Many of us worry that we are vulnerable to a heart attack, but hardly think about stroke, which is like a heart attack except that it occurs in the brain. Yet stroke is a leading cause of disability in the U.S, and the fifth largest killer. Nearly 800,000 Americans have a stroke every year, and about 130,000 die as a result. There are about 4 million stroke survivors, many disabled. Those who have had a stroke are at high risk for having another one. In fact, about one in seven stroke survivors will have a second stroke within a year of the first one.
And yet even if—or especially if—stroke runs in your family, you can change the odds. It helps to know what a stroke is, what its symptoms are, and what you should do in case you think you or someone you’re with is having a stroke. But most of all you need to know that a few very practical measures can help you avoid a stroke.
What is a stroke?
There’s more than one kind of stroke. A stroke, generally speaking, is a permanent injury to the brain resulting from a problem in blood flow to a specific area. More than four out of five strokes are ischemic (the word means “stopping blood”), in which a blood vessel supplying the brain is blocked. Deprived of blood, which brings oxygen and nutrients, brain cells begin to die. The other kind of stroke, called hemorrhagic or bleeding stroke, is less common but more likely to be fatal. It occurs when a blood vessel in the brain bursts.
A third kind—technically not a stroke—is the “mini-stroke,” or transient ischemic attack (TIA). This temporary interruption of blood flow usually lasts only minutes. By definition, the effects of a TIA are gone in 24 hours and don’t cause permanent damage. But TIAs are dangerous, since they signal an increased risk of an actual stroke, and about 1 out of every 3 people that have a TIA will have a stroke within a year.
It may be difficult to distinguish a TIA from a mild stroke, which may cause small problems but go unnoticed. But the cumulative effects of multiple mild strokes are an important cause of vascular dementia. The risk for this type of dementia, which comes from damaged blood vessels that reduce circulation in the brain, becomes greater with each stroke.
Signs of stroke
Stroke symptoms come on suddenly and are often confined to one side of the body. For instance, the first thing you may notice is sudden weakness or paralysis on one side. Other symptoms include difficulty speaking or understanding speech, disorientation, confusion, memory loss, dizziness, loss of coordination and balance, and loss of consciousness. A sudden splitting headache—often described as “the worst headache I ever had”—may be a symptom of a hemorrhagic stroke.
Unfortunately, stroke symptoms are too often missed, especially in women. In one survey of 1,200 women by the American Heart Association, 20% could not recognize even one symptom of a stroke, and significantly less than half recognized major symptoms like speech difficulty or sudden loss of vision in one eye. Perhaps more alarming, other studies have shown that even doctors in emergency rooms often miss signs of a stroke, attributing the symptoms to other possible causes.
Why early help is critical
Brain cells can die quickly, but if you can get to an emergency room soon, prompt treatment can help prevent brain damage and increase the chance of survival. There are two emergency treatments for stroke, which may be given one right after the other. The first is an anti-clotting medication known as tPA. If given within 4.5 hours of the first sign of symptoms, this drug can help break up blood clots in the brain that are causing the stroke. The drug works very well for small clots that block smaller blood vessels.
For larger clots in larger vessels, a follow-up procedure can further reduce the chances of major, incapacitating brain damage. The procedure, administered after treatment with tPA and within 6 hours of the start of symptoms, is called a mechanical thrombectomy. It involves the insertion of a stent with a catheter threaded through an artery in the groin. The stent captures the remaining clot and then is extracted.
If you or someone you know has symptoms of stroke, call 911 at once. If you can, note the time when the symptoms began. If you’re the one having the stroke, don’t drive yourself or be driven to the hospital by someone else. Wait for an ambulance—the emergency medical workers can begin treatment immediately and communicate with the hospital so that a medical team is ready when you arrive.
How to reduce your stroke risk
The first step toward preventing a stroke is to know what the risk factors are and then to take steps toward reducing those risks.
Those at highest risk for stroke include people with high blood pressure, those with a family or personal history of stroke or TIAs, and African-Americans. Smokers, too, are at higher risk, as are those with coronary artery disease. Risk also increases with age.
