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Causes and Prevention

What you should know: Personal risk factors for stroke

Risk factors that can not be changed:

Age — The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.

Heredity (family history) and race — Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians. This is partly due to higher rates of high blood pressure and diabetes in this group.

Sex (gender) — Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.

Prior stroke, TIA or heart attack — The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. If you've had a heart attack, you're at higher risk of having a stroke, too.

Stroke risk factors that can be changed, treated or controlled:

High blood pressure — High blood pressure or hypertension is the number one cause of stroke. High blood pressure can damage the small blood vessels of the brain. High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.

Cigarette smoking — Tobacco use in any form, especially cigarette smoking, is very bad for your health. In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk in women.

Diabetes mellitus — Diabetes is a risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke. Diabetes causes disease of small blood vessels in the brain and can lead to a stroke.

Carotid or other artery disease — The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque build-ups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It's caused by fatty build-ups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke. Causes of carotid artery disease are high blood pressure, diabetes, a diet high in fat, high cholesterol and smoking.

Atrial fibrillation — This heart rhythm disorder raises the risk for stroke. The heart's upper chambers quiver instead of beating regularly, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.

Other heart disease — People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.

Sickle cell disease (also called sickle cell anemia) — This is a genetic disorder that mainly affects African-American and Hispanic children. "Sickle-shaped" red blood cells are less able to carry oxygen to the body's tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

High blood cholesterol — People with high blood cholesterol have an increased risk for stroke. High blood cholesterol can be reduced by eating right (avoid fried, fatty foods) and exercising routinely. It may also require medication.

Poor diet — Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. A diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.

Physical inactivity and obesity — Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get at least 30 minutes of moderate physical activity five days of the week, or 20 minutes of vigorous physical activity, three days a week, with your doctor’s approval.

Prevention

The National Stroke Association’s Stroke Prevention Guidelines
  1. Know your blood pressure: have it checked at least annually. If it is elevated, work with your doctor to keep it under control. High blood pressure is the leading cause of stroke. Your doctor may prescribe medication, changes in your diet, or lifestyle.
  2. Find out if you have atrial fibrillation: Atrial fibrillation is an irregular heartbeat that changes how your heart works and allows blood to collect in the chambers of your heart. This blood which is not moving through your body, tends to clot and the beating of your heart can move one of these blood clots into your blood stream and ultimately into your brain, causing a stroke. Your doctor can determine if you have atrial fibrillation by taking your pulse. He would order a test called an EKG to confirm it. If AF is diagnosed, your doctor may choose to lower your risk for stroke by prescribing medicines called blood thinners. Aspirin and warfarin (Coumadin) are the most commonly prescribed treatments.
  3. If you smoke, STOP: Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will immediately begin to drop.
  4. If you drink alcohol, do so in moderation: Studies now show that drinking up to two alcoholic drinks per day can reduce your risk for stroke by about half. More alcohol than this can increase your risk for stroke by as much as three times and can lead to other health problems.
  5. Know your cholesterol number: if your total cholesterol level (LDL plus HDL) is over 200 talk to your doctor, you may be at increased risk for stroke. High cholesterol can be controlled with diet and exercise or may require medicine prescribed by the doctor.
  6. If you are a diabetic: follow your doctor’s advice carefully to control your diabetes. Check your blood sugar regularly- according to your doctor’s advice and know your hemoglobin a1c- which is a blood test taken in your doctor’s office that measures how you have been doing with your blood sugar control for the last 2 – 3 months. The goal of a diabetic is to keep this number at less than 7%.
  7. Exercise: include exercise in your daily activities. A brisk walk for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk of stroke.
  8. Enjoy a lower sodium (salt), lower fat diet: By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and most importantly, lower your risk for stroke. Adding fiber such as whole grain bread and cereal products, raw unpeeled fruits and vegetables and dried beans to the diet can reduce cholesterol levels, also reducing your risk of stroke.
  9. Circulation problems: Ask your doctor if you have circulation problems (movement of the blood through the heart and blood vessels) which increase your risk for stroke. These can usually be treated with medicines. If the doctor prescribes medications for circulation problems, it is important to take it exactly as prescribed.

Symptoms: If you have any stroke symptoms, seek immediate medical attention!

These include:

  • Sudden numbness or weakness of face, arm or leg- especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause