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• Actor Kat Dennings is opening up about her journey living with migraine headaches.
• She is speaking out to spread awareness and advocate for treatment reform.
• Dennings hopes others living with migraine attacks will join her in advocating for change.

Since she was 12 years old, Marvel and “2 Broke Girls” actor Kat Dennings has lived with migraine headaches.

Sometimes the pain she experienced was so intense and frightening that she slept near her mom.

“She actually had a cot in her closet that she would pull out when I had an attack,” Dennings told Healthline. “When she first took me to the doctor, we were told I would grow out of it, but news flash — I didn’t.”

In her 20s, Dennings finally connected with a doctor who officially diagnosed her with migraine.

She is one of over 40 million Americans (85% of who are female) who live with chronic migraine headaches.

To raise awareness about the seriousness of migraine headaches, Dennings is participating in the Migraine Blackout campaign by going dark for several days on social media.

In October, Dennings archived all posts on her Instagram account and has refrained from posting on any other forms of social media for five consecutive days as a symbolic stance to raise awareness of the toll migraine attacks can have on a person living with the condition.

She also hopes to rally the migraine community to push for care reform.

Pfizer and advocacy organizations, including the American Headache Society, National Headache Foundation, Alliance for Headache Disorders Advocacy, and The Headache & Migraine Policy Forum, are leading the campaign.

“The program is focused on some of the systematic issues that those with migraine face when trying to access treatment,” said Dennings. “We’re providing resources to help people navigate challenges when working with their insurance companies or in getting the treatments that they are prescribed while also advocating for step therapy reform.”

Step therapy requires people with migraine and other chronic diseases to try and fail insurer-preferred treatments before advancing to another therapy.

Patient advocacy groups, including the Alliance for Headache Disorders Advocacy and the Headache and Migraine Policy Reform, support step therapy reform. This aims to eliminate step therapy and help alleviate treatment delays so people can access treatments sooner.

“This push for federal change…is one of the most powerful ways we can spark change for people with migraine,” Dennings said.

To join in on her efforts, you can electronically sign an open letter that will be sent to your congressional representation asking them to support step therapy reform and emphasizing the urgency of improved patient access to migraine care.

“I’m an example of how long it can take to find the right doctor and treatment, so I know a lot of people may be frustrated that they can’t find help,” said Dennings. “I hope to help rally people to advocate for better access to care. I think we can help bring real change and increase access to medications for many people impacted by migraine.”

Below, Dennings shared more with Healthline about living with migraine headaches and speaking out for all those with the condition.

How debilitating are migraine headaches?

Dennings: I cancel personal plans all the time due to my migraine attacks, and that’s the worst because I feel like the ultimate flake. But the truth is, when I have a migraine, I struggle to do anything. That is why I blacked out my social content as part of the Migraine Blackout campaign. I’ve pushed through my pain for years, but this is my way of saying, “I’m done.” By going dark on social media, I’m showing that, really, people with migraine should check out and take care of themselves but also get the care that works for them.

Has a migraine attack ever interfered with your work?

I have never and would never cancel work because of my migraine attacks. I’ve always pushed through the pain because I don’t want to let people down and wasn’t sure if people would understand if I took time off because of it. But that says something, doesn’t it? There was a part of me that felt like having a migraine attack wasn’t a legitimate reason to rest up.

How have you learned to manage migraine headaches over the years?

When things are bad, my go-to solution is lying in a dark room with ice on my neck. Sometimes I’ll use this migraine helmet that helps apply pressure to my head, or I drink a cold slushy. It doesn’t get rid of the pain, but it helps. But the thing with migraine is that it affects everyone differently, so what works for me might not be right for someone else. If you’re experiencing migraine you should talk to your doctor to see what treatment approach is right for you. 

Have you had to go through any obstacles to get treatment?

Unfortunately, there were many times where I sought medical help and was met with a sort of  “well, being a woman is tough.” And as a woman, you feel like you are being a nuisance and that your experience is not legitimate, or someone thinks you are exaggerating. My current doctor is great, but it was hard to find him. It’s a lot of trial and error and asking friends and family who they go to. I’m glad I was able to find someone I like, but it’s a tedious journey.

How have you advocated for yourself when it comes to living with migraine headaches?

It’s sometimes hard to advocate for yourself, and I have to remind myself to speak up and be honest about what I’m feeling and what treatments are or aren’t working. Raising awareness about the real burden of migraine and helping improve access to care is why I wanted to join Migraine Blackout.

Many people don’t know about step therapy, it is a requirement by some states where people with migraine have to try three medicines without sufficient relief before getting to a newer one, even if your doctor prescribes the newer option. I am advocating for step therapy reform, and believe it is one of the most powerful ways we can spark change for people with migraine—and people can do that by signing the open letter at migraineblackout.com.

