• 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, African American race, or prior stroke cannot be.

    Developments in Prevention

    High Blood Pressure

    The most common and most preventable risk factor for stroke is high blood pressure . The National Stroke Association recommends all adults have their blood pressure checked every year. High blood pressure 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. If you have a certain condition, like diabetes, your doctor may have stricter blood pressure goals for you. Reducing high blood pressure may lower your risk for stroke.

    High Cholesterol

    Lowering cholesterol levels with diet, exercise, and medicine may help reduce the build-up of fatty arterial plaque that can trigger a stroke. The American Heart Association (AHA) recommends adults have a fasting cholesterol check at least once every five years. 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.

    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. 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 pressure low (eg, 120/80 mmHg) can reduce your risk of stroke. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors can be helpful for this purpose. Control of blood sugar is important, as well, in decreasing stroke risk.

    Smoking

    Smokers have twice the risk of suffering a stroke as nonsmokers. This risk is increased even more 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 medicines 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. Medicines like aspirin , clopidogrel (Plavix), or the combination of aspirin plus dipyridamole (Aggrenox) may be prescribed.

    Carotid Artery Surgery

    If you have fatty arterial deposits in their neck, which can lead to stroke, you may benefit from carotid artery surgery . 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 help 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://ww2.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 June 12, 2012.

    Stroke risk factors. American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/Understanding-Risk%5FUCM%5F308539%5FSubHomePage.jsp . Accessed June 12, 2012.

    Furie KL, Kasner SE, Adams RJ, 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/cgi/reprint/STR.0b013e3181f7d043v1 . Updated October 21, 2010. Accessed June 12, 2012.

    Goldstein LB, Adams R, Alberts MJ, 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.

    High blood pressure. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 2011. Accessed June 12, 2012.

    Am I at risk for a stroke? National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=risk . Accessed June 12, 2012.

    NCEP ATP III guidelines. EBSCO DynaMed website. http://www.dynamed.com/what.php. Accessed June 14, 2012.

    Prevention of stroke. EBSCO DynaMed website. http://www.dynamed.com/what.php. Updated June 6, 2012. Accessed June 14, 2012.

    9/19/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Amarenco P, Bogousslavsky J, Callahan A, 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/what.php : Grau AJ, Barth C, Geletneky B, et al. Association between recent sports activity, sports activity in young adulthood, and stroke. Stroke. 2009;40:426-431.

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