Strokes: Can They Happen Back-To-Back?

Experiencing a stroke can have a major impact on a person's quality of life, and having one increases the likelihood of having another. Recurrent strokes cause additional brain damage, increasing the risk of death and long-term disability. According to a 2022 study, mortality rates are higher after a recurrent stroke. So, what can be done to prevent this from happening?

Lifestyle changes can reduce the risk of a second stroke

According to the American Heart Association, nearly 800,000 strokes that occur annually are recurrent events, with a 13% to 16% chance of stroke recurrence in the first year and a 4% chance every year thereafter. This means that the risk of having another stroke is elevated to 30% by the fifth year and 43% by the tenth year.

The good news is that 80% of recurrent strokes can be prevented with diet modification, exercise, blood pressure control, and cholesterol reduction with the help of statins. Here are some ways to lower your risk of a second stroke:

Control your blood pressure

Hypertension is the single most common cause of stroke, and it is estimated that one-fourth of the US population has high blood pressure. By controlling your blood pressure through medication and lifestyle changes, you can reduce the risk of a second stroke by 28%.

Lower your cholesterol

Statins are a group of medications that have been highly effective in treating high cholesterol. They reduce the risk of a recurrent stroke by 25%. It is important to note that statins are usually added to discharge instructions after a stroke.

Exercise regularly

Physical activity can improve your overall health and fitness, reducing your risk of stroke contributors such as high blood pressure and obesity. Aim for at least 150 minutes of moderate physical activity per week.

Improve your diet

Adopting a healthy diet can significantly lower your risk of a second stroke. A Mediterranean diet, rich in fruits, vegetables, whole grains, and healthy fats like olive oil, is associated with a reduced rate of stroke.

Quit smoking

Smoking damages and tightens blood vessels, increasing your risk of stroke. Quitting smoking immediately reduces your stroke risk and improves your overall health.

Manage your weight

Being overweight or obese increases your risk of stroke. Work with your doctor to create a reasonable weight loss plan that includes a healthy diet and regular exercise.

Limit alcohol consumption

Heavy alcohol consumption increases the risk of stroke. It is recommended to limit alcohol intake to one drink per day for women and two drinks for men.

Manage stress

Chronic stress can have negative impacts on your health and increase your stroke risk. Learn stress management techniques and find healthy ways to cope with stress.

Take prescribed medications

It is important to take any prescribed medications as directed by your doctor. Not taking your medication as instructed is a significant risk factor for a repeat stroke.

High blood pressure is a common cause of strokes

High blood pressure is a leading cause of strokes, and it is estimated that 75 million people in the United States—a quarter of the population—have high blood pressure. This condition damages arteries throughout the body, creating conditions that can make arteries burst or clog easily. Weakened or blocked arteries in the brain significantly increase the risk of a stroke.

High blood pressure occurs when blood flows with too much force, putting more pressure on the arteries. This excess pressure stretches the arteries beyond their healthy limit and can cause small tears. The body then repairs these tears with scar tissue, which traps substances that form plaque and can lead to blockages, blood clots, and hardened, weakened arteries. This process can cause an ischemic stroke, where a clot blocks a blood vessel in the brain, or a hemorrhagic stroke, where a blood vessel in or near the brain bursts.

Managing high blood pressure is critical to reducing the risk of stroke. This can be achieved through lifestyle changes such as eating a healthy diet, reducing salt and alcohol intake, engaging in regular physical activity, and maintaining a healthy weight. Additionally, taking prescribed medications and avoiding tobacco smoke are essential for controlling high blood pressure and lowering the risk of stroke.

High blood pressure is a serious condition that can lead to life-threatening emergencies such as strokes. By understanding the risk factors and taking preventive measures, individuals can significantly reduce their chances of experiencing a stroke.

High cholesterol increases the risk of stroke

High Cholesterol and the Risk of Stroke

High cholesterol is a well-known risk factor for strokes. While the relationship between cholesterol and stroke risk is complex, several studies have found a link between high cholesterol and an increased risk of ischemic stroke, particularly the atherothrombotic and lacunar subtypes.