What do you think people misunderstand most about living with migraine headaches?

Everyone’s migraine pain is different. I have a friend whose migraines are so bad she has to go to the ER. But just because I don’t experience that doesn’t mean mine aren’t valid and painful. Having a migraine isn’t just an excuse to bail on plans—it’s a legitimate disease and should be taken seriously. It’s hard enough to navigate the world when you’re living with migraine, and the stigma just adds onto that.

• Exercise has a complex relationship with appetite that may make you feel hungry or satiated.
• New research indicates that high-intensity exercise could mitigate feelings of hunger, particularly in women, by decreasing ghrelin levels.
• Ghrelin, popularly referred to as the “hunger hormone” stimulates appetite and signals when the stomach is empty.

High-intensity exercise appears to play an important role in mitigating feelings of hunger, according to a new small study. Those findings were even more prominent among females.

The research, published online on October 24 in the Journal of the Endocrine Society, investigates the complex relationship between exercise, the hormone ghrelin, and perceived hunger.

Ghrelin is popularly known as “the hunger hormone,” due to its ability to stimulate appetite. Researchers also sought to fill in gaps in the literature, specifically related to sex. While there is plenty of research available on exercise and appetite, the study authors note that little of it involves females.

Additionally, prior studies have typically utilized only one form of ghrelin, known as acylated ghrelin (AG), but this latest research offers a more complete picture by including a second form, deacylated ghrelin (DAG).

“The key take-home message from the study is that exercise, particularly at a higher intensity, suppresses total, acylated, and unacylated ghrelin, and this effect appears to be more pronounced in women than men,” Alice Thackray, PhD, a senior research associate in exercise metabolism at Loughborough University who wasn’t affiliated with the research, told Healthline.

Both Thackray and the study authors acknowledge there is still much more to learn about the effects of exercise on appetite, but the study helps to confirm prior findings across sex and hint at a potential mechanism.

How exercise affects the ‘hunger hormone’

Your body is constantly burning calories, even when at rest. When you exercise, your body’s energy requirements ramp up too, burning more calories, which can make you feel hungry. But that isn’t always the case.

Unintuitive though it may seem, exercise can also suppress hunger. The exact reasons for this aren’t entirely certain, but researchers have homed in on the impact of exercise on circulating ghrelin.

In their study, researchers investigated this relationship utilizing 14 adults — eight of them male and six female. The participants were younger adults; the average age for men was 43 years old and 32 years old for women. Participants were not overweight, with both groups having an average body mass index (BMI) of about 22.

Each participant had three randomized visits of exercise. During their visit the participant would take part in no exercise, moderate exercise, or high intensity exercise.

Baseline and post-exercise measurements were taken for AG, DAG, total ghrelin, and lactate. Lactate is a metabolic byproduct that builds up during exercise and serves as a biological marker of muscle fatigue.

Participants also had to answer questions about their appetite, fullness, and desire to eat to create a composite score of perceived hunger.

In both groups, high-intensity exercise suppressed DAG, but women, whose baseline ghrelin was already higher than men, showed a dramatic drop in AG.

 “The decrease in acetylated ghrelin after high intensity was really driven by the female group,” Kara Anderson, PhD, first author of the study and postdoctoral fellow at the University of Virginia School of Medicine, told Healthline.

However, decreased ghrelin levels didn’t clearly correlate with a similar drop in perceived hunger for either group.

“The hunger scores in response to exercise are pretty similar between men and women. So, there’s still a lot of research to be done, but this does suggest that males and females may respond to exercise differently, especially considering their ghrelin levels,” said Anderson.

Why exercise intensity matters

The impact of exercise on hunger and ghrelin levels varied across exercise intensity. High-intensity exercise had the most significant effect on ghrelin across males and females. However, perceived hunger told a different story.

For females, both high-intensity and moderate-intensity exercise resulted in nearly identical hunger scores, both of which were higher than the control (no exercise). For males, high-intensity exercise resulted in diminished perceived hunger compared to the control, while moderate exercise resulted in increased hunger. 

But the most important aspect of high-intensity exercise may have to do with lactate, which the authors theorize could be involved in “exercise-induced ghrelin suppression.”

Essentially, when you exercise, your body builds up lactate as a byproduct. When your body produces lactate faster than it can be used aerobically, your body has crossed what’s known as the lactate threshold. 

To cross the lactate threshold, you have to be engaged in high-intensity exercise. And it may be the presence of lactate from crossing that threshold that is key for mitigating hunger. 

“The exercise-induced changes in ghrelin were observed alongside increases in lactate which has been proposed previously as a potential mechanism for ghrelin suppression with exercise,” Thackray said.