More women than men have strokes, and the risk increases with use of birth control pills, a history of gestational diabetes or high blood pressure during pregnancy, and use of postmenopausal hormone therapy.
Certain conditions, including diabetes and atrial fibrillation (irregular heartbeat), also put you at high risk for stroke.
Some risk factors you can't control, such as age or family history. But you can take steps to reduce others by making changes in certain lifestyle choices. And the good news is that the same measures that may protect you from a heart attack may also help prevent a stroke. You get two kinds of prevention for the price of one.
Know your blood pressure. Chronic high blood pressure, known as hypertension, is a direct cause of stroke. Hypertension usually has no symptoms.
If your blood pressure is normal, do all you can to keep it that way. If not, work with your physician to bring it down and keep it down. A reading below 120/80 is considered normal; above 140/90 is hypertension. Readings in between are called prehypertension and considered a signal to take preventive action. Whether you need blood-pressure medication or not, what kind you need, and what your goal should be are matters to discuss with your doctor.
Do take medications if they are prescribed for you, and follow medical advice. And do talk with your doctor about your risk factors for cardiovascular disease, including stroke, and how you can best protect yourself.
Have your blood pressure rechecked as often as you are advised to do so. If it’s normal, have it rechecked every two years.
If you smoke, quit. Five years after quitting, your risk of stroke returns to the level of a person who never smoked. And keep in mind that even being around smoke from other people puts you at risk. Indeed, according to the CDC, secondhand smoke leads to around 34,000 early deaths from heart and blood vessel disease in the U.S. each year (not counting more than 7,000 deaths from lung cancer).
Follow a heart-healthy diet that helps your control your weight. A high-fiber diet rich in fruits, vegetables, and whole grains, along with calcium-rich foods such as low-fat and nonfat dairy products, is essential to maintaining a healthy blood pressure. Keep your sodium intake below 2,300 milligrams a day—or, if you have hypertension, below 1,500 milligrams a day. It is easier to do this if you limit your intake of processed foods, especially fast food. Avoid foods high in saturated fats. The DASH diet (Dietary Approaches to Stop Hypertension) is a tested way to reduce blood pressure. Such a diet also helps you to maintain a healthy weight, which itself is an important step in reducing stroke risk.
Learn more about the DASH diet and get a sample menu. If you need to lose weight, also check out these 18 keys to healthy weight loss.
Get regular aerobic exercise, enough to work up a light sweat, at least three times a week. Exercise is a proven way to treat and prevent hypertension.
Control your blood cholesterol levels. High LDL (“bad”) and low HDL (“good”) cholesterol are both risks for atherosclerosis, which can lead to clots and thus a stroke. The advice above about diet, smoking, exercise, and weight control can help keep your cholesterol at healthy levels. If your physician advises, you may also need to take cholesterol-lowering drugs. Statins, in particular, have been shown to reduce stroke risk.
If you drink alcohol, keep your intake moderate. A daily drink for women, or two for men, has been shown to reduce the risk of ischemic stroke. This does not mean you should start drinking to reduce stroke risk. Alcohol can quickly turn from friend to foe if you drink more than moderately. Consuming more than a drink or two a day actually increases the risk of ischemic stroke. And, ironically, any drinking increases the risk of hemorrhagic stroke.
Aspirin, maybe. Low-dose aspirin (a quarter tablet, or 81 milligrams, daily) helps prevent heart attacks for some people, but if you are at risk for stroke, aspirin has some drawbacks. Low-dose aspirin can indeed reduce the risk of ischemic stroke, particularly a second stroke. But aspirin can promote bleeding and thus may increase the risk of hemorrhagic stroke, especially if you have uncontrolled high blood pressure. Before taking low-dose aspirin, talk with your doctor. For some people, but not all, its benefits outweigh its risks.
An important note on aspirin: If you think you are having a heart attack, the best advice is to chew and swallow a whole adult aspirin after calling 911. But you should not do this if you think you are having a stroke, because of its effect on bleeding; just call 911.
Published May 16, 2016