Stroke Prevention Guidelines
But most strokes can be prevented. You and your doctor can identify your stroke-risk factors, and then take action to reduce them.
Controlling your blood pressure may require the daily use of one or more medications. Several studies have proven that you can reduce your risk of having a stroke by 42% by lowering your blood pressure as little as five points.
If your blood pressure's top number (systolic) is between 120 and 139, or your bottom number (diastolic) is between 80 and 89, you have "pre-hypertension," a recently added category that says, "You may be heading toward full-blown high blood pressure." Because you are at risk of strokes and heart disease, it is important that you, like all people with high blood pressure, alter your eating habits and lifestyle. Here's how:
- Lose weight. Even modest weight loss will reduce your blood pressure.
- Reduce your salt intake
- Eat a diet that's rich in fresh fruits and vegetables and natural fiber, such as the DASH Diet
If you have high blood pressure and your numbers remain above 140 (systolic) or above 90 (diastolic) after you make lifestyle changes, your doctor will prescribe one or more medications to lower your blood pressure. It is important that you not miss doses. Most people with high blood pressure require lifetime treatment with medication.
You can improve your cholesterol by changing your diet or by taking medicine. Cholesterol-lowering drugs called statins are especially effective at preventing strokes.
With atrial fibrillation, blood clots are likely to form along the walls of the left atrium where blood flow becomes sluggish. The clots can break off from the wall and move into the bloodstream and then float through the circulation system and move to the brain, causing a stroke. Blood thinners such as warfarin (Coumadin) can dramatically lower the risk of strokes in people who have atrial fibrillation.
People with persistent or recurrent atrial fibrillation should take either warfarin or an antiplatelet drug. Warfarin does the best job of preventing a stroke, but it also carries a risk of bleeding. Your doctor will evaluate your individual risks and benefits of taking warfarin.
In general, atrial fibrillation is associated with the highest risk of stroke when a person has had a prior stroke. The combination of older age, high blood pressure and enlarged heart also increase stroke risk related to atrial fibrillation.
Warfarin (Coumadin) reduces the risk of stroke in people who have or have had atrial fibrillation. It prevents about 70 percent of the strokes that would otherwise occur. The medicine can lead to serious bleeding, however, so it may not be appropriate in certain people. People using warfarin need periodic blood tests to monitor the blood-thinning effects.
In some people with atrial fibrillation, aspirin can be used in place of warfarin as the blood thinner of choice. Aspirin is often used by people who are at low risk of having a stroke, or who cannot take warfarin safely. Aspirin is easier to take and generally safer than warfarin. It is rarely necessary to take both warfarin and aspirin at the same time.
For people who have severe heart failure, blood clots can form in the heart's lower left chamber (ventricle), in areas where blood flow becomes sluggish because the heart is not squeezing effectively. These clots can enter the bloodstream and travel to the brain to cause a stroke. People who have severe heart failure can reduce their risk of a stroke by taking warfarin or similar drugs.
For most other people who are at risk for having a stroke, milder blood thinners called "antiplatelet drugs" are adequate for prevention. Aspirin is the most well-known antiplatelet drug. Aspirin and other antiplatelet drugs prevent the first step in blood-clot formation — the clustering of platelet cells in the bloodstream. Most doctors recommend a dose between 81 and 325 milligrams of aspirin a day to prevent strokes. If a stroke or "mini-stroke" (transient ischemic attack or TIA) occurs despite aspirin use, your doctor may recommend another antiplatelet medicine, such as clopidogrel or a combination of dipyridamole and aspirin. Your doctor also may recommend warfarin.
- Eat your fruits and veggies. The optimum diet for preventing stroke is rich in fruits and vegetables. Every serving of fruits or vegetables per day is associated with a 7% lower risk of strokes in women and a 4% lower risk of strokes in men.
- Avoid bad fats. A stroke-conscious diet should be low in saturated fat. Avoid trans fats. Both of these raise your blood cholesterol more than any other dietary ingredient. High cholesterol leads to a buildup of plaque in the arteries of the brain and heart. Foods high in saturated fat include full-fat dairy products, meat and poultry, cocoa butter, palm kernel oil and palm oil. Trans fats are found in commercially deep-fried foods and in processed foods that contain "hydrogenated" or "partially hydrogenated" vegetable oils.
- Keep your calorie count down. A reduced-calorie diet will help you maintain a healthy weight, which can help to prevent diabetes, a major risk for stroke.
- Cut the salt. Too much salt can cause high blood pressure. Cutting down on salt can lower your blood pressure and reduce the risk of a stroke. (Most dietary sodium does not come from the salt shaker, but is hidden in packaged foods.) Read food labels and avoid salty items, such as chips, salted nuts, pretzels, olives, pizza, pickles and sauerkraut. Look for lower-sodium alternatives.
- Eat more fish. Research has shown that eating two to four servings of fish a week can lower your risk of stroke.
While the American Heart Association does not recommend alcohol for people who don't already drink, it does urge people who do drink to keep it within the beneficial zone.
Exercise at a moderately intense level by walking briskly, bicycling or swimming for at least 30 minutes on most days of the week.