“We need more research to support the mechanisms involved in exercise-related appetite responses, including how exercise influences appetite regulation within the brain,” she noted.

Takeaway

Exercise has a complex relationship with appetite that can both stimulate and suppress hunger.

New research indicates that both exercise intensity and sex are factors for the effects of exercise on appetite.

In their study, researchers from the University of Virginia found that high-intensity exercise resulted in significantly diminished levels of ghrelin, popularly known as the “hunger hormone.”

The effects were more pronounced in females compared to males. More research is needed to better understand the mechanisms involved in exercise-related appetite responses.

Unlocking the Benefits of Treadmills and Alternatives for Home Fitness Treadmills have become essential tools for home fitness, providing a convenient way to maintain an active lifestyle regardless of outside conditions. They cater to different fitness levels, whether you’re a beginner or an experienced athlete, making them a popular choice for households.  As more options, …

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• Healthgrades has revealed its 2025 awards for America’s top hospitals for specialty care.
• The rankings include overall specialty rankings, outpatient rankings, and specialty rankings by state.
• These facilities are among the top 5% or 10% of hospitals nationwide in each specialty area.

Choosing the best hospital for healthcare can be challenging, especially if you or someone you know haven’t been there before.

Healthgrades aims to make it easier to know whether you are getting care from the best doctors and hospitals.

On October 22, 2024, Healthgrades announced the recipients of hospital quality achievements recognizing excellence in specialty care:

• 2025 Specialty Excellence Awards
• 2025 Outpatient Awards
• 2025 Specialty State Rankings

In a press release, Healthgrades stated that its specialty excellence rankings “recognize hospitals for outstanding clinical performance in 16 specialty care areas, including cardiac surgery, critical care, and stroke care.”

The outpatient rankings “recognize the national leaders in outpatient care,” and the state rankings “identify the top three or five hospitals in each eligible state across 18 key specialties.”

Healthgrades noted that they used clinically validated methodologies to make their selections based on patient outcome data.

To choose the top hospitals for specialty care, Healthgrades examined clinical performance data on more than 4,500 hospitals across 31 common procedures and conditions. This enabled them to recognize hospitals with the following awards:

• America’s 100 Best Hospitals for Specialty Care (for 11 specialty areas)
• America’s 50 Best Hospitals for Specialty Care (for three speciality areas)

How Healthgrades determined the top hospitals for speciality care

Healthgrades explained that the Specialty Excellence ratings and awards were determined using Medicare inpatient data for years 2021 through 2023. 

This included data on deaths of patients undergoing certain procedures or with specific health conditions, and complications resulting from other procedures. 

To identify the top hospitals, Healthgrades uses a four-step procedure:

1. Calculate the predicted number of deaths or complications at each hospital for these procedures and conditions.
2. Compare the predicted value to the actual number of deaths or complications at each hospital.
3. Determine whether the difference between the predicted and actual values is statistically significant.
4. Use the statistical analysis to determine a hospital’s performance in each category.

For each condition or procedure, hospital performance was broken down into three categories:

• Better than expected
• As expected
• Worse than expected

A similar methodology was used for the Outpatient Awards and Specialty State Rankings.

The top 5% or 10% of hospitals within each specialty area are recognized as Specialty Excellence Award recipients or Outpatient Speciality Excellence Award recipients.

How Healthgrades’ hospital rankings can help patients

In the press release, Brad Bowman, MD, chief medical officer and head of data science at Healthgrades, said, “Our specialty awards highlight top-performing hospitals across medical specialties, empowering consumers to find high quality care for their unique needs. Doing your research ahead of time and understanding where you can find high quality care can positively impact your healthcare journey and overall experience.”

Sara Mathew, associate director of research and operations administration at Weill Cornell Medicine, says Healthgrades hospital rankings are “valuable tools” for patients.

“[These rankings] include data on surgical outcomes and complication rates, making it easier for patients to make informed decisions without needing specialized knowledge of the healthcare system,” she told Healthline.

Mathew noted that in the past, people searching for high quality healthcare depended on referrals from primary care physicians, friends, or family members. But now, many prefer to conduct their own research, including using online reviews and rankings.

“This is especially important in areas with multiple hospitals and healthcare providers, where the right choice can significantly impact not only treatment outcomes but also the overall patient experience, including how doctors, nurses, and staff interact, the cleanliness of facilities, and how promptly concerns are addressed,” she said.

However, she emphasized that Healthgrades rankings should be used as just one part of the decision making process. Patients should also consider other factors, such as whether a hospital or provider is in their health insurance’s network, the location of the facilities, and recommendations from their primary care physician.

