2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association

Kleindorfer, Dawn O.; Towfighi, Amytis; Chaturvedi, Seemant; Cockroft, Kevin M.; Gutierrez, Jose; Lombardi-Hill, Debbie; Kamel, Hooman; Kernan, Walter N.; Kittner, Steven J.; Leira, Enrique C.; Lennon, Olive; Meschia, James F.; Nguyen, Thanh N.; Pollak, Peter M.; Santangeli, Pasquale; Sharrief, Anjail Z.; Smith, Sidney C.; Turan, Tanya N.; Williams, Linda S.

doi:10.1161/str.0000000000000375

Cited by 3,237Acute Ischemic Stroke ManagementCerebrovascular and Carotid Artery DiseasesClinical practice guidelines implementation

2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association

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Kleindorfer, Dawn O., Towfighi, Amytis, Chaturvedi, Seemant, Cockroft, Kevin M., Gutierrez, Jose, Lombardi-Hill, Debbie, Kamel, Hooman, Kernan, Walter N. +11 more·2021·Stroke

DOI 10.1161/str.0000000000000375

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Abstract

The individual reviewers' relationships with industry information is available in Appendix 2.This document was approved for publication by the governing bodies of the ASA and the AHA.It was reviewed for evidence-based integrity

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Individuals with CKM stage 1 due to overweight and obesity are at increased risk for developing metabolic risk factors and CKD compared with those who have a normal weight without risk factors (CKM stage 0).
“Individuals with CKM stage 1 due to overweight and obesity are at increased risk for developing metabolic risk factors and CKD compared with those who have a normal weight without risk factors (CKM stage 0).5,6,41”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says that elevated blood pressure, dyslipidemia, and hyperglycemia track closely with weight, supporting a link between obesity and metabolic risk factors. It does not establish that people with CKM stage 1 develop these factors or CKD more often than people with CKM stage 0. (LLM, conf=0.80)
Experimental — accuracy not yet measured
Even in the absence of these metabolic risk factors, excess weight is associated with increased cardiovascular risk, particularly for HF.
“Even in the absence of these metabolic risk factors, excess weight is associated with increased cardiovascular risk, particularly for HF.6,42”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The obesity Synopsis reports that obesity increases ischemic stroke risk compared with normal weight. It describes that risk as mediated by factors including elevated blood pressure, dyslipidemia, and hyperglycemia; it does not establish increased risk in their absence or identify heart failure as a particular outcome. The indexed passages provide no page number. (LLM, conf=0.85)
Experimental — accuracy not yet measured
The emergence of metabolic risk factors from youth and young adulthood into middle age is primarily related to weight gain with aging.
“There is a particular focus on preventing the development of excess and dysfunctional adipose tissue because the emergence of metabolic risk factors from youth and young adulthood into middle age is primarily related to weight gain with aging.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis says that elevated blood pressure, dyslipidemia, and hyperglycemia track closely with weight, and that weight loss improves vascular risk factors. It does not say that metabolic risk factors emerge primarily because of weight gain from youth or young adulthood into middle age. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Self-directed digital health solutions can be beneficial to promote weight loss for CKM syndrome risk reduction in adults with overweight or obesity who have significant barriers to participating in multicomponent behavioral weight loss interventions.
“For adults with overweight or obesity who have significant barriers to participating in multicomponent behavioral weight loss interventions, self-directed digital health solutions can be beneficial to promote weight loss for CKM syndrome risk reduction.5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says weight loss can improve vascular risk factors, and the recommendations endorse intensive, multicomponent behavioral programs for patients with obesity after stroke. The passages do not support the specific claim that self-directed digital solutions benefit adults who face barriers to those programs, or establish CKM syndrome risk reduction. (LLM, conf=0.83)
Experimental — accuracy not yet measured
MBS can be beneficial to facilitate weight loss and mitigate CKM syndrome progression in patients with CKM stage 1 to 3 and obesity without adequate weight loss response to lifestyle modification.
“Among patients with CKM stage 1 to 3 and obesity without an adequate weight loss response to lifestyle modification, with or without the use of adjunctive obesity pharmacotherapies, MBS can be beneficial to facilitate weight loss and to mitigate CKM syndrome progression.1–8”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis discusses metabolic or bariatric surgery as a weight-loss option for selected patients and describes improvements in cardiovascular risk factors associated with surgical weight loss. The recommendations concern people with stroke or TIA; the paper does not establish a benefit for patients with CKM stages 1–3 who have not responded adequately to lifestyle modification, or show that surgery mitigates CKM syndrome progression. (LLM, conf=0.82)
Experimental — accuracy not yet measured

