Features June 2009 Issue

3 Simple Steps to Help You Lower Your Stroke Risk

Research shows the best outcomes result from maintaining a healthy diet, regular exercise and adherence to your doctor’s recommendations.

High blood pressure, heart disease and a family history of cardiac events can conspire to raise your stroke risk, but recent research suggests that you can help protect yourself by following some rather simple advice.

"There are a lot of different causes of stroke. They’re not the same for everybody," says Javier Provencio, MD, of the Cleveland Clinic Cerebrovascular Center. "Exercise is good for you no matter what. And if you manage your cholesterol and your blood pressure and go to a doctor who does the appropriate labs, you should live longer without having a stroke."

In simplest terms, a stroke is an interruption of blood flow to the brain. Most strokes result from blockage in an artery leading to the brain (ischemic stroke), while hemorrhagic strokes occur when a blood vessel bursts and blood seeps into brain tissue. To reduce your odds of experiencing such a traumatic experience, here are three proven rules to follow:

Eatright and exercise

As Dr. Provencio notes, exercise is critical to cardiovascular and cerebrovascular health. So too is a diet that is low in saturated fats and sodium. And research continues to stress the importance of limiting alcohol consumption and the dangers of smoking.

A study published online Feb. 20 in the British Medical Journal found that an unhealthy lifestyle more than doubles your risk of stroke. The study involved more than 20,000 men and women between the ages of 40 and 79 and gave each participant a score based on whether he or she smoked, level of activity or inactivity, alcohol intake, and vitamin C levels (indicating sufficient consumption of fruits and vegetables). Participants were followed for an average of 11 years and at the end of the study 599 had had a stroke. After adjusting for other risk factors, it was determined that those with the lowest or most unhealthy scores were 2.3 times as likely to suffer a stroke compared to the participants who ate five servings of fruits and vegetables a day, exercised regularly, didn’t smoke and averaged two or fewer drinks per day.

"It boils down to the same things: If you exercise and you stay active and eat right, you’re going to stay healthy longer," Dr. Provencio says. "It doesn’t have to be complicated. If you stay with the simple stuff, like eating fruits and vegetables and exercising every day, you’ll reduce your stroke risk."

Stay on your meds

The link between high blood pressure and stroke risk is well established, so it stands to reason that adhering to your hypertension medications is one of the most important things you can do to lower your stroke risk. In a study in the January issue of Stroke, researchers noted that greater adherence to antihypertensive medications reduces the risk of stroke by 22 percent, compared to low adherence

"Some blood pressure medications seem to have effects on preventing strokes beyond just controlling your blood pressure," Dr. Provencio says, explaining that angiotensin converting enzyme (ACE) inhibitors have been strongly associated with lower stroke risks. ACE inhibitors help reduce the body’s manufacturing of the hormone angiotensin II, which narrows blood vessels.

Dr. Provencio agrees that consistent medication adherence is important, primarily because allowing your blood pressure to rise and fall a lot puts you at a greater risk for stroke.

See your doctor regularly

Dr. Provencio says one of the most overlooked, yet easily controllable behaviors that help maintain good heart and brain health are regular doctor visits. He says too often patients make excuses not to have their yearly physicals or follow-ups with their cardiologists. He recommends patients with stroke risk factors to seek a second opinion if they feel unsure about the advice and care they are receiving.

Dr. Provencio recalls patients who visited him having been diagnosed as suffering "mini-strokes" or transient ischemic attacks (TIAs), which are brief interruptions of blood flow to the brain and may or may not be accompanied by noticeable symptoms.

"They tell me they eat right and take their aspirin and they can’t understand how these mini-strokes could have happened," Dr. Provencio says. "Turns out they have atrial fibrillation (AFib), but their other doctors had told them they had heart palpitations and not to worry." He urges patients whose doctors may have downplayed heart palpitations, for example, to seek a second opinion because those palpitations could be an arrhythmia such as AFib, a known stroke risk factor.

And if you have had a stroke or a TIA, you should definitely discuss prevention care with your doctor, because previous cerebrovascular events can increase your odds of subsequent events by 20 percent or more. A study published online March 5 in the journal Stroke found that even among stroke survivors, too few patients take advantage of preventive and rehabilitative care.

"Yearly visits to your doctor, even starting at young ages, are so important," Dr. Provencio says. "People who follow up with their doctors and follow their doctors’ advice have fewer health problems in general."