“By combining these considerations, patients can make the best healthcare decisions tailored to their individual needs,” she said.

Takeaway

Healthgrades announced the recipients of hospital quality achievements for excellence in specialty care, including the 2025 Speciality Excellence Awards, 2025 Outpatient Awards, and 2025 Speciality State Rankings.

The rankings are based on clinical performance data on more than 4,500 hospitals across 31 common procedures and conditions, including cardiac surgery, critical care, and stroke care.

Experts say the Healthgrades rankings are a valuable tool for patients and can help them make informed healthcare decisions. However, this information should be used in conjunction with other factors such as insurance coverage, location, and recommendations from their own primary care physician.

Healthgrades and Healthline are part of the RVO Health portfolio of brands.

• Semaglutide, the active ingredient in Ozempic and Wegovy, may protect against Alzheimer’s disease in people living with type 2 diabetes.
• People using the drug had a reduced risk of being diagnosed with the disease.
• Both diseases have insulin resistance and inflammation in common.
• Semaglutide might also help remove amyloid-beta from the brain.
• Amyloid-beta plaques can damage and kill brain cells, leading to dementia.

According to a study published on October 24, 2024, in the journal Alzheimer’s & Dementia, the type 2 diabetes and weight loss drug semaglutide (sold under the brand names Ozempic, Wegovy, and Rybelsus) may reduce people’s risk of Alzheimer’s disease.

Those people who were using semaglutide had a lower risk of being diagnosed with Alzheimer’s disease than those using other diabetes drugs.

The Alzheimer’s Association states that Alzheimer’s is a common type of dementia, accounting for around 60% to 80% of all dementia cases.

People with this disease experience memory loss and cognitive decline that is severe enough to interfere with their day-to-day life.

It is incurable and becomes progressively worse over time.

How Semaglutide is associated with lower Alzheimer’s disease risk

The team of Case Western Reserve researchers examined three years of medical records for over 1 million people living with type 2 diabetes in the United States.

Study participants had to be new users of antidiabetic medications, defined as not using these medications within the past 6 months.

Six different populations were identified who had never been diagnosed with Alzheimer’s: all patients, people ages 60 and above, women, men, patients with obesity, and patients without obesity.

For each of these groups, they conducted seven target trials comparing semaglutide with insulins, metformin, dipeptidyl-peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, and other GLP-1RAs (albiglutide, dulaglutide, exenatide, liraglutide, and lixisenatide).

Their methodology involved using target trial emulation, a type of study that aims to mimic a randomized controlled trial (RCT) but uses existing data rather than recruiting new participants and studying how the intervention affects their outcomes.

RCTs are considered to be the gold standard for evaluating the safety and effectiveness of drug treatments for diseases. However, sometimes, observational studies are conducted instead due to constraints like time, money, or ethical considerations.

A target trial emulation is meant to produce an observational study with better-quality data that is closer to an RCT.

When they analyzed the data, they found that semaglutide use was associated with 40% to 70% less risk of being diagnosed with Alzheimer’s in patients with type 2 diabetes. This was in comparison with the seven other similar diabetes drugs.

Results were consistent even when people’s obesity status, biological sex, and age were considered.

However, the study authors did note that the limitations of their study did not allow them to say for certain that semaglutide was responsible for this effect. Further studies are needed to confirm that semaglutide really does protect against Alzheimer’s.

Why semaglutide might reduce Alzheimer’s disease risk

Dr. Ramit Singh Sambyal, a General Physician associated with ClinicSpots who was not involved in the study, explained that semaglutide belongs to a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

These drugs work by mimicking the action of the hormone GLP-1; this helps regulate insulin and blood sugar levels.

“Semaglutide has been found to have anti-inflammatory and neuroprotective properties, which are crucial because inflammation and insulin resistance are both heavily involved in the progression of Alzheimer’s disease,” he said.

Sambyal went on to explain that people with type 2 diabetes are up to 50% to 100% more likely to develop Alzheimer’s when compared with those without diabetes.

“Brain insulin resistance is an emerging factor in Alzheimer’s research,” he continued, “sometimes leading to the condition being dubbed ‘type 3 diabetes‘ due to the metabolic dysfunctions observed in the brains of Alzheimer’s patients.”

Dr. John Lowe, a Physician at Restore Care who was not involved in the study, spoke about another way that semaglutide might be able to protect the brain. “They [GLP-1 drugs] can penetrate the blood-brain barrier and might aid in the clearance of amyloid-beta, which is a characteristic feature of Alzheimer’s disease,” he said.

Amyloid-beta peptide, also known as beta-amyloid, is a “sticky” substance that can build up in the brain—perhaps due to problems with its production, accumulation, or disposal—leading to the formation of plaques that can disrupt brain cell communication and eventually kill the cells.

