Stroke - Prevention

To reduce your risk, what dietary or lifestyle changes have you made to prevent a stroke?

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What can be done to prevent a stroke?

Risk factor reduction

High blood pressure: The possibility of suffering a stroke can be markedly decreased by controlling the risk factors. The most important risk factor for stroke is high blood pressure. When a person's blood pressure is persistently too high, roughly greater than 130/85, the risk of a stroke increases in proportion to the degree by which the blood pressure is elevated. Management of high blood pressure so that it is well controlled and in the normal range decreases the chances of a stroke.

Smoking: An important stroke risk factor is cigarette smoking or other tobacco use. Chemicals in cigarettes are associated with developing atherosclerosis or narrowing of the arteries in the body. This narrowing can involve the large carotid arteries as well as smaller arteries within the brain. Smoking is also a major risk factor in heart disease and artery disease.

Diabetes: Diabetes causes the small vessels to close prematurely. When these blood vessels close in the brain, small (lacunar) strokes may occur. Good control of blood sugar is important in decreasing the risk of stroke in people with diabetes.

High cholesterol: Elevated cholesterol and/or triglycerides in the bloodstream are risk factors for a stroke due to the eventual blockage of blood vessels (atherosclerosis) and plaque formation. A healthy diet and medications can help normalize an elevated blood cholesterol level.

Blood thinner/warfarin: An irregular heartbeat called atrial fibrillation, where the upper chambers of the heart do not beat in a coordinated fashion, can cause blood clots to form along the walls of the heart chamber. These can break off and travel or embolize to blood vessels in the brain, blocking blood flow and causing a stroke. Anticoagulation may be an appropriate prevention. Depending upon the patient risk factors, different medications may be suggested. Warfarin (Coumadin) is a blood "thinner" that prevents the blood from clotting. Newer medications like dabigatran (Pradaxa) and rivaroxaban (Xarelto) are also approved for use in atrial fibrillation. Warfarin is also sometimes used to prevent the recurrence of a stroke in certain other heart conditions and in patients with abnormal blood clotting tendencies (hypercoagulable states). Warfarin dosing is monitored by periodic blood tests to measure INR (international normalized ration) which assess how quickly the patient's blood clots.

Antiplatelet therapy: Many TIA and stroke patients may benefit from "antiplatelet" drugs that can decrease clotting risk and potentially reduce their risk of suffering another cerebrovascular event. These medicines act on platelets to decrease their stickiness and reduce the tendency to clot blood. The side effect is an increased risk of bleeding. Aspirin is the most commonly prescribed medication in this group. If the patient develops TIA or stroke symptoms while taking aspirin, other antiplatelet medications may be considered including clopidogrel (Plavix), prasugrel (Effient), and dipyridamole (Persantine).

Carotid endarterectomy: In many cases, a person may suffer a TIA or a stroke that is caused by the narrowing of the carotid arteries (the major arteries in the neck that supply blood to the brain). If left untreated, patients with these conditions have a higher risk of experiencing a major stroke in the future. An operation that cleans out the carotid artery and restores normal blood flow is known as a carotid endarterectomy. This procedure has been shown to reduce the incidence of a subsequent stroke. In patients who have a narrowed carotid artery, but no symptoms, this operation may be indicated in order to prevent the occurrence of a first stroke.

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