MBS can be beneficial in patients with T2D with a threshold BMI of 30 kg/m2.
“MBS has efficacy among individuals with a BMI ≥35 kg/m2 regardless of the presence of comorbidities and can be beneficial in patients with T2D with a threshold BMI of 30 kg/m2.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says studies of metabolic surgery associate weight loss with improved glucose control, which supports a general benefit relevant to T2D. It does not give a BMI threshold of 30 kg/m² for patients with T2D or establish efficacy at BMI ≥35 kg/m² regardless of comorbidities. The BMI ≥35 recommendation elsewhere in the copy concerns metformin for patients with prediabetes, not surgery. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Glycemia consistently improves with GLP-1-based agents, with some evidence for preventing progression to diabetes in those with insulin resistance.
“Glycemia consistently improves with use of these agents, with some evidence for preventing progression to diabetes in those with insulin resistance.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Clinical Statements and Guidelines section describes GLP-1 receptor agonists as glucose-lowering medications and says liraglutide has been shown to reduce progression to diabetes. It does not establish that glycemia consistently improves with GLP-1-based agents, or that GLP-1 agents prevent progression specifically in people with insulin resistance. For patients with prediabetes after stroke, it says the benefit of GLP-1 receptor agonists has not been investigated. (LLM, conf=0.84)
Experimental — accuracy not yet measured
MBS has efficacy among individuals with a BMI ≥35 kg/m2 regardless of the presence of comorbidities.
“MBS has efficacy among individuals with a BMI ≥35 kg/m2 regardless of the presence of comorbidities and can be beneficial in patients with T2D with a threshold BMI of 30 kg/m2.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The obesity Synopsis (page unavailable) says studies of metabolic surgery associate weight loss with improvements in glucose control, blood pressure, inflammation, and lipid metabolism. It does not establish efficacy specifically at BMI ≥35 kg/m² regardless of comorbidities. The guideline’s BMI ≥35 recommendation concerns metformin for selected patients with prediabetes after stroke or TIA, not surgery. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Counseling on dietary or combined dietary and exercise modifications effectively facilitates weight loss in postpartum women with GDM.
“Counseling on dietary or combined dietary and exercise modifications effectively facilitates weight loss in postpartum women with GDM.6,19–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says intensive behavioral counseling can help patients achieve meaningful weight loss. The guideline discusses weight loss after stroke and in people with overweight, obesity, or type 2 diabetes; it does not establish that dietary or combined diet-and-exercise counseling is effective specifically for postpartum women with gestational diabetes. (LLM, conf=0.86)
Experimental — accuracy not yet measured
RASi provide BP control and kidney and cardiovascular protection.
“RASi provide BP control and kidney and cardiovascular protection6 and are therefore preferred in patients with CKD and albuminuria.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The COR LOE Recommendations 1 A section (page unavailable) says ACE inhibitors and angiotensin receptor blockers lower BP and reduce recurrent stroke risk in patients with hypertension after stroke or TIA. This supports BP control and a specific vascular benefit, but the passages do not establish kidney protection or broader cardiovascular protection for RAS inhibitors. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Clinical trials and meta-analyses of SGLT2i in patients with CKD and T2D or CKD and UACR ≥200 mg/g without T2D have shown a significant reduction in risks of losing kidney function, kidney failure, cardiovascular death, and HF hospitalization when compared with placebo.
“Clinical trials and meta-analyses of SGLT2i in patients with CKD and T2D or CKD and UACR ≥200 mg/g without T2D have shown a significant reduction in risks of losing kidney function, kidney failure, cardiovascular death, and HF hospitalization when compared with placebo.5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
The presence of subclinical atherosclerosis (eg, elevated CAC) is associated with an increased cardiovascular risk among those with CKM risk factors (eg, diabetes, CKD).
“The presence of subclinical atherosclerosis (eg, elevated CAC) is associated with an increased cardiovascular risk among those with CKM risk factors (eg, diabetes, CKD).5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The 1 C-LD section reports that aortic arch plaque is associated with ischemic stroke and increased stroke recurrence, while Table 5 lists diabetes and chronic kidney disease as high-risk conditions for future ASCVD events. These passages support a related vascular-risk association, but they do not establish the claimed association between elevated coronary artery calcium and cardiovascular risk specifically among people with those risk factors. The available copy gives no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measured
A heart-healthy diet and regular physical activity remain the cornerstones of therapy in patients with T2D and ASCVD, with demonstrated benefits for CKM risk profiles.
