outpatient secondary stroke prevention care.

Drs. Sanossian and Saver review new evidence supporting intensified antithrombotic strategies to reduce recurrent ischemic stroke in high-risk, noncardioembolic patients without increasing intracranial hemorrhage. They place this within a comprehensive, multimodal secondary prevention framework that integrates pharmacologic therapy with aggressive risk factor modification (lipids, blood pressure, diabetes, and lifestyle).

Ashkan Shoamanesh, MD, FRCPC - Turning Pathophysiologic Promise Into Evidence-Based Potential: Are Factor XIa Inhibitors Ready for Prime Time in Secondary Stroke Prevention?

Ashkan Shoamanesh, MD, FRCPC - Turning Pathophysiologic Promise Into Evidence-Based Potential: Are Factor XIa Inhibitors Ready for Prime Time in Secondary Stroke Prevention?

Ashkan Shoamanesh, MD, FRCPC - Turning Pathophysiologic Promise Into Evidence-Based Potential: Are Factor XIa Inhibitors Ready for Prime Time in Secondary Stroke Prevention?

Ashkan Shoamanesh, MD, FRCPC - Turning Pathophysiologic Promise Into Evidence-Based Potential: Are Factor XIa Inhibitors Ready for Prime Time in Secondary Stroke Prevention?

Dr. Jeremy Liff, who trained at NYU and practices on Long Island, joined the podcast to discuss practical strategies for stroke prevention. Their conversation centers on sustainable lifestyle measures: reducing added sugars and artificial sweeteners, maintaining healthy blood pressure and cholesterol levels, and partnering with a primary care physician to manage cardiovascular risk. They also discuss GLP-1 medications within the broader context of risk reduction. https://jeremyliffmd.com/

Send a textMajor bleeding remains the principal complication of oral anticoagulation. In patients with device-detected subclinical atrial fibrillation, the decision to anticoagulate requires careful balancing of stroke prevention against bleeding risk.In this episode of CLOT Conversations, Dr. Deborah Siegal discusses a prespecified subanalysis of the ARTESiA randomized clinical trial, recently published in JAMA Cardiology. ARTESiA demonstrated a 37% reduction in stroke and systemic embolism with apixaban compared to aspirin — but at the cost of increased major bleeding.This subanalysis goes deeper, examining the site, severity, and clinical course of bleeding events. Most bleeding was gastrointestinal and non-critical. Rates of intracranial and fatal bleeding were low and similar between treatment arms. The majority of events were not clinical emergencies, and many were defined by hemoglobin decline rather than catastrophic presentation.We explore what these findings mean for individualized risk assessment, the importance of modifiable bleeding risk factors such as NSAID use, and how physicians and patients can approach shared decision-making in subclinical AF.Abstract (subscription required for full paper): Siegal DM, Sticherling C, Healey JS, McIntyre WF, Christensen LS, Parkash R, Vanassche T, Conen D, Gold M, Granger CB, Nielsen JC. Major Bleeding With Apixaban vs Aspirin: A Subanalysis of the ARTESiA Randomized Clinical Trial. JAMA cardiology. 2025 Dec;10(12):1305-14.https://jamanetwork.com/journals/jamacardiology/fullarticle/2841075Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

The panel breaks down salt and fat intake, stroke risks, genetic individuality, and the science behind optimizing nutrient absorption. #SaltDebate #FatIntake #FunctionalMedicine #HealthTalks

From radioactive shrimp recalls to Trump's health, to Big Brother star Mickey Lee's heartbreaking death at 35 from cardiac arrest, 2025 delivered some jaw-dropping health headlines. We're closing out the year by breaking down the biggest food recalls that had us checking our freezers (yes, including that Cesium-137 contamination), the celebrity health battles that opened critical conversations about prostate cancer, breast cancer, diabetes complications, and mental health struggles, plus the alarming rise in strokes and heart attacks among younger adults. We'll also recap the disease outbreaks that reminded us why prevention matters, from measles making its worst comeback in decades to H5N1 keeping scientists on alert. Plus, we'll wrap the year with a challenge to begin 2026 and help us all step into a healthier, happier, and more hopeful new year.This podcast is intended to be informational only.  It is not a medical consultation, nor is it personalized medical advice.  For medical advice, please consult your physician.#HealthHappyLifePodcast #DrFrita #DrFritaLIVE! #MedicalMondays #CelebrityHealthNews #MedicineInTheNewsHere are a few helpful resources to help on your journey to wellness:▶️ Subscribe so you will never miss a YouTube video.

