If there's one good thing that can be said of strokes, it's this: The vast majority of them don't need to happen.
Up to 80% of strokes can be prevented through healthy lifestyle changes and working with health care practitioners to control stroke risk factors. Researchers have identified numerous steps people can take to lower stroke risk, but health experts agree, trying to do them all at once can feel overwhelming.
"The biggest mistake people make is they are overly ambitious, and then they fail and give up," said Dr. Vladimir Hachinski, a Canadian neurologist and global expert in the field of stroke. "You have to start small."
The rewards are enormous, said Dr. Cheryl Bushnell, a neurologist and director of the Comprehensive Stroke Center at Wake Forest Baptist Health in Winston-Salem, North Carolina. It's "not just for preventing stroke, but for preventing dementia as well. You can do the same things to prevent both. You are killing two birds with one stone."
Here are five ways to get started on the road to prevention.
If you smoke, quit
Studies show that for every five cigarettes a person smokes each day, the risk of having a stroke goes up by 12%. For Black adults, smoking cigarettes more than doubles the risk of stroke compared to never smoking, a 2020 study found.
"People understand that smoking causes lung cancer, but they don't understand it also damages the brain and blood vessels," Bushnell said. "In terms of stroke prevention, quitting smoking is the lowest hanging fruit."
More active men and women have a 25%-30% lower risk of stroke than those who are least active. Physical activity has been shown to lower cholesterol, help maintain a healthy weight and lower blood pressure – all factors that can reduce stroke risk.
"The evidence for physical activity is undeniable," said Bushnell, who co-authored a 2014 statement from the American Heart Association and American Stroke Association on stroke prevention. "Even just moving around for 10 minutes every hour is better than sitting for an extended period of time. You don't have to run a 5K."
Hachinski placed exercise among the top three things a person could do to lower stroke risk – and agrees it needn't be overly ambitious. "The worst thing that can happen is to sit all day. Walking is the best exercise there is. Get up and walk around."
Keep blood pressure under control
High blood pressure, also called hypertension, is the leading cause of strokes. Half of all men – 52% – and 43% of women in the U.S. have blood pressure that is too high, according to AHA statistics. While it can be controlled through lifestyle changes or by taking medication, only about 1 in 5 adults keep it properly managed. Smoking, diabetes, obesity, high cholesterol and eating an unhealthy diet can push blood pressure out of the healthy range.
At-home monitoring and regular communication with doctors to make sure medications are working are important to keep high blood pressure in check, Bushnell said.
"People have to keep track of their own blood pressure," she said. "They have to know what their numbers are, know their medications and how to take them."
Eat a healthy diet
"One of the most subtle things that happens to people as they get older is they put on weight," Hachinski said.
Being careful to choose healthy foods can minimize weight gain, he said. But there's value to making healthier food choices regardless of weight.
"Nutrition is more important than weight loss," agreed Bushnell. "There are multiple diets shown to decrease the risk of stroke," such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean diets. Both emphasize eating a lot of fruits, vegetables and low-fat dairy, whole grains, fish and nuts, while cutting back on foods high in saturated fats, cholesterol and trans fats.
And recent research shows the same factors that cause strokes in older adults – such as high blood pressure, high cholesterol, obesity and diabetes – are causing strokes in younger adults.
"You don't think about disease when you are young," Hachinski said. But that's when good habits should start.
Hachinski recommends people start monitoring their blood pressure, cholesterol, lipids and blood sugar levels as soon as they transition from a pediatrician to a primary care physician as a young adult. "If you're going off to college or leaving home, your habits will change at this time. You begin eating on your own. This is a good time to think about how to prevent disease."
Other life transitions – such as moving in with a partner – should also be triggers for checking health metrics, he said. "It's a good time to take inventory, because it's when habits will change."
It doesn't have to be a massive undertaking, Hachinski said. Focus on just one thing to get started. "Identify the most important thing you are lacking," he said. "Is it exercise? Are you snacking too much?"
Set a specific and measurable goal, he said, and then break it into parts and stick to it until you reach it. Having a partner can help maintain motivation, as long as that person has healthy habits. "If you can get someone to do it with you, you double your chances for success."
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