“A heart-healthy diet and regular physical activity remain the cornerstones of therapy in patients with T2D and ASCVD, with demonstrated benefits for CKM risk profiles.5–12”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Clinical Statements and Guidelines section includes nutritional therapy and physical-activity counseling in T2D management, and says exercise interventions can reduce cardiometabolic risk factors in patients with stroke or TIA. It does not specifically establish that diet and exercise improve CKM risk profiles in patients who have both T2D and ASCVD. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Habitual physical activity, including activities that reduce sedentary time, aerobic physical activity, and resistance training, are associated with improvements in several CKM risk factors (HbA1c, waist circumference, fat percentage, BP) and mortality.
“In addition, habitual physical activity, including activities that reduce sedentary time, aerobic physical activity, and resistance training, are associated with improvements in several CKM risk factors (HbA1c, waist circumference, fat percentage, BP) and mortality.5–12”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
MBS is associated with a lower risk of incident major adverse liver outcomes and MACE in large cohort studies.
“MBS is associated with a lower risk of incident major adverse liver outcomes and MACE in large cohort studies.6,24,25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says observational research provides some evidence that weight loss after bariatric surgery may reduce stroke risk. It does not report a lower risk of major adverse liver outcomes or of MACE as a composite outcome in large cohort studies. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Patients with diabetes have a 60% increased risk of stroke recurrence.
“and a 60% increased risk of stroke recurrence.35”
From Neurodegeneration and Stroke After Semaglutide and Tirzepatide in Patients With Diabetes and Obesity (2025) · cites this paper as [35]
The Clinical Statements and Guidelines section reports that patients with type 2 diabetes and ischemic stroke have an increased risk of recurrence (RR, approximately 1.6), equivalent to a 60% increase. The claim extends that estimate to patients with diabetes generally, without the source’s type 2 diabetes and ischemic stroke qualifiers. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Standard stroke care includes medical treatment, routine stroke therapy, and rehabilitative exercises, as outlined in basic guidelines.
“Standard stroke care includes medical treatment, routine stroke therapy, and rehabilitative exercises, as outlined in the basic guidelines [35,36].”
From Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility (2024) · cites this paper as [36]
The Abstract recommends antithrombotic treatment and physical activity for secondary stroke prevention. The 2a C-EO recommendation discusses supervised exercise in addition to routine rehabilitation, but only for patients whose post-stroke deficits impair their ability to exercise. The guideline does not present all three elements as a universal package of standard stroke care. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Current guidelines recommend short-term dual antiplatelet therapy after high-risk transient ischemic attack and minor stroke.
“In addition, current guidelines recommend short-term dual antiplatelet therapy after high-risk transient ischemic attack and minor stroke (198).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [198]
The Recommendation-Specific Supportive Text (page unavailable) says minor strokes meeting POINT trial criteria should receive short-term aspirin and clopidogrel. The 2b B-NR recommendation (page unavailable) says ticagrelor plus aspirin for up to 30 days might be considered after a recent high-risk TIA or minor stroke, but only with concomitant ipsilateral intracranial-artery stenosis. The available passages therefore support short-term dual therapy in specified patients, not an unqualified recommendation for all high-risk TIAs and minor strokes. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Frequent and long-term engagement and behavioral support for lifestyle modification are needed for optimal effectiveness.
“However, owing to the chronicity of obesity and multiple compensatory changes in metabolism, hunger, and satiety promoting weight recidivism,6 frequent and long-term engagement and behavioral support for lifestyle modification are needed for optimal effectiveness.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Persistently elevated triglycerides are considered a risk enhancer for ASCVD.
“Additionally, as per clinical guidelines, persistently elevated triglycerides are considered a risk enhancer for ASCVD.2,4–6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
CAC assessment improves selection of patients for treatment with aggressive ASCVD risk factor modification (ie, statin therapy).
“CAC assessment improves prediction of ASCVD4,5 and selection of patients for treatment with aggressive ASCVD risk factor modification (ie, statin therapy).6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The COR LOE Recommendations (page unavailable) recommend statins for specified patients after stroke or TIA, but do not say that CAC assessment improves selection for treatment. Searches for “CAC,” “coronary artery calcium,” and calcium-based statin decisions found no passage addressing that claim in our copy; the copy is truncated. (LLM, conf=0.70)
Experimental — accuracy not yet measured
In the CorCal trial, the CAC arm had a greater reclassification of risk compared with the group using a risk calculator.
“CorCal (Effectiveness of a Proactive Cardiovascular Primary Prevention Strategy, With or Without the Use of CAC Screening, in Preventing Future MACE)6 randomized 601 primary prevention patients to CAC (n=302) or risk calculator guidance (n=299) for primary prevention; the CAC arm had a greater reclassification of risk compared with the group using a risk calculator.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The supplied guideline passages discuss secondary stroke prevention and carotid procedures, not the CorCal primary-prevention trial. Searches for CorCal and for CAC-based risk reclassification found no passage reporting the trial or the claimed comparison; the end of our copy may be missing. (LLM, conf=0.70)
