Preventing stroke
Strokes are a leading cause of death. Each year, more than 795,000 people in the United States have a stroke, according to the Centers for Disease Control and Prevention (CDC).
Many strokes can be prevented by reducing your risk factors such as high blood pressure, high cholesterol, smoking, obesity, and diabetes. One in three adults in the U.S. has at least one of these conditions or habits.
Other conditions, such as certain heart valve replacements, can also increase this risk, as can heavy alcohol use (15 or more drinks per week for men and 8 or more drinks per week for women).
Below are the leading risk factors and what you can do to reduce that risk.
Dr. Rx
My ultimate goal as a stroke neurologist is for people to never need to meet me at all as the best way to prevent disability from a stroke is to prevent one from occurring in the first place. —Dr. Karen Hoerst
Causes
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) is a temporary interruption in blood flow to the brain, similar to a stroke. It is often called a “mini-stroke.” But unlike a stroke, with a TIA, the blood flow to the brain improves before permanent damage to brain cells occurs. Symptoms are usually brief and go away in less than 24 hours.
However, a TIA greatly increases your risk of stroke for 3 to 6 months after having it. Risk factors for stroke and TIA are similar. And if you've had a TIA, it is a sign that you are at an increased risk for stroke.
What to do
After you’ve had a TIA, your doctor can give you treatments to reduce the chance of another TIA or stroke, like aspirin or other medications that thin your blood. It is also important to control any other risk factors for stroke.
High blood pressure
Untreated high blood pressure is the leading cause of stroke in the United States. High blood pressure puts strain on the walls of the blood vessels, causing damage that can lead to atherosclerosis (buildup of plaque on the inside walls of the blood vessels).
What to do
- Have your blood pressure checked at least every 2 years—more often if you have high blood pressure in your family.
- If your blood pressure is high, reducing your blood pressure by just a little can cut your risk of stroke nearly in half.
- Follow a healthy diet, that is high in fruits and vegetables, fiber, potassium rich foods, and low in salt. The DASH diet (for Dietary Approaches to Stop Hypertension) is high in whole grains, low-fat dairy products, vegetables, and fruits, and includes fish, poultry, beans, nuts, and healthy oils. It has been found to reduce blood pressure, and within only weeks of starting it.
- Quit smoking if you smoke.
- Your doctor may prescribe one of several classes of medications, including ACE inhibitors, beta blockers, calcium channel blockers, among others.
Atrial fibrillation
Atrial fibrillation is when the heartbeat is irregular and often beats rapidly. People with atrial fibrillation can have clots that can travel from the heart and lodge in an artery in the brain, causing a stroke.
Atrial fibrillation causes about 15% of all strokes. Some people with atrial fibrillation may have no symptoms, but you could also experience shortness of breath, chest pain, fatigue, or palpitations.
What to do
If you have any symptoms of atrial fibrillation, tell your doctor, who will give you tests to diagnose the problem.
If you are diagnosed with atrial fibrillation, your doctor can prescribe a range of drugs to decrease the risk of stroke. Medications include beta blockers, calcium channel blockers, antiarrhythmic drugs (medications that prevent abnormal rhythms in the heart), anticoagulant (blood thinners), and aspirin. Rarely, surgery is needed.
High cholesterol
High cholesterol levels in your blood and atherosclerosis (buildup of plaque in your arteries) can contribute to stroke in several ways. Some people have high cholesterol because of their diet and some have it because of family (genetic) risk.
What to do
- Have your cholesterol levels checked regularly.
- Eat a low-fat diet, limiting foods that are high in saturated fat and cholesterol such as red meat, butter, and foods containing butter. Eat more fruits, vegetables, and whole grain foods.
- Exercise for at least 30 minutes a day 5 days a week.
- Your doctor may prescribe a medication such as a statin to reduce cholesterol levels.
Pro Tip
People often think that we have little control over our medical diagnoses and which medical conditions we will develop. While it is true that some risk factors we can’t change, like age or our family history, there are important changes that we can make that positively impact our health. —Dr. Hoerst
Smoking
Smoking makes blood more prone to clotting, raises blood pressure, and damages the lining of blood vessels. The more you smoke, the greater your risk of stroke.
What to do
Quit smoking. Ask your doctor about strategies available to help you quit. There are a range of medications, nicotine replacement options, and psychological approaches to help you quit. The American Lung Association offers these resources to quit smoking.
Diabetes
Diabetes, which leads to high levels of sugar in your blood, also increases your risk of stroke. Type 2 diabetes affects about 45 million Americans. Being overweight is a major risk factor, but your genetics and ethnicity may also put you at greater risk.
What to do
- If you have diabetes, it’s critical to control your blood sugar levels (keeping them as close to normal as possible) through diet and medication.
- Maintain a healthy weight or lose weight if you’re overweight.
- Eat a healthy high-fiber, low-fat, low-sugar diet.
- Exercise at least 30 minutes a day for 5 days a week.
- Your doctor may prescribe medications to help lower blood sugar levels.
Obesity
Obesity increases the risk of stroke as much as twofold. You are considered obese if your body mass index (BMI) is 30 or greater.
What to do
Discuss with your doctor how to lose weight through a sensible diet and exercise
Program.
- Aim to lose about 1 to 2 pounds a week. Think long-term, not diet fads.
- You will need to eat about 500 to 1,000 fewer calories a day.
- Exercising is critical to help you burn calories and build muscle.
- A support group or therapist may help you reach your weight loss goals.
Pro Tip
Making changes to improve your health—like increasing physical activity, quitting smoking, or losing weight—can be really hard. But these changes improve your likelihood of having a longer, healthier life. It’s so worth the effort! Talk to your doctor about it, because we’d love to help. —Dr. Hoerst
Heart valves
Blood clots can develop on certain types of artificial heart valves. In general, this risk is reduced with medications, such as aspirin, or stronger blood thinners like warfarin.
What to do
If you had a heart valve replacement, you should talk to your doctor about what medication you need for stroke prevention. Depending on the type of blood thinner medication, your doctor may need to do regular blood tests to make sure the dose is correct.
Carotid artery stenosis
Narrowing of the blood vessels in the neck (carotid artery stenosis) is a major cause of stroke. This can be found by your doctor listening to your neck with the stethoscope at your office visit, or with other pictures such as an ultrasound, depending on your other risk factors.
Conditions that increase your risk for stroke from carotid stenosis include high blood pressure, diabetes, smoking, and high cholesterol.
What to do
If you have carotid artery stenosis, your doctor will determine your treatment. You may need more tests done, different medications, or in rare cases, surgery on your neck to open the blood vessel. Most patients do not require surgery and are instead treated with medications for stroke prevention.
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