Stroke Prevention: control risk factors
Control stroke risk factors
- Check blood pressure
- Stop smoking
- Exercise regularly
- Limit alcohol intake
- Eat a healthy diet and reduce salt intake
- Lower cholesterol
- Check for Atrial Fibrillation
- Control weight
- Check if you need medicines prescribed
- You may need an operation
Cause and prevention are often closely linked. You can reduce your stroke risk by controlling the stroke risk factors.
Despite common misconceptions, sudden shocks or arguments almost never cause strokes. Usually strokes happen as a consequence of a combination of factors that have been present or developing for a long period of time. If someone has two or more of the risk factors below, stroke risk can dramatically increase (do the ‘Risk Factors’ test with our ‘Self Assessment Scorecard’). Anyone who is high risk should see their doctor, who will usually assess each risk factor for stroke (and heart disease) before deciding on necessary treatments.
Here are some simple rules to reduce stroke risk:
1. Get your blood pressure checked
Because it is one of the greatest stroke risk factors, failure to detect and control high blood pressure is the number one cause of avoidable strokes. A person with high blood pressure is up to seven times more likely to have a stroke than someone with normal or low blood pressure.
High blood pressure puts too much pressure and stress on the walls of blood vessels and increases the risk of both haemorrhages and blood clots. High blood pressure is usually silent and rarely gives any warning signs – the only way to know is to have it checked. It is important to have it checked twice a year, especially for men aged over 45 years and women over 55 years – earlier if there is a family history of stroke or heart attack or any other risk factors for stroke or heart attack.
A doctor will recommend strategies to lower your blood pressure and your risk of stroke including lifestyle changes such as losing weight, changing unhealthy eating habits, reducing your salt intake, exercising more and stopping smoking. In many cases, a doctor may also prescribe medication to lower blood pressure.
2. Stop Smoking
Smoking quadruples stroke risk. Chemicals and gases in tobacco smoke speed up the process of atherosclerosis (hardening of the arteries) and make blood vessels throughout the body tighten, reducing blood flow. Smoking also makes the blood more likely to clot, especially inside damaged blood vessels.
As soon as someone stops smoking, their stroke risk begins to drop and continues to improve each day. Many people find it difficult to stop smoking, but there are lots of things that can help. Talk to a GP for advice and support, or call the Smoking Quit Line on 0800 778 778.
Note: If you smoke and have high blood pressure you have 18 times more risk of stroke than someone the same age who doesn’t smoke and has normal blood pressure.
3. Exercise Regularly
People who are physically inactive have greater stroke risk than those who keep active. Being physically inactive over a long period is linked to high blood pressure, a leading cause of strokes.
Include exercise in your day-to-day activities. As little as 30 minutes of moderate exercise a day can increase your fitness and reduce your risk of stroke. Any physical activity is good as long as it is enough to make you slightly warm and a little out of breath.
Regular exercise will lower your blood pressure, slow your resting heart rate and reduce the stress on your artery walls as well as increasing your fitness. It can halve your risk of stroke!
4. Limit the Amount of Alcohol You Drink
Studies now show that drinking up to two small drinks a day can reduce stroke risk – but drinking any more than that increases stroke risk by as much as three times. A drinking binge creates as much as five times greater risk. Regular heavy drinking increases stroke risk, because it can raise blood pressure and increase the risk of haemmorhage in the brain.
5. Eat a Healthy Diet and Reduce Salt Intake
Cutting down on fat and salt should lower a person’s blood pressure and cholesterol levels. Too much fat in a diet can cause silting of the arteries (atherosclerosis), which can cause strokes. Too much salt can raise blood pressure and this also can cause strokes.
It is best to eat a balanced diet with lots of fresh fruit and vegetables, grains and a moderate amount of lean meat or low fat protein each day. Fruit and vegetables contain antioxidant vitamins and potassium, both good for the arteries. Fibre, such as cereals and whole grain bread, also helps reduce cholesterol.
6. Lower your cholesterol
Cholesterol is essential to all of the body’s cells and normally the body will produce all the cholesterol it requires. Consuming foods high in cholesterol and saturated fats may accelerate atherosclerosis. Keep on top of cholesterol levels by having a blood test and by being prepared to change eating habits.
If necessary, a doctor might also prescribe a cholesterol lowering drug (called lipid-lowering agents, usually a ‘statin’).
7. Find out if you have Atrial Fibrillation
Atrial fibrillation is a type of irregular heartbeat. People with this condition have a five times greater stroke risk because the irregular heartbeat may lead to blood clots forming in the heart. These can then break off and travel though the blood vessels to the brain where they may cut off blood supply, causing a stroke.
If someone suspects they have atrial fibrillation, it is important to see a doctor. The doctor might prescribe tablets to make the blood less sticky and less likely to form clots (warfarin) and make the heartbeat more regular.
8. Control Your Weight
Being overweight strains the entire circulatory system and creates higher cholesterol levels, high blood pressure and diabetes – all of which increase stroke risk.
9. Medicines
A doctor might use a combination of medicines to reduce someone’s future stroke risk. If you want more information about your medicines ask your doctor or pharmacist. These medicines may include:
- Aspirin
Aspirin is known as an ‘antiplatelet’ agent. In simple terms, it helps to make the blood less ‘sticky’. Blood clots are formed when special blood cells (platelets) clump together. Aspirin helps prevent these cells from sticking together and is the most commonly used drug to prevent strokes. However, it should only be used on a doctor’s advice as it may promote stomach ulcers or cause bleeding in susceptible people. - Dipyridamole
Is another antiplatelet drug similar to aspirin, but it works by a different method. On its own, dipyridamole is not as powerful as aspirin, but the combination of aspirin plus dipyridamole is more effective at preventing recurrent stroke than aspirin alone. Specialist authorisation for funding of treatment with dipyridamole is currently required. However, the cost is less than $1 a day and some people may wish to consider this treatment after a stroke or TIA has occurred, even if they do not meet government funding criteria. Your doctor can provide more information. The main side-effect from dipyridamole is headache, which can affect up to one-third of people who take the drug, causing them to stop taking it. - Blood pressure lowering drugs
Lowering blood pressure, even if it was not high beforehand, has been proven to reduce the risk of further strokes. There are many different drugs used to lower blood pressure, and people often need two or more different ones to control their blood pressure. - Cholesterol lowering drugs
The most common drugs to lower cholesterol are called ‘statins’ because the actual name of the drug ends with ‘statin’ (eg simvastatin, atorvastatin, pravastatin) although the trade name may be different. They are highly effective drugs for preventing strokes and heart attacks, and work best when following a healthy diet. - Warfarin
Warfarin is an anticoagulant (blood thinner) used particularly in people who are at high risk of forming blood clots because of atrial fibrillation or a blood-clotting problem. Treatment with Warfarin requires careful monitoring and is not suitable for everybody. - Other medicines are sometimes used and a doctor will explain the need for these.
10. Operations
Some people may benefit from an operation if they have a severe narrowing of the main blood vessels in the neck (carotid stenosis).
Stroke Foundation of N.Z. Inc (National office)
P O Box 12482
L1, Federation House
95-99 Molesworth Street
WELLINGTON
Tel: 04 472 8099
0800 STROKE (0800 78 76 53)
E-mail: strokenz@stroke.org.nz
© 2007 New Zealand Stroke Foundation Inc. All Rights Reserved.