How to Prevent a Stroke, According to a Neurologist

80% of strokes could have been prevented.

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Strokes often get mistaken as “just a normal part of aging.” It’s true that the risk of stroke increases as you age, but it does not necessarily mean that strokes are an unavoidable part of your golden years.

“Up to 80 percent of strokes can be prevented, which is huge,” says Carolyn Brockington, MD, neurologist at Mount Sinai Hospital. “You do that by identifying your own risk factors and changing them or modifying them appropriately.”

Modifiable Risk Factors for Stroke

Most of the time, stroke is influenced by lifestyle factors. “We go after things we can change,” says Dr. Brockington.

  • Hypertension: High blood pressure “is the number one reason why people have heart disease and stroke,” says Dr. Brockington. “If you have [high] blood pressure, treat it.” Risk factors for high blood pressure include a sedentary lifestyle, smoking, and a high-sodium diet.

  • Diabetes: A lesser-known effect of diabetes is its destructive effect on the blood vessels, which can increase the risk of stroke. Additionally, high BP is common among people with diabetes. Here are other complications of diabetes to know about.

  • High cholesterol:  Too much LDL cholesterol in the blood can cause a plaque buildup in the arteries, leading to a condition called atherosclerosis. This means the arteries are hardening, narrowing, and becoming less flexible, and this increases the risk of both heart attack and stroke.

  • Heart disease: Heart disease often goes hand-in-hand with high blood pressure and high cholesterol, but it may also involve valve defects and atrial fibrillation. In fact, AFib causes one in four strokes in people over the age of 80, according to the National Institute of Neurological Disorders and Stroke (NINDS).

  • Smoking: Cigarette smoking causes atherosclerosis in the neck artery that transports blood to the brain. It also raises blood pressure, inhibits the amount of oxygen your blood can carry, makes your blood more likely to clot, and promotes the formation of brain aneurysms. For these reasons, smoking doubles your risk of an ischemic stroke and quadruples your risk of hemorrhagic stroke, according to NINDS. Learn the difference between ischemic and hemorrhagic strokes here.

  • Obesity: A higher BMI is statistically associated with high BP, diabetes, and heart disease. Even losing just 10 pounds can lower your risk of stroke and several other conditions.

Non-Modifiable Risk Factors for Stroke

There are some stroke risk factors that are less in your control. These non-modifiable risk factors may increase your risk of stroke:

  • Age: Starting at age 55, the risk of stroke doubles each decade, according to the National Stroke Association (NSA). With that said, young people can and do have strokes, too.

  • Gender:  Women have more strokes than men do each year, partially because they live longer. Learn more about stroke risk in women here.

  • Family history of stroke: If a parent, grandparent, or sibling has had a stroke or heart attack, your risk is also higher. This can be for a number of reasons, such as similar lifestyles or a genetic predisposition to hypertension or diabetes.

  • Race and ethnicity: Stroke risk among African Americans and Hispanics is twice that of white Americans, according to NINDS. This is partially due to an increased prevalence of high blood pressure, diabetes, and obesity. Another unique risk factor among African Americans is sickle cell disease, which can narrow the arteries and lead to a stroke.

  • Inherited medical conditions: Disorders affecting the blood, heart, or arteries can impact blood flow in different ways. For example, a patent foramen ovale—a small hole in the heart—affects one in five Americans and increases the risk of stroke, according to NSA.

What’s important to remember is that having any or all of the above risk factors does not leave you “doomed” for stroke. You can still manage your risk by living a heart-healthy lifestyle and treating medical conditions that increase your risk of stroke.

What to Do to Prevent a Stroke

“In order to try to prevent a stroke, the move that anybody can do is to talk to [their] doctor and go over what their personal risk factors are,” says Dr. Brockington. Then you can discuss with your doctor about the best way to reduce your stroke risk. “Sometimes it’s just diet, sometimes it’s exercise, [and] sometimes it’s all those things plus medication.”

This should go without saying, but if you have hypertension, high cholesterol, or any of the other conditions mentioned above, treat it. Even small reductions in blood pressure numbers can make a difference: In a study of nearly 960,000 people, the risk of stroke doubled for every 20 mm Hg of systolic and 10 mm Hg of diastolic BP.

Another tool in stroke prevention is aspirin. “Aspirin is what we call an antiplatelet medicine,” says Dr. Brockington. “If you cut yourself now, all these platelets have to sort of clump or come together in order to create the clot. Aspirin doesn’t allow them to clump as effectively. It doesn’t mean that you can’t clot at all, but it means that your bleeding time probably is a little off.”

Doctors may prescribe aspirin to reduce the risk of stroke over your lifetime. That said, do *not* take aspirin during a stroke—it may make your stroke outcome worse.

Other options include surgery to open up the carotid artery (the main neck artery leading to the brain).  This surgery, called carotid endarterectomy, can help improve blood flow to the brain.

“We want people everywhere to be able to identify what their own personal risk factors are because it’s key in reducing the chance of stroke in the future,” says Dr. Brockington.