Most people worry more about having a heart attack than a stroke. Heart attacks are more common, but even what may seem like a mild stroke can have serious consequences, leaving you with functional deficits that affect everyday life. Stroke is the third-leading cause of death in the US and 15% to 30% of patients who have a stroke are permanently disabled.

New strategies: The American Stroke Association's guidelines include both well-known preventive measures (such as regular exercise) and measures that have only recently come to light.

Example: Premenopausal women who suffer from migraines have about twice the risk of stroke as those who don't have migraines (although the absolute risk of stroke for women with migraines is small). It's not known if treating migraines reduces stroke risk-but these patients need to be especially careful about controlling other risk factors for stroke.

Important steps everyone can take...

Manage Blood Pressure

Hypertension (high blood pressure) is the single most important treatable stroke risk factor. It increases the risk of both types of stroke-ischemic, in which a clot blocks circulation to the brain, and hemorrhagic, when a blood vessel in the brain leaks or ruptures.

Because hypertension doesn't cause symptoms in most patients, millions of Americans who have it don't know it. Among those who have been diagnosed, less than half manage hypertension successfully.

Good news: For every 10-point reduction in systolic pressure (the upper number) and fivepoint reduction in diastolic pressure (lower number), the risk of stroke drops by about 30%.

What to do: Get your blood pressure checked. A reading below 120/80 is optimal for stroke prevention. Patients who have had a prior stroke or a transient ischemic attack (TIA, sometimes referred to as a "ministroke," which typically causes symptoms for an hour or less) should almost always take steps to lower their blood pressure. Available data suggest that those who have had a stroke and have blood pressure below 120/80 benefit from lowering pressure further.

Most patients can significantly lower blood pressure with lifestyle changes, such as losing weight, exercising more and consuming less salt. If the numbers stay elevated—140/90 is the threshold for hypertension-patients should be treated with antihypertensive drugs.

Check Your Heart’s Rhythm

Atrial fibrillation is an irregular rhythm in the upper chambers (atria) of the heart. It prevents blood from circulating efficiently, which makes clots more likely. This, in turn, increases the risk of ischemic stroke.

Some patients with atrial fibrillation have no symptoms. Those who have symptoms may experience palpitations, confusion, light-headedness or shortness of breath.

What to do: Check your wrist pulse. See a doctor if the rhythm seems irregular.

Atrial fibrillation often can be treated with daily aspirin to reduce clotting. Patients with additional stroke risk factors, including those who have had a prior stroke or a TIA, have a higher risk. They may require warfarin (Coumadin), a more potent anti-clotting drug. There is no evidence that treating the rhythm problem itself decreases stroke risk.

Control Cholesterol

Patients with high cholesterol-above 240 milligrams per deciliter (mg/dL)-have an increased risk of ischemic stroke. The Asia Pacific Cohort Studies Collaboration, which looked at more than 352,000 people, found a 25% increase in ischemic stroke rates for every 38.7 mg/l increase in cholesterol.

What to do: Most people can significantly improve cholesterol with regular exercise and a healthy diet-less saturated fat, more fiber, etc.

Patients with existing heart disease, or those who have had a prior stroke or a TIA, should talk to their doctors about cholesterol-lowering statin drugs. The use of statins can decrease the risk of stroke in some patients who have seemingly "normal" cholesterol levels.

Don’t Ignore Snoring

Loud snoring may be a sign of sleep apnea, in which breathing intermittently stops and starts during sleep. Moderate-to-severe sleep apnea raises blood pressure, can worsen atrial fibrillation and increases stroke risk.

What to do: A person with apnea symptoms-loud snores/snorts, gasping for breath, daytime fatigue and morning headaches-needs to be evaluated by a sleep specialist. Talk to your primary care provider about sleep specialists in your area.

Avoid Secondhand Smoke

People who smoke have approximately twice the risk for ischemic stroke as nonsmokers, and two to four times the risk for hemorrhagic stroke. Smoking is believed to contribute to at least 12% of all stroke deaths.

Secondhand danger: Exposure to environmental (secondhand) cigarette smoke is nearly as dangerous as active smoking. People who are exposed to secondhand smoke regularly are 50% more likely to have a stroke than unexposed nonsmokers.

What to do: If you smoke, talk to your doctor about behavioral and pharmacological treatments for smoking cessation...avoid secondhand smoke whenever possible.

Eat More Fruits And Vegetables

The average American diet is high in sodium and low in potassium=two factors that can increase blood pressure and stroke risk. A diet that's high in fruits and vegetables (and relatively low in saturated fat) naturally increases potassium and lowers sodium.

Data from the Nurses Health Study and the Health Professionals Follow-up Study indicate that each daily serving of fruits and vegetables can reduce the risk of ischemic stroke by 6%.

What to do: Eat a minimum of three servings of fruits and vegetables daily-but the more produce you eat, the lower your risk of stroke.

Ask About Aspirin For Women

Low-dose aspirin therapy is not typically recommended for stroke prevention in men, but it does make a difference in women—particularly those with an elevated stroke risk, for whom the benefits of aspirin can outweigh the potential side effects (such as intestinal bleeding).

What to do: Women who are at high risk for stroke should discuss aspirin therapy with their doctors. The recommended dose is 81 mg daily.

Five Warning Signs of Stroke

ne treatment for ischemic stroke is a drug called tissue plasminogen activator (tPA)—but it has to be given within three hours of the onset of symptoms to be effective.

Unfortunately, about half of American adults can't name a single stroke symptom. It's common for patients to ignore mild symptoms and fail to get to an emergency room in time.

What to do: You should call 911 immediately if you or anyone you are with has any of these symptoms…

  • Sudden unexplained weakness, tingling or numbness in the face, arm or leg-usually on just one side.
  • Sudden difficulty speaking or understanding words.
  • Sudden changes in vision, such as blurred or decreased vision.
  • Sudden and severe headache, sometimes with nausea/vomiting,
  • Sudden dizziness or difficulty with walking/coordination.

Easy Ways to Spot a Stroke

Detect warning signs of stroke with the acronym HELP NOW. Headache-a sudden, severe headache, particularly in someone with no history of headaches. Eyesight-a sudden change in vision in either or both eyes. Language-sudden difficulty talking or understanding speech. Paralysis—sudden onset of complete inability to use a part of the body, especially an arm and a leg on the same side. Numbness-sudden onset of numbness in the face, an arm and/or a leg, especially on the same side. Orientation—sudden onset of disorientation or confusion. Weakness-sudden onset of weakness in an arm and/or leg, especially on the same side.

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