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Could You Be at a Higher Risk for Stroke and Not Know It?

Could You Be at a Higher Risk for Stroke and Not Know It?

About 800,000 Americans have a stroke each year. Here's how to lower your odds.

Often called ‘brain attacks,” strokes occur when disease or trauma suddenly disrupt blood flow to the brain, or far more rarely, cause blood vessels inside the brain to burst. Estimates suggest that stroke kills 140,000 Americans each year, making it the nation’s fifth leading cause of death.

Although a majority of individuals recognize sudden numbness on one side as a symptom of stroke, fewer than half know the biggest five signs, such as slurred speech and difficulty speaking, according to the Centers for Disease Control and Prevention (CDC). Fewer still know the signs and call 911 for help first during these life-threatening events.

When a stroke occurs, time to get treatment is considered critical to preventing death and long-term disability. And, despite medical advances in treating ischemic strokes—those in which blood to the brain becomes blocked—stroke prevention remains an essential public health strategy.

Some stroke risk factors are beyond our control, such as age and gender. But, experts say, some 80 percent of strokes are preventable.

Stroke risk factors you can influence
The most important modifiable stroke risk factor, physicians agree, is high blood pressure, also called hypertension, which damages your blood vessels and makes them more susceptible to clots and leakage.

In fact, so vital is blood pressure to overall cardiovascular health that the American College of Cardiology and the American Heart Association (AHA) recently revised their guidelines to allow for earlier intervention, lowering the definition of high blood pressure from 140/90 mmHg to 130 mmHg systolic or 80 mmHg diastolic. Almost half of US adults are expected to fall within this new definition, with the most notable impact among adults under age 45.

Closely linked to high blood pressure as a modifiable risk factor is high cholesterol, or hypercholesterolemia. The ‘bad’ type of cholesterol, known as low-density lipoprotein (LDLs), contributes to a buildup of plaque that narrows your arteries, including in the brain. This raises your risk of stroke in a few ways:

  • It means your heart must work harder to pump blood throughout the body, which can raise blood pressure to unacceptable levels.
  • The plaques themselves can rupture or form blood clots, which may break off and travel to your brain. The arteries there are more likely to be blocked, since they've been narrowed by cholesterol.

Even though some patients recognize that having high blood pressure, high cholesterol or both carries a greater risk for stroke, many fail to understand the relationship to their lifestyle, says Sangeeta Shah, MD, a neurologist at Covenant Medical Center in Waterloo, Iowa. “In my opinion, obesity and lack of physical activity are the least understood risk factors for stroke,” she says. So, shedding pounds and keeping active represent clear strategies for lessening that risk.

Slimming down is particularly effective; for every 2.2 lbs lost, your blood pressure falls about 1 mmHg. Help control your weight by eating a healthy diet full of produce, legumes, whole grains and lean meat—and low in sugar, saturated fats, trans fats and cholesterol. Limit salt intake, choose foods high in fiber and consider the DASH diet, which is particularly helpful for addressing hypertension. Consider tracking both your diet and physical activity, which increases accountability and can help build healthy habits; the Sharecare app, available for iOS and Android, features trackers for both at your fingertips.

More modifiable factors
In addition to modifying your diet and exercise plan, other strategies for lowering your stroke risk include:

  • Quitting smoking, which damages blood vessels and can lead to blockages causing stroke.
  • Moderating alcohol intake, since even moderate drinking can raise blood pressure, increasing the risk for stroke. The CDC recommends that men have no more than two drinks per day, while women should have no more than one. But an April 2019 study of more than 150,000 people published in The Lancet found that even low levels of alcohol consumption was associated with an increased risk for stroke, challenging claims that moderate drinking could have a protective effect. The more you drink, the higher your risk. The study also found that drinking four drinks per day could increase stroke risk by up to 35 percent.
  • Controlling certain medical conditions, such as diabetes, which raises the risk of both heart disease and stroke twofold.

Being able to identify the signs of transient ischemic attacks (TIAs) is helpful, as well. These mini-strokes produce symptoms similar to that of a full-blown stroke, but usually carry no lasting effects. Having a TIA, however, is considered a risk for future strokes.

Preventing strokes in younger people
Nearly 90 percent of all strokes occur in individuals over age 50, the CDC says. But a 2016 study published in the Journal of the American Heart Association found that, while ischemic stroke hospitalizations declined overall between 2000 and 2010, there was a 43.8 percent increase in hospitalizations among adults age 25 to 44.

According to Dr. Shah, the steady rise in this younger age group can be partly attributed to the same lifestyle factors that put older adults at peril for stroke, namely obesity and lack of exercise. But, in addition, she says, many young people don’t go to a doctor regularly, and often experience high stress from family obligations or employment concerns that can raise their risk.

Ultimately, no matter your age or the type of stroke, regular medical checkups play an important role beyond what individuals can do on their own to lessen risk. “Everyone should have physical checkups to make sure all of their risk factors are under adequate control,” Shah says.