Experimental — accuracy not yet measured
At 1 year in the CorCal trial, LDL-C levels were lower in the CAC arm.
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The guideline’s COR LOE Recommendations and Recommendation-Specific Supportive Text discuss LDL-C targets and statin treatment after stroke, but do not report a one-year LDL-C comparison between CorCal trial arms. Searches for “CorCal,” “CAC arm,” and the claimed cost comparison found no relevant passage in our copy; its truncation also limits what can be ruled out. (LLM, conf=0.70)
Experimental — accuracy not yet measured
At 1 year in the CorCal trial, estimated costs were similar or reduced in the CAC arm.
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The guideline passages on LDL-C lowering (Clinical Statements and Guidelines; page unavailable) discuss statin effects and adherence, but not the CorCal trial or costs in a CAC arm. Searches for “CorCal,” “CAC arm,” and the estimated-cost claim found no relevant passage in the available copy, whose end may be missing. (LLM, conf=0.70)
Experimental — accuracy not yet measured
At 1 year in the CorCal trial, statin adherence was superior in the CAC arm.
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The COR LOE Recommendations and Recommendation-Specific Supportive Text discuss statin treatment and adherence monitoring after stroke or TIA, but do not report a CorCal trial or compare statin adherence between CAC and other arms at one year. Searches for CorCal and for coronary artery calcium, statin adherence, and costs found no passage addressing that result; the available copy is truncated. (LLM, conf=0.73)
Experimental — accuracy not yet measured
Once obesity is established, multiple compensatory mechanisms impacting metabolism, hunger, and satiety are triggered in the setting of intentional weight loss, which commonly result in weight regain.
“Once obesity is established, multiple compensatory mechanisms impacting metabolism, hunger, and satiety are triggered in the setting of intentional weight loss, which commonly result in weight regain.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis discusses weight-loss treatments and their effects on vascular risk factors, but does not describe compensatory changes in metabolism, hunger, or satiety that cause weight regain. Searches for those mechanisms and for weight regain after intentional weight loss found no supporting passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
In EMPA-Kidney, the risk reduction for the primary outcome (a composite of progression of kidney disease or death from cardiovascular causes) with empagliflozin compared with placebo was larger among patients with higher UACR (UACR ≥30-300: HR, 0.91; 95% CI, 0.65-1.26 versus UACR ≥300: HR, 0.67; 95% CI, 0.58-0.78).
“In EMPA-Kidney, the risk reduction for the primary outcome (a composite of progression of kidney disease or death from cardiovascular causes) with empagliflozin compared with placebo was larger among patients with higher UACR (UACR ≥30–300: HR, 0.91; 95% CI, 0.65–1.26 versus UACR ≥300: HR, 0.67; 95% CI, 0.58–0.78).6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
The rate of eGFR decline after the initial decrease was slower in the empagliflozin group than in the placebo group in all key subgroups, including in the subgroup of patients with a UACR <30 mg/g.
“However, the rate of eGFR decline after the initial decrease was slower in the empagliflozin group than in the placebo group in all key subgroups, including in the subgroup of patients with a UACR <30 mg/g.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Clinical Statements and Guidelines passages discuss diabetes treatments and recommend an SGLT2 inhibitor when chronic kidney disease is a concern, but they do not report an empagliflozin–placebo comparison of eGFR decline. Searches for empagliflozin, eGFR slope, and UACR <30 mg/g found no passage addressing the claimed subgroup result; the copy is truncated. (LLM, conf=0.73)
Experimental — accuracy not yet measured
Simulation studies suggest that combinations of CKM therapies may have additive benefits for heart and kidney protection.
“Simulation studies suggest that combinations of CKM therapies may have additive benefits for heart and kidney protection.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The guideline’s diabetes discussion mentions therapies relevant to cardiovascular and kidney disease, but the passages found do not address simulation studies or additive benefits from combinations of CKM therapies. Searches for those terms and their paraphrases found no supporting passage; our copy is truncated, so the claim cannot be verified from it. (LLM, conf=0.72)
Experimental — accuracy not yet measured
In the SELECT trial, among participants with BMI ≥27 kg/m2 and established ASCVD without T2D, end-stage kidney disease, or dialysis, semaglutide 2.4 mg reduced the risk of the composite primary endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke by 20% compared with placebo.
“In the SELECT trial,6 17 604 participants with BMI ≥27 kg/m2 and established ASCVD (prior MI, stroke, or symptomatic PAD), and without T2D, end-stage kidney disease, or dialysis, were enrolled. The trial demonstrated a 20% reduction in risk of the composite primary endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke for those treated with semaglutide (2.4 mg) as compared with placebo”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
