Stroke is a leading cause of disability. While it is important to treat stroke patients, it is also important to try to avoid ever having a stroke. When someone has never had a stroke, but health interventions are taken to reduce the risk of stroke, this is considered primary prevention of stroke. When someone has already had a stroke, these measures are considered secondary prevention. This blog focuses on how a person can take control of her or his health to reduce the risk of ever having a stroke in the first place. While there are some non-modifiable risk factors for stroke that are out of our control – such as advancing age, male gender, certain genetic conditions, or non-white race – there are many ways that people can take care of their health to reduce their stroke risk. In this post, we focus on the top 10 strategies to reduce your risk of having a stroke.
1. Physical activity
While physical inactivity is harmful to many aspects of health, this certainly applies specifically to stroke risk. Physically active people have been found to have as much as a 30% lower risk of having a stroke.
Being physically active helps decrease blood pressure, lowers the “bad” cholesterol and raises the “good” cholesterol, decreases inflammation in the body, improves the immune system, and reduces clotting factors like fibrinogen. While specific activities can vary depending on a person’s unique circumstances, you should be physically active where you are breathing hard enough that it would be challenging to hold a conversation more days than not during the week, for a total of 75-150 minutes throughout the week. If you cannot meet this time threshold, keep in mind that some physical activity is better than none and can lead to health benefits.
2. Diet and nutrition
Our food is the fuel for our body, so it only makes sense that it can affect our overall health and stroke risk. Keeping this in mind, nutrition is a cornerstone of having a healthy lifestyle to prevent stroke.
Some limited medical data suggests that a Mediterranean diet may be the healthiest diet for preventing stroke. As it is based on traditional foods that people eat in Italy and Greece, a Mediterranean diet involves vegetables, fruits, whole grains, and obtaining protein from fish, seafood, nuts, seeds, and legumes. Dairy products are used in moderation, and there is not much red meat. This diet avoids added sugars, highly processed foods, and sugary beverages.
However, the data is not overwhelming suggestive of a Mediterranean diet. Typically, people can focus on eating fruits and vegetables, avoiding high-fat products, avoiding high sodium (“salt”) intake, and avoiding highly processed foods.
These dietary choices can help control blood sugar, blood pressure, and cholesterol. This can also reduce inflammation in the body.
It is also recommended that people who choose to drink alcohol have less than or equal to 2 drinks per day for men and less than or equal to 1 drink per day for non-pregnant women. Excessive alcohol intake can increase the risk of bleeding or developing abnormal heart function that can cause a stroke.
3. Treat high blood pressure
High blood pressure – also known as hypertension – is the most proven and likely most important risk factor for stroke that can be modified. Controlling blood pressure can reduce the risk for both strokes, from lack of blood flow (“ischemic”) and bleeding (“hemorrhagic”).
Some limited medical data suggests that a Mediterranean diet may be the healthiest diet for preventing stroke. As it is based on traditional foods that people eat in Italy and Greece, a Mediterranean diet involves vegetables, fruits, whole grains, and obtaining protein from fish, seafood, nuts, seeds, and legumes. Dairy products are used in moderation, and there is not much red meat. This diet avoids added sugars, highly processed foods, and sugary beverages.
However, the data is not overwhelming suggestive of a Mediterranean diet. Typically, people can focus on eating fruits and vegetables, avoiding high-fat products, avoiding high sodium (“salt”) intake, and avoiding highly processed foods.
These dietary choices can help control blood sugar, blood pressure, and cholesterol. This can also reduce inflammation in the body.
It is also recommended that people who choose to drink alcohol have less than or equal to 2 drinks per day for men and less than or equal to 1 drink per day for non-pregnant women. Excessive alcohol intake can increase the risk of bleeding or developing abnormal heart function that can cause a stroke.
4. Treat High Cholesterol
High cholesterol can lead to atherosclerosis, also known as “hardening of the arteries,” which increases the risk of stroke. Your medical provider can check your cholesterol levels. These include the “bad cholesterol” LDL, the “good cholesterol” HDL, and triglycerides.
Using these numbers, your age, your gender, and your other medications, your provider can estimate your 10-year risk of having a problem with blood flow in your heart or brain. According to most guidelines, if this is more than 5%, you would be indicated for starting a cholesterol medication. The most impressive data for preventing stroke involves using statin cholesterol medications, but other categories of medications can be considered in certain circumstances.
