Preventing Stroke

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Harvard Medical School
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Preventing Stroke

Preventing Stroke
Preventing Stroke
Preventing Stroke
You can help prevent stroke in many cases by modifying your risk factors.
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

Stroke Prevention Guidelines

A stroke can be a very disabling event, leading to problems with memory, thought, movement and speech. You can help to prevent strokes by controlling your risk factors.

But most strokes can be prevented. You and your doctor can identify your stroke-risk factors, and then take action to reduce them.

Control High Blood Pressure
High blood pressure, also called hypertension, is one of the strongest risk factors for strokes. It is also a risk factor that can be controlled, unlike your age, genetic makeup and race

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.
  • Exercise
  • 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.

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Control Cholesterol Problems
If you already had a heart attack, your risk for a stroke is higher than average — about 1 percent to 2 percent each year. This is understandable. The same factors that cause a heart attack (high blood pressure and a buildup of cholesterol in the arteries) also cause strokes. The risk of a stroke is highest within the first few weeks after a heart attack.

You can improve your cholesterol by changing your diet or by taking medicine. Cholesterol-lowering drugs called statins are especially effective at preventing strokes.

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Have Your Heart Rhythm Evaluated
A heart rhythm condition called atrial fibrillation is a major risk factor for strokes. With this condition, the walls of the two upper chambers (atria) of the heart do not move rhythmically. They move fast or erratically. You may feel an irregular heartbeat and you may experience dizziness.

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.

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Use Clot-Prevention Medicine
Because almost all strokes start as a blood clot somewhere in the body, medicines that work to prevent clots from forming can be lifesavers. Depending on the cause of the stroke, your doctor may recommend the anticoagulant medicine warfarin (Coumadin) or an antiplatelet medicine (aspirin or one of its relatives).

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.

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Eat a Healthy Diet
Your diet can affect your risk of stroke just as it affects your risk of heart attack. Here are some guidelines that might help thwart your risk of a stroke:
  • 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.

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Keep Alcohol Consumption Modest
For light-to-moderate drinkers (a maximum of two drinks a day for a man and one drink per day for a woman), alcohol has been shown to have a protective effect against the most common type of strokes. However, when alcohol consumption rises above moderate levels, the risk of a stroke increases.

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.

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Exercise lowers the risk of heart disease. Regular exercise that works up a sweat can lower your risk of having a stroke by as much as 20%.

Exercise at a moderately intense level by walking briskly, bicycling or swimming for at least 30 minutes on most days of the week.

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Quit Smoking
Cigarette smoking leads to the buildup of blockages in the carotid artery, which is the main blood supply for the brain. Blocked and cholesterol-laden arteries are the leading cause of stroke. The nicotine in tobacco raises blood pressure, and the carbon monoxide in smoke reduces the amount of oxygen in circulation. Components of cigarette smoke increase the tendency of the blood to clot. Because of the strong link between smoking and heart disease, stroke and cancer, it's essential to quit smoking as soon as possible.

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Consider Surgery (If Your Doctor Recommends It)
Your doctor may recommend a procedure to open one or both carotid arteries if they show significant narrowing. There are two methods to increase blood flow in a carotid artery. One is surgery called carotid endarterectomy. A surgeon removes fatty deposits from the wall of the blood vessel. The other option is carotid artery stenting. This is a less invasive procedure. The doctor inserts a metal-mesh tube, called a stent, into the carotid artery at the site of blockage. The mesh expands and pushes open the blood vessel.

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Last updated April 10, 2012

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