Dr. Hoffman continues his conversation with Alan Frost, founder of Flava Naturals, and Dr. Joseph C. Maroon, MD, FACS, clinical professor and vice chairman of the Department of Neurological Surgery and Heindl Scholar in Neuroscience at the University of Pittsburgh Medical Center, and author of "The Science of Cocoa."

Alan Frost, founder of Flava Naturals, and Dr. Joseph C. Maroon, MD, FACS, clinical professor and vice chairman of the Department of Neurological Surgery and Heindl Scholar in Neuroscience at the University of Pittsburgh Medical Center, and author of "The Science of Cocoa," detail recent scientific findings on the cardiovascular and cognitive benefits of cocoa flavanols, the importance of sourcing and processing cocoa, and how cocoa can enhance athletic performance and brain health. The episode also covers the benefits of cocoa for skin health, fighting inflammation, and even mitigating some of the effects of sitting. Dr. Maroon elaborates on his protocols for concussion recovery, including the use of omega-3 fish oil, creatine, and CBD. The episode concludes with a discussion on how cocoa impacts mood and a special discount offer for Flava Naturals products. Just go to FlavaNaturals.com and use coupon code HOFFMAN20 for 20% off site-wide, plus get free shipping on all orders over $30.

Mike Sharma, MD, MSc, FRCPC - Challenging the Status Quo in Secondary Stroke Prevention: Current Perspectives on the Potential of Factor XIa Inhibition

Mike Sharma, MD, MSc, FRCPC - Challenging the Status Quo in Secondary Stroke Prevention: Current Perspectives on the Potential of Factor XIa Inhibition

Atrial fibrillation raises stroke risk fivefold. But what if blood thinners are too dangerous after a brain bleed or major fall?A new monthly injection, abelacimab, may prevent strokes without the bleeding risk of traditional anticoagulants.Is this the future for AFib patients who can't take blood thinners? Cardiologist Dr. Alain Bouchard discusses this groundbreaking drug with Dr. Charles V. Pollack, a consultant clinical scientist and professional educator with Novartis, owner of abelacimab.About the TeamDr. Alain Bouchard is a clinical cardiologist at Cardiology Specialists of Birmingham, AL. He is a native of Quebec, Canada and trained in Internal Medicine at McGill University in Montreal. He continued as a Research Fellow at the Montreal Heart Institute. He did a clinical cardiology fellowship at the University of California in San Francisco. He joined the faculty at the University of Alabama Birmingham from 1986 to 1990. He worked at CardiologyPC and Baptist Medical Center at Princeton from 1990-2019. He is now part of the Cardiology Specialists of Birmingham at UAB Medicine.Dr. Philip Johnson is originally from Selma, AL. Philip began his studies at Vanderbilt University in Nashville, TN, where he double majored in Biomedical and Electrical Engineering. After a year in the “real world” working for his father as a machine design engineer, he went to graduate school at UAB in Birmingham, AL, where he completed a Masters and PhD in Biomedical Engineering before becoming a research assistant professor in Biomedical Engineering. After a short stint in academics, he continued his education at UAB in Medical School, Internal Medicine Residency, and is currently a cardiology fellow in training with a special interest in cardiac electrophysiology.Medical DisclaimerThe contents of the MyHeart.net podcast, including as textual content, graphical content, images, and any other content contained in the Podcast (“Content”) are purely for informational purposes. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or heard on the Podcast!If you think you may have a medical emergency, call your doctor or 911 immediately. MyHeart.net does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Podcast. Reliance on any information provided by MyHeart.net, MyHeart.net employees, others appearing on the Podcast at the invitation of MyHeart.net, or other visitors to the Podcast is solely at your own risk.The Podcast and the Content are provided on an “as is” basis.