Regardless of the use of medications, lifestyle changes – including diet and physical activity – should be pursued to optimize healthy cholesterol levels.
5. Improve body weight
When considered in the medical setting, body weight and body fat distribution is typically addressed through calculating the Body Mass Index (BMI), which accounts for a person’s weight for his or her height.
A BMI of 25-29 is considered overweight, and a BMI greater than 30 is considered obese. In both categories, weight reduction has been shown to lower blood pressure and reduce the risk of stroke.
Weight loss is not an easy undertaking, but efforts can significantly prevent life-altering strokes. This can involve making nutritional changes, working with a dietician, increasing physical activity, considering certain medications, or even pursuing weight loss surgery in certain circumstances. Your medical provider should partner with you and support you through this process.
6. Control blood sugar
Elevated blood sugar – which is seen in the condition Diabetes Mellitus – has been associated with developing the disease in the head and neck arteries that supply blood and nutrients to the brain. Diabetes itself is a risk factor for stroke and doubles the risk of stroke compared to the non-diabetic person. In a person with diabetes, studies have shown that taking steps to control blood sugar helps prevent stroke.
Diet, physical activity, and optimizing body weight can improve glycemic control and lower the risk of developing diabetes. Medical providers should screen people for diabetes. When diabetes is diagnosed, care should be taken with lifestyle interventions and medications to improve blood sugar control while also focusing on other conditions that can co-occur with diabetes, including high blood pressure or high cholesterol. In people with diabetes who have a calculated 10-year risk of having the cardiovascular disease of greater than 10%, starting a daily aspirin may be considered to prevent stroke.
7. Avoid tobacco products
In today’s world, most people are aware that smoking cigarettes are not suitable for your health. This applies specifically to stroke risk and generally with all tobacco products. Smoking has been associated both with strokes due to lack of blood flow (“ischemic”) and with strokes with bleeding around the outside of the brain (“subarachnoid hemorrhage”).
Some people may think that the damage has already been done, so they may as well continue smoking. However, medical studies have shown that the increased risk of stroke with smoking disappears completely after five years of quitting, so it is never too late to quit smoking to prevent stroke. Quitting smoking can be very challenging, so a medical provider can partner to help, including options such as nicotine replacement, medications that help reduce the cravings and counseling. These approaches have been shown to improve the odds of quitting smoking. If you don’t smoke now, your brain health should avoid all tobacco products.
8. Use blood thinners for atrial fibrillation
Atrial fibrillation is a condition where the electrical activity in the top part of the heart – the left atrium – is abnormal, leading to the quivering of that heart’s chamber. This can lead to stasis of blood in the nooks and crannies of the atrium, resulting in blood clots that can form, which then travel to the brain to cause a stroke. This is a common risk factor for stroke, leading to a 400-500% increase in the risk of stroke if no blood thinner is used.
The bottom part of the heart – the ventricle – still usually pumps when someone has atrial fibrillation, so people who have this heart rhythm may not feel anything abnormal. If an electrocardiogram or physical exam suggests atrial fibrillation, your medical provider can start medications to prevent a telestroke.
Risk stratification scales can be used to assess who is most likely to benefit from strong blood thinners to prevent stroke. While warfarin is a historical medication used as a strong blood thinner (anticoagulant) that would require dietary modifications and frequent blood testing, several newer medications on the market can be taken once or twice a day without the need for frequent testing or dietary changes.
9. Carotid stenosis
The carotid arteries are the major blood vessels on each side of the front of your neck. They supply the blood flow to the front portions of your brain. Stenosis refers to a narrowing. A build-up of plaque over time can lead to carotid stenosis, including the risk of stroke.
Your medical provider may hear abnormal blood flow through these arteries on a physical exam or testing (such as ultrasound, CT, or MRI), which may reveal narrowing. In this case, it is important to treat carotid stenosis to help reduce the risk of stroke.
In people who have never had a stroke, if the narrowing is under 70%, intensive medical therapy
One sleep disorder, called obstructive sleep apnea, occurs when a person stops breathing during sleep. This can lead to poor sleep quality, low oxygen levels at night, and increased inflammation – all of which are bad for your brain. Your medical provider can ask you questions about snoring tiredness during the day, evaluate the size of your neck, assess the anatomy of your airway, and decide if you would qualify for a sleep test. If sleep apnea is found, you can consider various treatments to improve this.
