10 Ways to Reduce Your Stroke Risk

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 10 Ways to Reduce Your Stroke Risk

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 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 for many aspects of health, this certainly applies specifically to stroke risk. People who are physically active have been found to have as much as a 30% lower risk of having 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 used to 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 so typically people can benefit from simply focusing 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 for people who choose to drink alcohol to 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 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 from 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 used to 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 so typically people can benefit from simply focusing 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 for people who choose to drink alcohol to 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 stroke.

4.Treat High Cholesterol

High cholesterol can lead to atherosclerosis, which is 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 the use of 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 of greater than 30 is considered obese. In both categories, weight reduction has been shown to both lower blood pressure and also reduce the risk of stroke.

Weight loss is not an easy undertaking, but efforts can pay significant dividends in preventing 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 disease in the arteries of the head and neck 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 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 is not good 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 to 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 5 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 / or counseling. These approaches have been shown to improve the odds of quitting smoking. If you don’t smoke now, it is best for your brain health that you 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 quivering of that chamber of the heart. 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, on average leading to a 400-500% increase risk of stroke if no blood thinner is used.

 

The bottom part of the heart – the ventricle – still pumps normally most of the time that 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 stroke.

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, there are several newer medications on the market that 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 the carotid stenosis to help reduce the risk of stroke. In people who have never had 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.

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