Preventing Stroke: Simple Steps To Reduce Your Risk

Stroke is a leading cause of death and long-term disability in adults. It can cause brain damage and affect a person's memory and ability to control their muscles. The good news is that strokes are largely preventable. Here are some ways to reduce your risk of stroke.

Keep blood pressure and cholesterol levels in check

Keeping your blood pressure and cholesterol levels in check is key to reducing your risk of stroke. High blood pressure is the number one risk factor for stroke, and it often has no signs or symptoms. Therefore, it is important to get your blood pressure checked regularly by a healthcare professional or at home with an automated monitor. If your blood pressure is high, work with your doctor to create a plan to lower it through lifestyle changes or medication.

To manage your cholesterol, it is important to get it checked regularly, especially if you are over 18 years old. High cholesterol can increase your risk of stroke by building up in your blood vessels, leading to stenosis and atherosclerosis. This build-up of plaque can block blood vessels and contribute to the formation of blood clots, increasing the likelihood of a stroke. If your cholesterol levels are high, your doctor may recommend lifestyle changes or medication to help lower them.

• Diet: Eat a healthy diet that includes plenty of fruits and vegetables, whole grains, low-fat dairy, and healthy proteins and fats. Limit your intake of salt, saturated fat, and cholesterol. Avoid high-cholesterol foods such as burgers, cheese, and ice cream.
• Exercise: Regular physical activity can help lower your cholesterol and blood pressure. Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking or biking, most days of the week.
• Weight Management: Maintain a healthy weight by combining a nutritious diet with regular exercise. Losing weight, even a small amount, can significantly impact your stroke risk.
• Smoking Cessation: Smoking increases your risk of stroke by thickening your blood and promoting clot formation. Quitting smoking is one of the most effective ways to reduce your risk.

Maintain a healthy weight

Maintaining a healthy weight is key to reducing your risk of stroke. Obesity increases your chances of having a stroke, so keeping your weight in a healthy range is important. Doctors often calculate body mass index (BMI) to determine whether a person's weight is in a healthy range. While an ideal BMI is 25 or less, this may not be realistic for everyone. It's important to work with your doctor to create a personalised weight loss strategy if you are overweight. Even losing as little as 10 pounds can significantly impact your stroke risk.

To maintain a healthy weight, it's crucial to focus on both diet and exercise. Eating a healthy diet can help you control your weight and lower your risk of stroke. Aim to consume a balanced diet that includes plenty of fruits and vegetables, whole grains, low-fat dairy, healthy proteins, and fats. Avoid high-cholesterol and high-saturated fat foods, such as burgers, cheese, and ice cream. Limit your salt intake and increase your potassium consumption to help manage blood pressure, a major risk factor for stroke.

In addition to a healthy diet, regular physical activity is essential for maintaining a healthy weight. Exercise contributes to weight loss and can independently reduce your risk of stroke. Aim for at least 30 minutes of moderate-intensity aerobic activity, such as brisk walking or biking, most days of the week. If you can't do 30 minutes at once, break it up into shorter 10- to 15-minute sessions throughout the day. You can also incorporate activities like walking, golfing, or playing tennis into your daily routine. Joining a fitness club or finding an exercise partner can help keep you motivated.

It's important to note that everyone's situation is unique, and you should always consult with your doctor before starting any weight loss or exercise program. They can help you create a personalised plan that considers your health history, current weight, activity level, and lifestyle. By combining a healthy diet and regular physical activity, you can effectively maintain a healthy weight and significantly reduce your risk of stroke.

Exercise regularly

Exercise is a key factor in reducing your risk of stroke. Physical activity supports the health of your brain and the rest of your body. It can help lower your cholesterol and blood pressure, two of the biggest risk factors for stroke.