“This two-pronged approach—especially the potential for metabolic health and brain health improvement—suggests semaglutide may be the answer for how to lower the risk for the development of Alzheimer’s in diabetic patients,” said Lowe.

Takeaway

According to a new study, the type 2 diabetes and weight loss drug semaglutide might also have applications in preventing Alzheimer’s disease.

This progressive and incurable form of dementia has been referred to as “type 3 diabetes” due to the insulin and inflammation that type 2 diabetes and Alzheimer’s appear to have in common.

Semaglutide can improve insulin resistance and inflammation.

It might also be able to clear amyloid-beta, the damaging substance that is thought to cause Alzheimer’s, from the brain.

However, more research is needed to confirm whether semaglutide can truly protect against Alzheimer’s disease.

• The Biden-Harris administration has proposed a new rule that would significantly expand contraception coverage for 52 million females of reproductive age.
• If finalized, the rule would require private health insurers to cover over-the-counter birth control and other contraceptives at no additional cost to patients.
• With reproductive rights at the forefront of the 2024 U.S. presidential election, access to contraception has never been more important.

For the first time in more than 10 years, the Biden-Harris administration has proposed a rule aiming to significantly expand contraception coverage under the Affordable Care Act.

The rule would provide access to over-the-counter birth control pills and other contraceptives to 52 million women in the United States with private health insurance at no cost, the White House announced on October 21.

The proposal from the Departments of Health and Human Services (HHS), Labor, and the Treasury would build on the ACA mandate requiring private health insurers to cover contraception as preventive care without cost-sharing.

This means for the first time, females of reproductive age could obtain OTC contraceptives without a prescription at no additional cost, such as emergency contraception and Opill, the first FDA-approved OTC birth control pill that recently became widely available across the U.S.

If finalized, the rule is expected to go into effect sometime in 2025. It would be the largest expansion of contraceptive coverage under the ACA since 2012.

Since the U.S. Supreme Court overturned Roe v. Wade in 2022, the Biden-Harris administration has remained committed to reproductive rights by strengthening contraception access and affordability under the ACA through Medicare and Medicaid, the White House said.

While most people with health insurance can already obtain free birth control, the addition of OTC birth control at no additional cost could further improve access.

“When someone needs to get their birth control pills over the counter, it should be covered by health insurance,” said Sarah W. Prager, MD, a professor in the Department of Obstetrics and Gynecology at the University of Washington School of Medicine. 

“People need to access over-the-counter contraception for lots of reasons, including traveling and forgetting to bring pills, running out of the prescription, and needing to stay covered until getting in to see a provider. Extending health insurance to birth control pills that are obtained over the counter just makes sense,” Prager told Healthline.

OTC birth control helps prevent unplanned pregnancy

Opill, the only daily birth control pill from drug manufacturer Perrigo, is approved for use without a prescription by the Food and Drug Administration (FDA).

Under the Biden-Harris administration’s proposed rule, OTC contraceptives like Opill would be covered without cost-sharing.

Other methods of birth control, such as sponges, condoms, and spermicides would be covered under the new rule, as well as some contraceptive devices, such as intrauterine devices (IUDs). Emergency contraceptives like Plan B, the morning-after pill, would also be provided at no additional cost.

With reproductive rights at the forefront of the 2024 presidential election, access to effective and affordable contraceptives has never been more important.

Kecia Gaither, MD, MPH, double board certified OB-GYN and maternal-fetal medicine specialist and director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, agreed OTC birth control is key for preventing unintended pregnancies.

“Easier access reduces the likelihood of unintended pregnancies, which can have significant economic, social, and emotional consequences for women and their families,” Gaither told Healthline.

“Allowing OTC birth control enhances [a person’s] autonomy — [they have] more control over their reproductive health without requiring consultation with a healthcare provider,” she added.

Gaither listed other ways OTC birth control is an essential aspect of preventive care:

• Increased accessibility: Obtaining birth control and emergency contraceptive pills without a prescription or a doctor’s visit can lower barriers to access, which is crucial for people in rural or undeserved communities and those who live in “medical deserts.”
• Immediate availability: OTC birth control can be obtained quickly, and discretely, making them more effective when taken soon after intercourse without a barrier method.
• Cost-effective: OTC contraceptives may be more affordable than a doctor’s visit and a prescription, which helps alleviate financial barriers to obtaining contraception.
• Public health impact: Access to free birth control can help lower the incidence of sexually transmitted infections (STIs), which can contribute to better overall public health outcomes. Of course, not all birth control methods, such as condoms, lower the risk of STIs.
• Increased health literacy: OTC contraceptives often come with simplified instructions, which help enhance awareness and understanding of reproductive health.