Cholesterol and Ischemic Stroke Risk

Ischemic strokes account for about 80% of all strokes and occur when blood vessels in the brain are blocked, cutting off blood flow. Research has shown that high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a higher risk of ischemic stroke. Specifically, the subtype of atherothrombotic or large artery occlusive disease has been most closely tied to higher levels of TC and LDL-C.

Two case-control studies have also identified cholesterol as a risk factor for lacunar stroke, a subtype of ischemic stroke caused by small vessel blockage. Higher cholesterol levels may enhance the formation of microatheromata or plaque rupture, increasing the risk of lacunar stroke.

Cholesterol-Lowering Treatments and Stroke Prevention

Several cholesterol-lowering interventions have been found to reduce the risk of ischemic stroke. These include:

• Statins: Statins are a group of medications that have revolutionized the treatment of high cholesterol. They reduce the risk of recurrent stroke by about 25%.
• Ezetimibe: Ezetimibe lowers TC and LDL-C by inhibiting the Niemann-Pick C1-like 1 protein. It has been found to reduce the risk of ischemic stroke, particularly in patients with a history of prior stroke.
• PCSK9 inhibitors: PCSK9 inhibitors are monoclonal antibodies that increase the number of cell surface LDL receptors available to take up plasma LDL particles. They have been found to reduce the risk of total stroke and ischemic stroke.

Managing High Cholesterol to Prevent Stroke

While high cholesterol is a risk factor for stroke, it is important to note that it is just one piece of the puzzle. Stroke risk is influenced by a variety of factors, including age, medical history, lifestyle choices, and other medical conditions.

To reduce the risk of stroke, it is crucial to manage high cholesterol levels through a combination of lifestyle changes and medical treatments. This may include dietary modifications, such as adopting a Mediterranean diet rich in fruits and vegetables, whole grains, and healthy fats like olive oil. Additionally, prescription medications, such as statins, can effectively lower cholesterol levels and reduce the risk of stroke.

It is important to work closely with a healthcare provider to determine the best course of action for managing high cholesterol and reducing stroke risk.

The risk of a second stroke is high in the first week after a TIA

Strokes are a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. They are the second leading cause of death worldwide and the fifth in the United States. Transient ischemic attacks (TIAs), often called "mini-strokes", are temporary blockages of blood flow to the brain that can act as a warning sign of a future stroke.

To prevent a second stroke, it is essential to address lifestyle factors such as lack of physical activity, excessive alcohol consumption, psychosocial stress, and atrial fibrillation or previous heart attack. Additionally, maintaining a healthy diet, exercising, controlling blood pressure, and reducing cholesterol levels through statins can significantly reduce the risk of a recurrent stroke.

In summary, the risk of a second stroke is significant in the first week following a TIA, and prompt medical attention is crucial to lower this risk and prevent permanent damage or death.

Stroke treatment depends on the type of stroke

There are two main ways that strokes occur: ischemia and hemorrhage. Ischemic strokes are the most common, accounting for about 80% of all strokes, while hemorrhagic strokes are less common and account for the remaining 20%.

Ischemic Strokes

Ischemic strokes occur when blood vessels supplying blood to the brain are obstructed, usually by a blood clot. The top priority in treating ischemic strokes is to restore circulation to the affected areas of the brain. This is done using thrombolytic drugs, which dissolve existing clots, and/or a catheterization procedure called mechanical thrombectomy. Thrombolytic drugs must be administered within three to four and a half hours of the onset of stroke symptoms, as they increase the risk of dangerous bleeding complications if given outside of this time frame. Mechanical thrombectomy procedures are also time-sensitive, with the best window for treatment being within 24 hours of symptom onset.

Hemorrhagic Strokes

Hemorrhagic strokes occur when a weakened blood vessel, often due to uncontrolled high blood pressure, ruptures and bleeds. Treatment for hemorrhagic strokes depends on the location and severity of the bleeding. Reducing blood pressure is often the first priority to limit bleeding and prevent it from worsening. Improving clotting can also help stop the bleeding. Surgery may be necessary to relieve pressure on the brain from accumulated blood.

Frequently asked questions