Your Health

Progress in Stroke Prevention

Who Is at Risk for a Stroke?

HCA image A stroke occurs when an artery in the brain becomes blocked or a blood vessel carrying blood to the brain bursts. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.
Many of the risk factors for stroke can be lowered or treated. Others, such as increasing age, family history of stroke, your race, or prior stroke cannot be. The more risk factors you control, the more you can reduce your risk of having a stroke.

Developments in Prevention

Hypertension

Hypertension is the most common and most preventable risk factor for stroke. Hypertension is defined as having a systolic pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg. A good blood pressure is 120 mm Hg/80 mm Hg or lower. Blood pressure varies with age and normal values tend to increase with age. The American Heart Association recommends your blood pressure be measured on a regular basis starting at age 20. If you have normal blood pressure, you should get it checked at least once every two years or at every healthcare visit. If you have a certain condition, like diabetes, or repeated blood pressure readings that are elevated, your doctor may have stricter blood pressure goals for you. Reducing high blood pressure lowers your risk for stroke.

High Cholesterol

Lowering cholesterol levels with diet, exercise, and medication may help reduce the build-up of fatty arterial plaque (atherosclerosis) that can trigger a stroke. The American Heart Association recommends adults have a fasting cholesterol check at least once every five years starting at age 20. A desirable total cholesterol level is less than 200 mg/dL. If you have cardiovascular disease or diabetes, your doctor will have you follow stricter cholesterol guidelines and may check it more often.

Heart Arrhythmias

If you have atrial fibrillation (an irregular heart rhythm), a blood thinner such as warfarin may be able to lower your risk for stroke. Blood thinners help reduce blood clots from forming. Blood clots can block arteries that feed the brain, causing a stroke. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.

Diabetes

If you have diabetes, keeping your blood in a specified target range can reduce your risk of stroke. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors can be helpful for this purpose. Following your treatment plan to control your blood glucose level is also important in decreasing stroke risk.

Smoking

Smokers have twice the risk of suffering a stroke as nonsmokers. This risk is increased even higher if you are also taking oral contraceptive pills. However, if you stop smoking, your risk of stroke will fall—within about five years—to the same level as someone who never smoked. There are many smoking cessation aids available today, including online support groups, nicotine patches, sprays, gum, or certain drugs. Talk to your doctor if you need help to quit smoking.

Antiplatelet Medication

Antiplatelet medications make blood platelets less sticky and, therefore, less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a transient ischemic attack (TIA) may benefit from taking an antiplatelet agent. Medications like aspirin, clopidogrel, or the combination of aspirin plus dipyridamol, may be prescribed.

Carotid Artery Surgery

If you have fatty arterial deposits in your neck, which can lead to stroke, you may benefit from carotid artery surgery. The carotid arteries supply the brain with oxygen. The surgery is done to restore blood flow. If you have severe arterial blockage and a history of previous stroke or TIA, this surgery may significantly reduce your risk of a second stroke.

Exercise

Exercising regularly can reduce your risk of stroke. Work with your doctor to create an exercise routine that is safe for you.
Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke, discuss your options with your doctor. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes, the time to diagnosis and treatment is extremely important. If you think you are having a stroke, call for emergency medical services right away.

RESOURCES

American Stroke Association http://www.strokeassociation.org

National Stroke Association http://www.stroke.org

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.ca

References

Impact of stroke (stroke statistics). American Heart and Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/Impact-of-Stroke-Stroke-statistics%5FUCM%5F310728%5FArticle.jsp. Updated May 1, 2012. Accessed March 26, 2014.

Furie KL, Kasner SE, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2010 October 21. Available at: http://stroke.ahajournals.org/content/early/2010/10/21/STR.0b013e3181f7d043.full.pdf+html. Accessed March 26, 2014.

Goff DC Jr, Lloyd-Jones DM, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013. [Epub 2013 Nov].

Goldstein LB, Adams R, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: co-sponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity and Metabolism Council; and the Quality of Care and Outcomes research Interdisciplinary Working Group. Circulation. 2006;113:e873-923.

Prevention of stroke. EBSCO DynaMed website. http://www.ebscohost.com/dynamed. Updated March 17, 2014. Accessed March 26, 2014.

Numbers that count for a healthy heart; recommended screenings/risk factors. American Heart Association website. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm%5F428691.pdf. Updated October 15, 2013. Accessed March 26, 2014.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. http://www.ebscohost.com/dynamed. Updated September 27, 2013. Accessed March 26, 2014.

Stroke (acute management). EBSCO DynaMed website. http://www.ebscohost.com/dynamed. Updated February 26, 2014. Accessed March 26, 2014.

9/19/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Amarenco P, Bogousslavsky J, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-559.

2/24/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Grau AJ, Barth C, et al. Association between recent sports activity, sports activity in young adulthood, and stroke. Stroke. 2009;40:426-431.

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