Preventing Stroke After A Tia: What You Need To Know

A transient ischaemic attack (TIA) is a temporary condition that can precede a stroke, with a stroke risk of up to 10% in the week following a TIA and 20% in the first 90 days. It is critical to seek immediate medical attention if you are experiencing stroke symptoms, as one in three people who have a TIA will experience a stroke in the future. While a TIA doesn't usually lead to lasting disability, it is a warning sign of a more serious stroke. To prevent a stroke after a TIA, it is important to manage your blood pressure, cholesterol levels, and blood sugar, treat existing heart conditions, and make lifestyle changes such as improving your diet and exercise regimen, and quitting smoking.

Take medication to control blood pressure, cholesterol and blood sugar levels

After a transient ischemic attack (TIA), it is important to take steps to prevent another TIA or a full stroke from happening in the future. Almost everyone will need to take medication to reduce this risk.

Medication to Control Blood Pressure

High blood pressure is the biggest risk factor for stroke. Normal blood pressure is around 120/80. If your blood pressure is regularly over 140/90, you have high blood pressure. High blood pressure can damage the walls of blood vessels and lead to clots or plaques breaking off and blocking an artery in the brain, causing a stroke.

Almost everyone who has had a TIA or stroke should take anti-hypertensives, even if their blood pressure is normal. There are several types of antihypertensive medications that can help control blood pressure, including angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers. Your doctor will advise you on which medication is most suitable for you. Some people may be offered a combination of two or more different medications.

Medication to Control Cholesterol

High cholesterol is another risk factor for stroke. Cholesterol can build up on the walls of arteries, narrowing them and increasing the risk of a blood clot forming and causing a stroke. Statins are the most common type of medication used to control cholesterol levels. They are effective in reducing the risk of ischemic stroke, regardless of your cholesterol level. Higher doses of statins are typically prescribed, even for people with normal cholesterol levels. Examples of statins often given to people who have had a TIA include atorvastatin, simvastatin, and rosuvastatin.

Medication to Control Blood Sugar Levels

High blood sugar levels can damage your arteries, organs, and blood vessels, increasing your risk of a stroke. It is important to keep blood sugar levels in a healthy range, especially for people with type 1 or type 2 diabetes. In general, a fasting blood glucose level of below 130 milligrams (mg)/deciliter is recommended. If you've had a TIA, tracking your daily blood sugar levels and making dietary adjustments is a good idea.

Adopt a healthy diet and exercise regimen

Adopting a healthy diet and exercise regimen is crucial for preventing a stroke after a Transient Ischaemic Attack (TIA) or "ministroke." Here are some detailed instructions and guidelines to help you get started:

Diet:

• Focus on a low-fat, high-fibre diet: Emphasise fresh fruits and vegetables, aiming for at least five portions per day. Include plenty of legumes, whole grains, and healthy fats like olive oil.
• Reduce salt intake: Limit your daily salt consumption to no more than 6 grams, which is about one teaspoon.
• Limit processed foods: Avoid eating too much of any single food, especially processed foods high in salt, as they can increase your blood pressure.
• Increase unsaturated fats: Opt for foods like fish, nuts, olive oil, and avocados, which can help lower cholesterol levels.
• Mediterranean diet: Consider adopting this diet, which includes plenty of vegetables, legumes, olive oil, and healthy fats. It has been shown to reduce stroke risk by around 40% or more in high-risk individuals.
• Manage blood sugar: If you have diabetes or are at risk, work with a healthcare professional to monitor and manage your blood sugar levels.

Exercise:

• Aim for regular exercise: Engage in at least 150 minutes of moderate-intensity activity, such as cycling or fast walking, or 75 minutes of vigorous-intensity activity like running or swimming, every week.
• Strength training: Include strength exercises at least two days a week as part of your routine.
• Break up your exercise: You don't have to do all your exercise at once. For example, you can take three 10-minute brisk walks throughout the day to total 30 minutes of exercise.
• Adapt to your needs: If you have difficulty with physical activity due to health conditions or disabilities, consult a doctor, trainer, or physical therapist for adaptations.

Remember, combining a healthy diet with regular exercise is the most effective way to maintain a healthy weight and lower your risk of stroke after a TIA.

Stop smoking

Quitting smoking is one of the most important things you can do to reduce your risk of a stroke after a TIA. People who continue smoking have a two-fold higher risk of stroke than non-smokers.

Withdrawal Symptoms

Most people who quit smoking will experience some symptoms of nicotine withdrawal. While these symptoms are generally uncomfortable, they are not usually harmful and will fade over time. Symptoms include:

• Cravings to smoke
• Feeling irritated, upset, or grouchy
• Feeling restless or jumpy
• Difficulty concentrating
• Difficulty sleeping
• Feeling hungrier than usual and weight gain
• Feeling sad, depressed, or anxious

Benefits of Quitting

The benefits of quitting smoking begin within 20 minutes of your last cigarette. Here is a timeline of the health benefits you can expect:

