10/31/2023
Most strokes are preventable.
Follow these 6 steps to reduce your risk.
Every 40 seconds, someone in the United States has a stroke, and about three-quarters occur in people ages 65 and older. “As people age, their arteries have a tendency to become less flexible,” and clogged arteries are more likely, says Doris Chan, an interventional cardiologist at NYU Langone Health. This hikes the risk of an ischemic stroke — the most common type — when a blood vessel to the brain becomes blocked by a blood clot.
But about 80 percent of all strokes are preventable, according to the Centers for Disease Control and Prevention. And the lifestyle steps you take can be especially powerful in fending off stroke.
Here’s what you can do to reduce your risk.
1. Watch these issues. Keeping certain conditions at bay or managing them properly can cut the likelihood of a stroke. Take high blood pressure, which some research suggests is responsible for almost half of strokes. A heart-healthy eating plan may help control it. Also, try to limit sodium to less than 1,500 milligrams a day, maintain a healthy weight and exercise regularly, says Sahil Khera, an interventional cardiologist at the Mount Sinai Hospital in New York.
If your blood pressure is high even with the above measures, ask your doctor what levels you should strive for and whether meds are appropriate. Staying out of the hypertensive range can be challenging with age because of the higher potential for medication side effects. While blood pressure below 120/80 can reduce cardiovascular risk, that target should be adjusted if side effects such as dizziness occur, says Hardik Amin, an associate professor of neurology at the Yale School of Medicine in New Haven, Conn.
Another important condition to watch for is atrial fibrillation (AFib), an irregular and often rapid heartbeat, which affects at least 10 percent of people over age 80, according to a 2022 study in the Journal of the American College of Cardiology. People with AFib are about five times as likely to have a stroke.
A heart-healthy lifestyle can reduce that risk. But older adults may still develop AFib, so report heart palpitations, chest pressure, shortness of breath and dizziness to your doctor right away. Treatments for AFib include blood thinners and procedures such as nonsurgical electrical cardioversion or the surgical implantation of a pacemaker.
Type 2 diabetes and high cholesterol make you more prone to having a stroke as well, so it’s also important to get them under control, says Nieca Goldberg, medical director of Atria New York City, a health-care organization.
2. Get enough physical activity. Exercise can help you maintain a healthy weight, and being overweight or obese is itself a stroke risk — especially for those who carry a lot of fat around their midsection. (Even normal-weight women with abdominal fat may have a higher stroke risk, the American Stroke Association says.)
The CDC recommends at least 150 minutes of moderate activity, including walking, each week. Small bursts of movement, such as vacuuming, count, Goldberg says. And stay on your feet as much as you can. A study in the JAMA Network Open in 2022 found that people who sat for 13 hours a day or more had a 44 percent higher risk of stroke.
If you’ve been very inactive, start slowly, adding 500 steps at a time. “You don’t have to get them in all at once,” says Erin Dooley, an assistant professor of epidemiology at the University of Alabama at Birmingham School of Public Health. “Just walking down the hallway every so often will have benefits.”
3. Eat for health. The best way to eat for stroke prevention is probably the Mediterranean diet and reduced salt intake, Khera says. The diet is rich in whole grains, fruits, vegetables and legumes, plus heart-friendly fats such as olive oil and small amounts of animal protein, particularly fish. Among the studies on the Mediterranean diet is one published in the Lancet in 2022, which looked at people with heart disease. It found that, among those who followed the eating pattern for seven years, the risk of a major cardiovascular event like a heart attack or stroke fell by 26 percent compared with those on a low-fat diet.
4. Watch your alcohol intake. Generally, high alcohol consumption (more than 14 drinks for women and more than 21 for men per week) is linked to a higher stroke risk, according to a study published in January in the journal Neurology. Most older adults should limit their intake to one drink per day, Goldberg says.
And space those drinks out. Binge drinking, which the CDC defines as four or more alcoholic beverages in a short period for women and five or more for men, raises heart attack and stroke risk, Goldberg says.
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And if you smoke, work toward stopping. While smoking doubles the likelihood of dying from a stroke, the risk goes down to that of a nonsmoker’s in as little as five years after quitting.
5. Avoid pollutants. Even short-term exposure to air pollution may raise your stroke risk, according to a review published in 2022 in the journal Stroke. So check the air quality in your area on sites like AirNow.gov. On high-pollution days, limit your time outdoors. When indoors, use exhaust fans in the bathroom and kitchen, vent clothes dryers and consider an air purifier.
6. Control stress. High stress is associated with an increased stroke risk, says research that was published in 2022 in JAMA Network Open. The study found that one stressful life event raised the likelihood of stroke by 17 percent, while two hiked it to 31 percent.
To ease stress, Goldberg recommends using mindfulness-based apps. A 2020 study published in the International Journal of Environmental Research and Public Health found that these apps may also help reduce blood pressure, a key stroke risk factor.
Recognize the signs of a mini-stroke
If you think you might be having a transient ischemic attack (TIA, or a mini-stroke), call 911. You should be evaluated immediately. Almost 1 in 5 people with a possible TIA will have a full stroke within three months. “It’s hard to diagnose a TIA for sure,” Amin says. Symptoms often fade by the time people reach an emergency room. Here are key tests that may be done there:
Brain and blood vessel imaging. MRIs show that up to 40 percent of people whose symptoms have resolved have had a stroke, which probably hikes their future stroke risk, says Amin, author of a recent American Heart Association scientific statement on TIAs.
Bloodwork to rule out hypoglycemia and to screen for conditions such as diabetes and high cholesterol.
An electrocardiogram to check heart rhythms if a TIA is suspected.
TIA patients will probably be prescribed aspirin and medicines for risk factors like high blood pressure. They should see a neurologist, ideally within 48 hours of discharge. “There’s a high risk of stroke in the days following a TIA,” Amin says.
Know these danger signs
It’s important to know the signs of a stroke and to get emergency help right away if you experience them. The American Stroke Association uses the acronym FAST to help people remember several key signs.
They are:
F for face drooping.
A for arm weakness.
S for speech difficulty.
T for time to call 911.
These can include the following:
Numbness of the face, arm or leg, especially on one side of the body.
Confusion.
Trouble seeing.
Trouble walking.
Severe headache.
Some people may have additional symptoms as well.
If you notice any of those symptoms, call 911 immediately (or have someone call), even if they’re mild and subside within a minute or two, as they often do with a mini-stroke
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