Takeaway

The Biden-Harris administration proposed a new rule on October 21 that would significantly expand coverage for contraceptives, including OTC birth control and emergency contraception. With reproductive rights at the core of the 2024 presidential race, access to effective and affordable contraceptives has never been more crucial.

• The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.
• In their recommendations, the ASA urges healthcare professionals to carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.
• The new stroke guidelines highlight unique risk factors for females and transgender women and how social determinants of health impact stroke risk.
• The guidelines also emphasize the benefits of GLP-1 drugs for cardiovascular health, and encourage a balanced diet, regular physical activity, maintaining a healthy weight, and getting adequate sleep.

The Centers for Disease Control and Prevention (CDC) estimates nearly 800,000 people have a stroke every year in the United States. Of these, more than 600,000 will be a first-time stroke.

For the first time in 10 years, the American Stroke Association (ASA) has updated its guidelines for reducing stroke risk. According to an ASA news release, up to 80% of strokes may be preventable through diet and lifestyle changes and other modifications.

The 2024 Guideline for the Primary Prevention of Stroke also urges healthcare professionals to carefully screen individuals for stroke risk factors, including: 

• high blood pressure
• elevated cholesterol levels
• high blood sugar
• obesity

Many of the new stroke guidelines coincide with the American Heart Association’s Life’s Essential 8, which promotes cardiovascular and brain health. The lifestyle factors in the ASA’s new stroke guidelines include a healthy diet, regular exercise, better sleep, and smoking cessation.

“Patients looking to reduce their stroke risk (and cardiovascular disease risk in general) should strive to follow the American Heart Association’s Essential 8 recommendations for healthy living,” said Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California. Chen wasn’t involved in the new guidelines.

“We recommend that people eat a healthy balanced diet, engage in regular physical activity, get an adequate amount of sleep, maintain a healthy weight, avoid tobacco and alcohol, reduce stress, and control their blood pressure and cholesterol numbers,” Chen told Healthline.

Overall, the guidelines provide a clear pathway for medical professionals and their patients. The guidelines also call for more public awareness and education about how people can lower their risk of stroke.

Women face unique stroke risk factors

The updated stroke guidelines recommend that medical professionals screen for conditions that can increase the risk of stroke in females.

Stroke risk factors affecting females include the use of oral hormonal contraceptives, developing high blood pressure during pregnancy, and pregnancy complications, such as:

• premature birth
• endometriosis
• premature ovarian failure
• early-onset menopause

The guidelines also note that transgender women and gender-diverse individuals taking estrogen may also be at an increased risk of stroke.

Social determinants of health and stroke risk

The new stroke recommendations emphasize “social drivers of health.” These non-medical factors include inequities in healthcare, education, economic stability, and structural racism.

The ASA adds that neighborhood factors such as a lack of walkability and access to healthy food also play a role. The guidelines urge medical professionals to advocate for patients in these circumstances.

“Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk,” said Cheryl Bushnell, MD, a professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in North Carolina, in a news release. Bushnell is chair of the group that wrote the new guidelines.

“This guideline is important because new discoveries have been made since the last update 10 years ago,” she continued. “Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.”

José Morales, MD, a vascular neurologist and neurointerventional surgeon at Providence Saint John’s Health Center in California Morales echoed the importance of primary stroke prevention and said the guidelines were long overdue. Morales wasn’t involved in developing the new guidelines.

“The focus on equitable access to healthcare, social determinants of health, and gender-specific recommendations are important additions to guiding clinical practice in an evidence-driven matter,” he told Healthline.

GLP-1 drugs may reduce stroke risk

The ASA’s guidelines include a new recommendation for healthcare professionals to consider prescribing GLP-1 weight loss drugs, such as Ozempic, Mounjaro, Zepbound, and Wegovy.

The medications, which have been approved by federal regulators as treatments for obesity or type 2 diabetes, have shown promise in clinical trials in improving cardiovascular health and reducing the risk of stroke.

Chen said the inclusion of newer topics such as weight-loss drugs into the new guidelines is an important step.

“These updated guidelines also incorporate the important new class of drug (GLP-1 agonists) that we are finding to be extremely effective in treating those same risk factors for stroke,” Chen noted.

Healthy diet for stroke prevention

One of the most important things you can do to prevent a stroke is to maintain a healthy, balanced diet.

The new guidelines urge people to stick closely to a Mediterranean diet. This diet focuses on the eating habits of people who live along the Mediterranean Sea.

That plan encourages people to consume more fruits and vegetables as well as legumes, nuts, seeds, and heart-healthy fats. It discourages the consumption of processed foods, added sugars, refined grains. It also recommends limiting the consumption of alcohol.