In this episode, we sit down with Dr. Olajide Williams to explore how stroke awareness, prevention, and treatment intersect with culture, equity, and the arts. He shares both personal insights and groundbreaking research that has saved lives in Harlem and beyond.Together, we discuss:* The urgent reality of stroke – why every minute counts (“time is brain”).* Why stroke disproportionately affects Black and Brown communities—and tragically, at younger ages.* The treatment window: from clot-dissolving medications like tenecteplase to advanced clot-removal procedures.* The hidden barriers to timely stroke care—knowledge gaps, delayed responses, and reliance on cabs or waiting rooms instead of calling 911.* The power of health literacy as the first pit stop on the road to health equity.* How the Hip Hop Stroke Program quadrupled treatment rates in Harlem by engaging children, who then educated their parents and grandparents.* Why music, art, and emotional connection are indispensable for learning and transforming community health.Key Insights & Gems

Send us a textIn this episode of WTR Small-Cap Spotlight, host Tim Gerdeman and WTR's Robert Sassoon speak with Marvin Slosman, CEO of InspireMD (NASDAQ: NSPR), to discuss how the company is transforming carotid artery disease treatment with its groundbreaking CGuard® Prime Carotid Stent System. The conversation covers FDA approval, clinical data, market adoption, competitive positioning, and InspireMD's long-term growth strategy.

On this episode of Rich Valdes America at Night, Richard V. Battle, a fifth-generation Texan, business leader, and award-winning author, shares insights from his latest book Americans Who Made America as we reflect on Constitution Day and explore the nation's core principles amid modern challenges. Then, Dr. Jeremy M. Liff, a board-certified neurologist specializing in stroke and brain aneurysms, outlines five ways to lower the risk of stroke and protect brain health. Later, Krystina Alarcón, columnist, researcher, and author, joins the conversation to discuss her new book Politically Media: Exposing Bias and Clickbait in the News, examining how today's headlines shape public perception. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Perioperative stroke represents a rare but potentially devastating complication of anesthesia care. While occurring in less than 1% of non-cardiac surgical patients, this complication fundamentally threatens not just patient outcomes but their very identity. As Dr. Jacob Nadler poignantly notes in our podcast, "By maintaining brain health, we're preserving the essence of who our patients are—their memories, their personality, their ability to connect with friends and family."The most significant recent development in this field comes from the 2024 joint guidelines that have dramatically shortened the recommended waiting period following stroke before elective surgery. What was once a nine-month wait has been reduced to just three months based on compelling evidence from a cohort study of 5.8 million patients showing risk stabilization after 90 days. This change has profound implications for surgical planning and patient care timelines.Anesthesia professionals must be vigilant about key risk factors including advanced age, previous stroke history, renal dysfunction, and anemia. The podcast explores critical medication management considerations, particularly regarding anticoagulation protocols, alongside specific intraoperative targets for blood pressure and hemoglobin levels. For suspected perioperative stroke, rapid multidisciplinary intervention with emergent brain imaging, possible thrombolytics, and mechanical thrombectomy may be indicated.For every anesthesia professional, this episode provides essential insights to help fulfill our commitment that no one shall be harmed by anesthesia care. Subscribe on Spotify or YouTube and share with colleagues to spread this vital safety information.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/266-protecting-the-brain-perioperative-stroke-prevention/© 2025, The Anesthesia Patient Safety Foundation

Vascular neurologist Dr. Carolyn Brockington shares essential tips on how to prevent strokes and what to do if someone you know shows warning signs. Also, Craig visits a group of Atlanta dads transforming their local library into the neighborhood's go-to hangout spot. Plus, Mia Threapleton joins to talk about her role in the new Wes Anderson film ‘The Phoenician Scheme,' where she plays the daughter of a wealthy businessman. And, our Shop TODAY team rounds up great gift ideas for the graduate in your life.

Natto is a Superfood for Stroke Prevention, Blood Clot Reduction, and More! Looking for natural ways to boost your health? In this episode, I'm sharing the surprising benefits of natto—a traditional fermented soybean dish packed with powerful nutrients like nattokinase and vitamin K2. From preventing strokes and dissolving blood clots to potentially helping your body clear spike proteins post-COVID, natto is a sticky superfood with serious science behind it. I'll share how to enjoy it (even if the taste is new to you), how to make it yourself, and why this humble food has become a daily staple in my kitchen. Episode link:  https://www.culturedfoodlife.com/podcast/episode-314-natto-the-sticky-secret-to-health/ Link(s) I talked about: Article: https://www.culturedfoodlife.com/natto-superfood-for-stroke-prevention-blood-clot-reduction-and-more/ Check out these other links: My Story Video: https://youtu.be/CbX9Nv9OtGM For health tips and recipes, subscribe to our weekly emails. We'll also send you our free Getting Started Guide: http://bit.ly/2BnHpay Listen to all my podcasts: http://bit.ly/cflpodcast Become a Biotic Pro Member: http://bit.ly/2kkhwS1 Cultured Food Recipes: http://bit.ly/2UIfY2x Health and Food Topics: http://bit.ly/2SdzIOS My Amazon Shop: https://bit.ly/3KdhEge MY STARTER CULTURES Milk Kefir Grains: http://bit.ly/2rQ99PE L. Reuteri Superfood: https://bit.ly/LReuteriSuperfoodStarter L. Gasseri Superfood: https://bit.ly/LGasseriSuperfoodStarter Easy Kefir: http://bit.ly/2MQ1nPV Kefir Soda Starter: http://bit.ly/3YVErTa Kombucha Starter: http://bit.ly/2g2R9hE Vegetable Starter: http://bit.ly/2SzzVem Water Kefir Crystals:  http://bit.ly/2irmImW Sourdough Starter: http://bit.ly/2IjaaXK Other items in my store: http://bit.ly/2HTKZ27 STAY CONNECTED Instagram: http://instagram.com/culturedfoodlife/ Facebook: https://www.facebook.com/CulturedFoodLife/ Pinterest: http://pinterest.com/donnaschwenk/ Twitter: https://twitter.com/donnaschwenk

