Every year, approximately 750,000 Americans experience strokes. Although quick treatment using clot-busting drugs can sharply reduce the damage caused by a stroke, treatments must be given within the early hours of the stroke's occurrence.
Only 1% to 2% of US stroke victims arrive at a hospital in time to get treated with anti-clotting medication. So it is even more important that people do their best to prevent strokes. They can do this by lowering or eliminating their stroke risk factors. Here are the major risk factors that can and can't be changed and how to manage them effectively…
Risk Factors You Can’t Avoid
There's nothing you can do about some risk factors. The more you have, the more vigilant you need to be about those that you can control. Non-modifiable factors include…
- Age. The risk of stroke goes up steadily with age.
- Gender. Since women usually live longer than men, they experience more disability and deaths from stroke.
- Race and ethnicity. African-Americans are two times more likely to both have a stroke and die from one than white Americans are. The stroke risk among Hispanic-Americans also appears to be nearly double that of white Americans in the same communities.
- Genetic background. If your father, mother or sibling has had a stroke, you may be at elevated risk as well
Risk Factors You Can Manage
Here are the major stroke risk factors that can be managed, and how to handle them...
High blood pressure (hypertension) is the biggest risk factor of all. Clinical studies have shown conclusively that when high blood pressure is lowered, risk of stroke is also reduced.
Risk-reduction strategy: While a low-sodium diet and 30 minutes of daily exercise can help control blood pressure, most people who have hypertension (defined as blood pressure of 140/90 or higher) also require medication, such as beta-blockers, calcium-channel blockers or diuretics, to reach a "normal" blood pressure of 120/80.
People who have moderately elevated blood pressure (121-139/81-89) should seek treatment if they're overweight or have other stroke risk factors.
There's also growing evidence that achieving a blood pressure even lower than 120/80 reduces stroke risk even more.
- Diabetes. Having diabetes—defined as a fasting blood sugar level of 126 mg/dL or higher—increases risk of stroke due to increased incidence of small and large blood vessel disease.
Risk-reduction strategy: Work closely with your doctor to manage your blood sugar levels through diet, exercise, regular blood-sugar testing and taking insulin, if necessary. For people with other stroke risk factors, treatment may even be warranted at prediabetic blood sugar levels (more than 110 mg/dL).
- High LDL ("bad") cholesterol. While elevated blood cholesterol hasn't been directly linked to increased stroke risk (as it has to coronary artery disease), evidence suggests that people who take statins to lower their LDL cholesterol may also reduce stroke risk.
Risk-reduction strategy. Take statins, maintain a low-fat diet and exercise to boost HDL ("good") cholesterol. For people at low stroke risk, the LDL target is typically 160 mg/dL. With several risk factors present, the target drops to 130. For those at high risk for a stroke, the target might be 100 or even 70.
- High triglycerides (a blood lipid). Triglyceride levels of 150 mg/dL or higher have been shown to increase stroke risk in people with preexisting heart disease.
Risk-reduction strategy: Maintain a low-fat diet and take triglyceride-lowering medication, such as statins and fibrates (another group of cholesterol-lowering drugs).
- Other heart ailments. Atrial fibrillation, congestive heart failure and valvular heart disease all have been linked to an increased Stroke risk
Risk-reduction strategy: Prompt diagnosis and treatment. Also, possibly, the use of blood thinners such as warfarin.
- Prior stroke or heart attack. Someone who has had a stroke is at much greater risk of having another. Heart attack survivors are also at increased risk for stroke.
Risk-reduction strategy: Aspirin and other antiplatelet drugs significantly reduce the risk of another stroke or heart attack.
- Cigarette smoking. Smoking increases stroke risk significantly, in part because smoking damages the walls of the blood vessels, making formation of stroke-causing blood clots more likely
Risk-reduction strategy: Quit immediately.
- Heavy alcohol use. Up to two alcoholic drinks a day for men and one for women may reduce risk of stroke. Drink more than that, however, and the pendulum begins to swing in the other direction.
For women and men, over five drinks a day raises stroke risk by increasing the blood's tendency to clot and contributes to hypertension and heart and liver disease).
Risk-reduction strategy: Men should limit themselves to two drinks per day... women, one drink
Physical inactivity and obesity. Being overweight, inactive or both increases not only stroke risk, but also your risk for high blood pressure, high cholesterol, heart disease and diabetes.
Risk-reduction strategy. A diet that is restricted in calories. Thirty minutes of aerobic exercise, most or all days of the week.
- Plaque in the carotid arteries. Almost 20% of all strokes occur when the carotid arteries are blocked by a blood dot. These arteries are located in the neck and supply blood to the brain. This is more likely to occur in people whose carotid arteries are narrowed by plaque buildup.
Risk-reduction strategy: Diagnostic tests include ultrasound scans, angiograms and magnetic resonance angiograms. Treatments include medication (anticoagulants, antiplatelets, statins or other lipid-lowering drugs) and surgical procedures (endarterectomy-surgery to clean out the carotid artery-and angioplasty or stenting).
- Transient ischemic attacks (TIA). TIAS are "warning strokes" or "ministrokes." Treating a TIA promptly by getting urgent medical attention can reduce your risk of a full-blown stroke.
Risk-reduction strategy: Learn the warning signs of a TIA or stroke. Call 911 and get to a hospital immediately.
High Blood Pressure Facts
Approximately 65 million American adults A have high blood pressure, according to the National Heart, Lung, and Blood Institute (NHLBI).
Hypertension is often called the silent killer" because it usually has no symptoms but leads to an increased risk for heart attack, congestive heart failure, stroke and kidney failure.