“Risk factors for stroke vary by age, gender, genetics, comorbidities, and even medications. Therefore, I think the suggestion of screening for not only the basic risk factors but also secondary factors is essential to prescribe the right lifestyle interventions,” said Kristin Kirkpatrick, MS RDN, a dietitian at the Cleveland Clinic Department of Wellness & Preventive Medicine in Ohio. Kirkpatrick wasn’t involved in the new guidelines.

“For my patients, I will often also recommend a Mediterranean pattern, but then work with the patient to assess tweaks to that pattern,” she told Healthline.

“For example, with someone who has insulin resistance or type 2 diabetes, I may focus on a more moderate carbohydrate version of the Med diet. For patients with high blood pressure, I may counsel more on a low sodium perspective. The most important component, however, may be to focus as a whole on a more plant-forward approach that limits ultra-processed foods, sugar, refined grains, and excess amounts of alcohol,” Kirkpatrick continued.

“I also recommend nutrigenomics testing for my patients as well to be able to get a truly personalized approach to prevention based on genetics,” she said.

Exercise and stroke prevention

The guidelines recommend that healthcare professionals screen patients for sedentary behavior and counsel them to engage in regular exercise.

As noted by the ASA’s news release, physical activity is “essential for stroke risk reduction and overall heart health.”

The CDC recommends that adults get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity. That exercise should be spread throughout the week.

Regular exercise can help improve metrics such as blood pressure, cholesterol levels, inflammatory markers, insulin resistance, and overall weight.

“A combination of both aerobic and anaerobic is essential to focus on both muscle retention (and growth) as well as cardiovascular health. Flexibility is also an important factor,” Kirkpatrick said.

High blood pressure and stroke risk

A person may develop high blood pressure for years without any symptoms.

Untreated high blood pressure, also known as hypertension, can cause damage to arteries that can eventually lead to a higher risk of stroke, heart attack, and other cardiovascular issues.

The typical way to diagnose hypertension is by having your blood pressure checked.

Causes of high blood pressure include family history, smoking, and a high intake of caffeine, alcohol, and salt. A lack of physical activity and obesity can also be factors.

In addition to regular screenings, the guidelines urge healthcare professionals to make sure patients at risk for high blood pressure are eating a heathy diet and getting regular exercise.

“Over the past decade, we have gained a better appreciation for the need to manage lifestyle-related cardiometabolic risk factors such as hypertension, overweight/obesity, cholesterol, and blood sugar control,” Chen said.

Sleep quality and stroke prevention

Healthy sleep is listed in both the new guidelines and the Life’s Essential 8 as an important component of reducing stroke risk and promoting heart health.

The CDC estimates that more than 30% of U.S. adults get insufficient sleep.

The CDC recommends that adults obtain a minimum of 7 hours of sleep per night. It’s also not recommended that you get more than 9 hours of sleep per night.

“Adequate and consistent sleep, mindfulness, and taking steps to reduce exposure to pollution would be other factors,” Kirkpatrick said.

What to know about stroke

Stroke is the fifth leading cause of death with nearly 160,000 related deaths annually. The CDC notes that stroke is also a leading cause of long-term disability.

CDC officials add that stroke-related costs in the U.S. were $56 billion between 2019 and 2020. Those costs included healthcare services, medications, and missed days of work.

A stroke occurs when there is a blockage in the blood supply to the brain or when a blood vessel in the brain ruptures. The blockage or rupture prevents blood and oxygen from reaching the brain’s tissues.

Symptoms of a stroke include:

• paralysis
• numbness or weakness in the arm, face, or leg.
• trouble speaking or understanding others
• vision problems
• dizziness
• sudden headache

Medical professionals say the quicker someone is diagnosed with a stroke and receives treatment, the better their chances for survival and recovery.

They recommend a person attending to a person who is suspected of having a stroke to adhere to a checking system with the acronym BE-FAST. That stands for:

• Balance: Does the person have trouble standing?
• Eyes: Are they experiencing vision difficulties?
• Face: Does one side of their face droop?
• Arms: Can they lift both arms?
• Speech: Is their speech slurred or difficult to understand?
• Time: If any of the above symptoms are present, call 911

Takeaway

The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.

In their recommendations, the association urge healthcare professionals to more carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.

The new stroke guidelines also highlight unique stroke factors for females and transgender women.

The ASA also emphasizes the benefits of GLP-1 drugs for heart health and urges more awareness of the health dangers of poor diet, sedentary behavior, obesity, and lack of adequate sleep.

• Liam Payne, a former member of pop group One Direction, passed away on October 16. 
• His death is still under investigation, but authorities believe that drug use was a potential contributing factor.
• Over the years, Payne had been outspoken about his mental health journey and living with substance misuse.