Do you know your “remnant cholesterol”? It could be better than LDL for predicting your risk of having a heart attack or stroke; Vagal nerve stimulation for seizures—could adding a keto diet help? Exoskeletons that help runners, hikers, and cyclists have hit the consumer marketplace for recreational athletes; RFK Jr's HHS launches program to improve infant formulas; Insurers bilk taxpayers for billions by double-charging Medicaid.

Chime In, Send Us a Text Message!Episode 81: Managing PFO after Stroke: A discussion on diagnosis, treatment options including the patient perspectives and quality of life decisions with David Thaler,MD of Tufts Medical Center.This conversation in collaboration with the SAYA Consortium explores the relationship between patent foramen ovale (PFO) and stroke, particularly in young adults. Our expert guest, Dr. David Thaler, a vascular neurologist with Tufts Medical Center, discusses the definition of PFO, its diagnosis, and its implications for stroke risk. The discussion highlights the importance of understanding cryptogenic strokes, which often have no identifiable cause, the PFO paradox and how a PFO is often discovered with cryptogenic strokes, the diagnostic tests and the management options available for patients with PFO. The conversation emphasizes the need for patient education and awareness regarding stroke risks and prevention strategies. In this conversation, Dr. Thaler discusses the implications of PFO closure in recurrent stroke prevention, medical management and the importance of patient choice and quality of life, plus the outcomes of the RESPECT Trial. Co-host David Dansereau shares his patient experience as a stroke survivor with PFO who elected for device closure.  The dialogue highlights the evolving landscape of PFO research and the significance of understanding individual patient risks and lifestyle choices.More About Our Guest: David Thaler,MD-Tufts Medical CenterShow mentions:  Lester Leung,MD,  Katelyn Skeels, SAYA Consortium, RESPECT Trial , Co-Host David's Book ClosureThanks to: Rory Polera (guest on Ep.69), stroke survivor and interview outline reviewer with SAYA ConsortiumAdditional Education: Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack

Dr. Bradley Stoner, Director of the Division of STD Prevention at the CDC, reports the findings in the latest STI Surveillance report; Katherine Feldman, Chief Performance Officer at the Maryland Department of Health, details the success of Maryland's State Health Improvement Plan; an ASTHO blog article outlines heart disease and stroke prevention in the pacific territories; and the Alabama Department of Public Health marks 150 years in existence. National Coalition of STD Directors Web Page: NCSD Congratulates Dr. Bradley Stoner on CDC Appointment; Applauds Leadership During STI Crisis CDC Web Page: Sexually Transmitted Infections Surveillance, 2023 Maryland Web Page: Building a Healthier Maryland ASTHO Blog Article: Maryland Achieves Success Through Thoughtful Planning ASTHO Blog Article: Heart Disease and Stroke Prevention in the Pacific Territories  

Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AF ablation Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017 Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195 Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288 II Post-Stroke AF monitoring Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026 Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686 Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933 III RCTs Large simple randomized controlled trials—from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707 IV Troponin Testing in the ED Cardiac Biomarker Testing in US Emergency Departments https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344 Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967 V Choice of AVR Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

“Active holistic therapy” for prostate cancer with diet and fish oil helps defer need for surgery, hormone blockade, radiation; Why 70 is the new 60; Long-term harmful effects of acid-blockers; Do memory supplements pass the blood-brain barrier? Fish oil, krill oil, olive oil for cardiovascular prevention; Paxlovid aggressively promoted but overprescribed for otherwise healthy patients.