The Surgeon General recommends that adults get 2 hours and 30 minutes of moderate-intensity aerobic physical activity, such as a brisk walk, each week. This can be broken down into 30 minutes of moderate activity, five times a week. If that feels unachievable, start smaller. Even 5 or 10 minutes of physical activity has real health benefits. You can also break your exercise up into 10- to 15-minute sessions a few times a day. Walking is one of the best exercises you can do, so try taking a walk around your neighbourhood each morning, or taking the stairs instead of the elevator. You could also try biking, golfing, playing tennis, or joining a fitness club with friends.

If you have children or teens, encouraging them to get regular physical activity will also reduce their risk of stroke. Children and teens should get 1 hour of physical activity every day.

Avoid smoking and drinking

Smoking is a well-established risk factor for all forms of stroke, with cigarette smoking greatly increasing your chances of having a stroke. The more you smoke, the more you stroke. The risk of stroke associated with smoking is generally acknowledged, but it is less well recognised that there is a strong dose-response relationship between smoking and stroke risk. The more cigarettes you smoke per day, the higher your risk of stroke.

The evidence linking smoking to stroke is extremely convincing. Current smokers have at least a two- to fourfold increased risk of stroke compared with lifelong non-smokers or individuals who had quit smoking more than 10 years ago. In one study, the risk increased to sixfold when this population was compared with non-smokers who had never been exposed to environmental tobacco smoke (i.e. second-hand smoke). In a separate study, this sixfold increase in risk persisted when cigarette-smoking women with smoking spouses were compared with smoking women with non-smoking spouses, further demonstrating the effect of second-hand smoke on stroke risk.

The association between smoking and stroke is dose-dependent. The more cigarettes you smoke, the higher your risk of stroke. This relationship has been observed across the age spectrum, including in young women.

The mechanisms through which smoking affects stroke risk are numerous and include:

• Carboxyhaemoglobinemia
• Increased platelet aggregability
• Increased fibrinogen levels
• Reduced HDL-cholesterol
• Direct toxic effects of compounds such as 1,3-butadiene, a vapor phase constituent of environmental tobacco smoke that has been shown to accelerate atherosclerosis in animal models
• Progression of atherosclerosis
• Early arterial damage
• Advanced atherogenesis, potentially in relation to chronic infection
• Impaired endogenous fibrinolysis and reduced blood flow in the brain secondary to smoking-induced vasoconstriction

Atherosclerosis and arterial damage thus explain how smoking predisposes individuals to large- and small-vessel lacunar stroke. Impaired endogenous fibrinolysis and reduced blood flow in the brain secondary to smoking-induced vasoconstriction may also contribute to lacunar stroke. While atrial fibrillation and hypertension may outweigh the risk of smoking for cardioembolic stroke, an association is believed to exist for this stroke subtype as well.

Ischemic stroke is not the only form of stroke associated with smoking; both intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH) risks are also elevated. Results of the Multiple Risk Factor Intervention Trial showed a strong relationship between smoking and SAH, ICH and non-haemorrhagic stroke.

The increased risk of SAH appears to be related to the increased incidence of aneurysms seen in smokers. Heavy smoking (>20 cigarettes/day) men and currently smoking women have been found to have adjusted relative risks of aneurysmal haemorrhage of 7.3 and 2.1, respectively, as compared with men who had never smoked and with women who were not current smokers. Smoking may cause ICH by damaging the walls of small intraparenchymal arteries, leading to their rupture.

The Hemorrhagic Stroke Project found cigarette smoking to be an independent risk factor of primary haemorrhage. A more recent study of 39,484 patients demonstrated that high alcohol intake and smoking favour haemorrhagic stroke over ischemic stroke. A dose-response relationship has also been shown in a case-control study; the odds ratio was 3.33 for those smoking 1-20 cigarettes per day and was 9.78 for those smoking more than 21 cigarettes per day.