A single-arm 15-week pragmatic weight management program achieved a mean weight loss of 8.1 kg (−6.7%) for patients with obesity-related HFpEF.
“A single-arm 15-week pragmatic weight management program (weekly consultations with exercise specialists, dietitians, and behavioral specialists), achieved a mean weight loss of 8.1 kg (−6.7%) for patients with obesity-related HFpEF.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis discusses behavioral weight-loss programs generally, and the recommendations concern patients with stroke or TIA. Searches for the 15-week program, the 8.1 kg (−6.7%) result, and obesity-related HFpEF found no passage addressing the claimed study; the available copy is truncated. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Among patients with HFrEF, RASi improves both HF outcomes and risk for worsening kidney disease in several clinical trials.
“Among patients with HFrEF, RASi improves both HF outcomes and risk for worsening kidney disease in several clinical trials.1–8,28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis (page unavailable) says ACE inhibitors and angiotensin receptor blockers have shown benefit in trials, but it discusses blood-pressure treatment after stroke, not outcomes in HFrEF. The Clinical Statements and Guidelines section (page unavailable) discusses heart-failure trials of antithrombotic drugs, not RAS inhibitors or worsening kidney disease. Searches for HFrEF, renin–angiotensin inhibitors, and kidney outcomes found no passage establishing the claimed combined benefit in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
A directionally similar reduction in risk of the cardiovascular outcome was observed in a subgroup with CKD G4 in the FIDELITY meta-analysis of finerenone in diabetic patients, but this was nonsignificant.
“A directionally similar reduction in risk of the cardiovascular outcome (cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for HF) was observed in a subgroup with CKD G4 in the FIDELITY meta-analysis of finerenone in diabetic patients, but this was nonsignificant and requires further investigation.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The supplied Clinical Statements and Guidelines passages discuss other cardiovascular trials and renal disease, but not the FIDELITY meta-analysis or finerenone. Searches for the CKD G4 subgroup and the specified cardiovascular outcome found no relevant passage in our copy; the copy is truncated. (LLM, conf=0.73)
Experimental — accuracy not yet measured
Metabolic and bariatric surgery causes remission of MASLD, even in advanced stages.
“Metabolic and bariatric surgery causes remission of MASLD, even in advanced stages.6,24,25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The Synopsis discusses metabolic and bariatric surgery in relation to weight loss, glucose control, and vascular risk factors, but does not address MASLD remission or advanced-stage liver disease. Searches for MASLD and for fatty liver, steatohepatitis, and fibrosis found no passage supporting the claim; our copy is truncated, so a relevant passage may be missing. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Hyperkalemia was more frequent in those with CKD G4 treated with finerenone.
“Hyperkalemia was more frequent in those with CKD G4 treated with finerenone.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The available Clinical Statements and Guidelines passages discuss chronic kidney disease in relation to recurrent stroke and anticoagulant use, not finerenone. Searches for finerenone, CKD G4, and hyperkalemia found no passage addressing the claim; the copy is truncated, so the missing text cannot be ruled out. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Abdominal adiposity is one of the strongest VTE risk factors.
“Abdominal adiposity is one of the strongest VTE risk factors.3,5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The obesity Synopsis (page unavailable) links obesity to ischemic stroke, not venous thromboembolism. Searches for abdominal adiposity and obesity as VTE risk factors found no passage in our copy ranking abdominal adiposity among VTE risk factors; the copy is truncated. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Many guidelines recommend adding GLP-1 receptor agonists to ongoing antihyperglycemic regimens to lower stroke risk in type 2 diabetes.
“Accordingly, many guidelines now recommend the addition of GLP-1RAs to ongoing antihyperglycemic regimens to lower the risk of stroke in type 2 diabetes.”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]
The AHA/ASA guideline suggests GLP-1RAs as second-line to metformin regardless of baseline HbA1c in individuals with established atherosclerotic CVD to avoid further vascular events.
“the American Heart Association/American Stroke Association guideline suggests GLP-1RAs as second-line to metformin regardless of baseline HbA1c in individuals with established atherosclerotic CVD to avoid further vascular events 7”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]
The 2020 Canadian Stroke Best Practices update, 2021 Spanish Society of Neurology consensus statement, 2021 AHA/ASA guideline, and Diabetes, Cardiorenal, and Metabolic Diseases Multispecialty Task Force all endorse GLP-1RAs for reducing stroke risk in individuals with T2DM.
“In the same vein, the 2020 Canadian Stroke Best Practices update for secondary prevention of stroke, 8 2021 Spanish Society of Neurology consensus statement, 9 2021 American Heart Association/American Stroke Association Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack, 7 and the Diabetes, Cardiorenal, and Metabolic Diseases Multispecialty Task Force 55”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]