• 20 minutes: Heart rate and blood pressure begin to drop, and circulation may start to improve.
• 12 hours: The body cleanses itself of excess carbon monoxide from cigarettes, increasing oxygen levels.
• 1 day: Risk of heart attack begins to decrease. Blood pressure begins to drop, decreasing the risk of heart disease. Oxygen levels will have risen, making physical activity and exercise easier.
• 2 days: A heightened sense of smell and more vivid tastes may be noticed as the nerve endings responsible for these senses begin to heal.
• 3 days: Bronchial tubes begin to relax, making it easier to breathe and possibly increasing energy levels.
• 2 weeks: Circulation and lung function begin to improve. Blood can pump through the heart and muscles more easily.
• 1 month: Coughing and shortness of breath decrease as the hair-like structures in the lungs (cilia) regain their ability to move mucus out of the lungs and reduce the risk of infection.
• 3-9 months: Lung function increases by 10%, improving any coughing, wheezing, or breathing problems.
• 1 year: Risk of a heart attack and coronary heart disease is halved compared to a person who smokes.
• 5 years: Risk of certain cancers, including lung, cervical, and bladder cancer, is reduced by half. Risk of stroke returns to that of a non-smoker.
• 10 years: Risk of developing and dying from lung cancer is reduced to around half that of a smoker. Risk of larynx and pancreatic cancer also decreases.
• 15 years: Risk of coronary heart disease becomes close to that of a non-smoker.

Resources for Quitting

If you wish to stop smoking, there are many resources available to help you, including:

• Helplines and support services, such as the NHS Smokefree helpline (for UK residents)
• Nicotine replacement therapy, such as nicotine patches, gum, lozenges, nasal spray, or inhalers
• Non-nicotine drugs, such as bupropion, which works by altering your brain chemistry
• Counselling and support from a healthcare professional
• E-cigarettes

Limit alcohol consumption

Heavy alcohol consumption is linked to an increased risk of ischemic stroke, especially if other risk factors are present. According to the United Kingdom's Stroke Association, excessive drinking can:

• Raise blood pressure
• Trigger atrial fibrillation, a stroke risk factor
• Damage the liver, which affects blood clotting
• Cause weight gain, making it harder to maintain a moderate weight

To limit health risks associated with alcohol consumption, the NHS recommends that men and women should not drink more than 14 units of alcohol per week on a regular basis. If you regularly drink 14 units per week, it is advised to spread your drinking over three or more days. If you want to cut down, it is recommended to have several drink-free days each week.

If you are taking medications after a TIA, consult a doctor about whether drinking alcohol is safe for you. If you are struggling to reduce your alcohol intake, it is important to seek help. Various organisations, such as Alcoholics Anonymous (AA) and Al-Anon, offer support and information for those concerned about their drinking or affected by someone else's drinking.

Manage underlying health conditions

Managing underlying health conditions is key to reducing your risk of a stroke after a TIA. This includes controlling high blood pressure, high cholesterol, blood sugar levels, and treating existing heart conditions. Here are some detailed steps to help you manage these conditions effectively:

Manage High Blood Pressure

High blood pressure, or hypertension, is a major risk factor for stroke and other cardiovascular issues. Lowering your blood pressure can be achieved through a combination of medication and healthy lifestyle changes.

• Medication: Angiotensin-converting enzyme (ACE) inhibitors and diuretics are often recommended to lower blood pressure.
• Healthy Weight: Work with a healthcare professional to determine a moderate weight goal and create a plan to achieve and maintain it.
• Sleep: Prioritize good quality sleep, aiming for 7-9 hours each night. Address any sleep disorders or conditions, such as insomnia or obstructive sleep apnea, that may interfere with your sleep.
• Stress Management: Adopt relaxation techniques like breathing exercises, meditation, or physical exercise to reduce stress levels.

Work with your Doctor to Reduce High Cholesterol

Cholesterol is a waxy, fatty substance that can build up in your blood vessels, narrowing your arteries and restricting blood flow. Lowering your cholesterol levels can be achieved through dietary changes, exercise, maintaining a healthy weight, and medication if necessary.

• Dietary Changes: Reduce your intake of saturated and trans fats, increase your fiber intake, and consume more fruits and vegetables.
• Exercise: Aim for at least 30 minutes of physical activity most days of the week.
• Medication: If recommended by your doctor, consider taking cholesterol-lowering medications like statins.

Keep Blood Sugar Levels in Check

High blood sugar can damage your arteries, organs, and blood vessels, increasing the risk of stroke. Maintaining healthy blood sugar levels is crucial, especially for individuals with type 1 or type 2 diabetes.

• Dietary Adjustments: Monitor your daily blood sugar levels and make dietary changes as needed.
• Long-Term Management: Strict long-term blood sugar management is recommended after a stroke to prevent further complications.

Treat Existing Heart Conditions

Certain heart conditions, such as atrial fibrillation (AFib), can significantly increase the risk of stroke. Work closely with your doctor to determine the appropriate treatment plan for your specific heart condition.

• Treatment Options: Depending on your diagnosis, your doctor may prescribe medications such as antiplatelet drugs, anticoagulants, statins, beta-blockers, or insulin.
• Lifestyle Changes: In addition to medication, lifestyle changes like a healthy diet, regular exercise, and smoking cessation can also help manage heart conditions.

Frequently asked questions