The death of Liam Payne on October 16th is a tragic reminder of the complexities of navigating mental health and drug misuse, even for those with the resources to do so.

Payne, a singer and former member of the pop group One Direction, fell to his death from the balcony of a hotel in Argentina on October 16, 2024. He was 31 years old.

The incident is still under investigation, and police have yet to determine if the death was caused by accident or suicide.

In the months leading up to his death, Payne had apparently told those in his inner circle that he was sober.

But the scene in his hotel room told a different story, where suspected drug paraphernalia, unknown powder, and anti-anxiety medication were littered around.

According to early toxicology results, a cocktail of drugs, including “pink cocaine,” ketamine, MDMA, and methamphetamine, were all found in his system.

Reports indicate that an individual at the hotel had been acting erratically before the incident. Police have suggested that a drug-induced hallucination may have led to the fall, but that has not been confirmed at this time.

Nicola Payne, Liam’s sister, wrote a tribute to her brother after the news of his death.

“You led your life with a motto of why bother doing something unless you are brilliant at it, and Liam you were certainly brilliant at everything you did!! … I hope you have finally found peace up there and that you’ll continue to look after us all as you have done in life,” she wrote.

Payne had shared details about his mental health journey and substance use before his death

The former One Direction member had been outspoken over the years about his mental health journey and drug misuse, exacerbated by the pressures of fame and celebrity. 

The singer, who was only 16 when he joined One Direction, was catapulted to fame after the group took off on the television show “The X Factor” in 2010. Payne left the band in 2015, and the group disbanded in 2016.

Payne later revealed some of his experiences with alcohol and suicidal ideation on the Diary of a CEO podcast, describing going through a “pills and booze phase” while touring with One Direction.

“Where’s rock bottom for me? And you would never have seen it. I’m very good at hiding it. No one would ever have seen it… There is some stuff that I have definitely never, never spoken about. It was really, really, really severe. And it was a problem,” he said.

He also described some of his time with the group as boring and unfulfilling, referring to getting up on stage as “putting the Disney costume on.” 

Rachel Goldman, PhD, a licensed psychologist in private practice in NYC and clinical assistant professor in the Department of Psychiatry at New York University, told Healthline that those kinds of negative feelings are all too common.

“Mental health concerns and mental health illnesses don’t discriminate. Celebrities have a lot of pressure; they often have a different persona on stage or on camera than in real life, and that isnt easy to manage. Mental health resources need to be more readily available, accessible, encouraged, and normalized — even for celebrities,” she told Healthline.

Goldman also points out that discussing mental health is still heavily stigmatized, especially for men.

“We can do better regarding raising awareness around men’s mental health and continuing to break the stigma regarding asking for help and seeking help,” she said.

Signs of drug misuse and emotional distress

It can be difficult to identify the signs of drug misuse and emotional distress.

Payne’s story highlights how even when an individual is adamant about their sobriety, they can still relapse. But if you’re worried about someone and suspect they are struggling somehow, there are still things to look out for.

“In general, I like to ask people if they have noticed changes in mood, sleep, energy, focus/concentration, appetite, or motivation,” said Goldman.

Emotional distress can manifest in specific ways, including:

• Declining performance at work or school
• Trouble making decisions
• Eating more or less than usual
• Unusual irritability or aggression
• Withdrawal from loved ones and friends

Signs of drug misuse may overlap with signs of emotional distress and include:

• Losing interest in favorite activities
• Quickly changing emotions (e.g. feeling very sad followed by very happy)
• Not caring for oneself (e.g. not showering or brushing teeth)
• Sleeping strange hours
• Changing friends frequently
• Having interpersonal and familial problems

Drug misuse and mental health are complex issues, but Goldman suggests that beginning by validating someone’s feelings is a good place to start addressing them.

“Oftentimes, people need to know their feelings are valid and want to be heard. Many times people aren’t looking for advice or others to solve their problems (although sometimes that is what people want). Just simply listening and offering a listening ear can show that you care and you are concerned,” she said.

“Making the connection, validating their feelings, and showing that you care and are concerned is often the first step as it gives them a safe space,” added Goldman.

The bottom line

Liam Payne, a former member of the pop group One Direction, died on October 16 in Argentina after falling from his hotel balcony.

His death is still under investigation by police, but early reports indicate that drug use was a potential contributing factor.

Payne was outspoken about his struggles with mental health and drug misuse over the years.

Identifying the signs of drug misuse and emotional distress can be difficult. They often include changes to sleep, mood, social life, and performance at work.

If you or someone you know is struggling or in crisis, help is available. In the United States, call or text the suicide and crisis lifeline at 988.