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[673]Lawrence K, Keleher T. Structural Racism. Paper presented at: Race and Public Policy Conference; November 11-13, 2004; Berkeley, CA. 862.

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EHA Guidelines on Management of Antithrombotic Treatments in Thrombocytopenic Patients With Cancer
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When Direct Oral Anticoagulants Should Not Be Standard Treatment
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Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists
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1. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare
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A Guideline From the American Heart Association/American Stroke Association Stroke
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Authors: Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S.
ORCID: Kleindorfer, Dawn O.
Towfighi, Amytis
Chaturvedi, Seemant
Cockroft, Kevin M.
Kamel, Hooman
Kernan, Walter N.
Kittner, Steven J.
Leira, Enrique C.
Lennon, Olive
Meschia, James F.
Nguyen, Thanh N.
Pollak, Peter M.
Santangeli, Pasquale
Sharrief, Anjail Z.
Turan, Tanya N.
Williams, Linda S.
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2021-07
Volume: 52
Issue: 7
Pages: e364-e467
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/str.0000000000000375
OpenAlex: W3164908038
Semantic Scholar: 18bb9d19bdfe54d5d1289c0a74fbcb410e3e1b6d
Cited by: 3,237
References: 892
Citations by year: 2026: 653 · 2025: 670 · 2024: 778 · 2023: 618 · 2022: 432 · 2021: 82 · 2018: 1 · 2016: 1 · 2014: 1
FWCI: 72.98
Type: journal article
Language: en
Update notices: correction (2021-06-28)
Open access: bronze
doi.org
Locations: Stroke (publishedVersion)
PubMed (publishedVersion)
Funders: American Heart Association
Congress of Neurological Surgeons
Topics: Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: secondary stroke prevention, stroke recurrence, transient ischemic attack, stroke risk factors
MeSH terms: Clinical Decision-Making, American Heart Association, Ischemic Attack, Transient, Humans, United States, Practice Guidelines as Topic, Stroke, Risk Reduction Behavior

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2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association

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