It has been suggested by some that the relationship between smoking and ICH is weak and inconsistent. For example, a recent pooled cohort of the Atherosclerosis Risk in Communities (ARIC) study and Cardiovascular Health Study (CHS) did not find any consistent or independent relationship between smoking and ICH. As this was a pooled analysis, this study had limited power with confounding and study interactions potentially altering the results in unpredictable ways. However, this and other such studies raise the possibility that the association between smoking and ICH may be somewhat less straightforward. For example, one study showed that current smoking increases the risk of ischemic stroke only, while former smokers have a 50-60% increase in the relative risk of both ischemic and haemorrhagic stroke. Another study has shown that smoking may be unrelated to nonlobar primary ICH, but doubles the risk for lobar primary ICH. A study on a select group of Korean men with low cholesterol found no overall association of smoking with ICH, but an increased risk in those with a body mass index less than 25 kg/m2. A pooled Japanese analysis found a significantly increased risk of ICH in female current and ever-smokers, but not in men. Finally, the Melbourne Risk Factor Study Group showed no increase in risk of ICH with smoking, but post hoc analysis suggested a significant interaction between smoking and hypertension on the risk of ICH.

Quitting smoking results in a considerable reduction in stroke risk across gender, race and age. This fact has been demonstrated in numerous studies both in the USA and worldwide. In a cohort of Asian men, heavy smokers (>20 cigarettes/day) who quit smoking showed significantly lower risks of ischemic stroke and SAH compared with heavy smokers who continued to smoke. An Australian study investigating the effect of smoking cessation among Asians and Australasians found that current smokers had a higher relative risk of stroke compared with non-smokers, whereas ex-smokers had a lower relative risk of stroke compared with current smokers. Mechanistically, the return to baseline or near-baseline stroke risk is thought to be related to normalisation of the procoagulant state seen in smokers. However, not all studies demonstrate a full return to non-smoker risk status, which may in part be related to several factors including the duration of smoking, concomitant risk factors and the quantity of atherosclerotic disease developed while smoking.

The association between drinking and stroke is complex. Some studies have shown that moderate alcohol consumption is associated with better health and lower mortality risks. However, drinking too much alcohol can increase your risk of stroke. Globally, excessive alcohol consumption is linked to over 1 million strokes each year.

Drinking too much alcohol can increase your risk of stroke because alcohol is linked to a number of other conditions which are associated with strokes:

Hypertension – drinking too much alcohol

Control blood sugar

To reduce your risk of stroke, it's important to keep your blood sugar in the normal range. Here are some detailed tips to help you control your blood sugar levels:

Understand Blood Glucose

Firstly, it's important to understand what causes blood sugar levels to rise. Glucose, which comes from the carbohydrates and sugars in your food and drink, is converted into glucose (sugar) in your stomach and digestive system. It then enters your bloodstream. Insulin, a hormone produced by the pancreas, helps your body's cells take up glucose from the blood and lower blood sugar levels. In Type 2 diabetes, the body may become resistant to insulin or the pancreas may not produce enough insulin, leading to a build-up of glucose in the blood.

Monitor Your Blood Sugar

Use a blood sugar meter or a continuous glucose monitor (CGM) to regularly check your blood sugar levels. Typical times to check include when you first wake up and before meals, and two hours after a meal. If you have specific concerns, consult your doctor about how often you should check your blood sugar levels.

Adjust Your Diet

Eat a healthy diet that includes vegetables, fruits, whole grains, beans, legumes, nuts, plant-based proteins, and lean animal proteins like fish and seafood. Choose complex carbohydrates, such as whole grains, lentils, and legumes, as they slow digestion and help keep blood sugar levels stable. Limit your consumption of sugary foods and drinks, refined carbohydrates, red or processed meats, salty foods, and highly processed foods. Drinking water instead of sugary drinks can also help manage blood sugar.

Exercise Regularly

Physical activity helps lower blood sugar levels because your muscles take up glucose and use it for energy. Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week. You can also incorporate full-body strength training a couple of times a week.

Manage Your Weight

Maintaining a healthy weight is crucial in controlling blood sugar levels. Being overweight or obese can increase your risk of developing health conditions that contribute to high blood sugar, such as diabetes.

Frequently asked questions