Slash Your Stroke Risk by Addressing Crucial Modifiable Risk Factors

Around 750,000 people have a stroke every year, and of these, 5 to 14 percent will have a second stroke within 12 months. Many of the risk factors for stroke can be mitigated with simple lifestyle changes—according to the American Stroke Association, 80 percent of strokes are preventable. However, research suggests that many Americans aren’t aware of just what makes them vulnerable to stroke.

Doojin Kim, MD, associate professor of neurology at UCLA Medical Center and director of the Santa Monica-UCLA Stroke Program, points to a “quadruple whammy” of modifiable stroke risk factors—high blood pressure, high cholesterol, and high blood sugar—and says that being proactive in addressing these (as well as quitting smoking) is key for effective stroke prevention.

Maintain normal blood pressure

Dr. Kim says the most important step you can take to help prevent a stroke is to control your blood pressure. “High blood pressure raises the risk for stroke because it accelerates the effects of atherosclerosis—narrowed arteries due to a build up of fatty deposits called plaques—which is a risk factor for blood clots that can block blood flow to the brain,” Dr. Kim explains. “High blood pressure also can weaken artery walls, raising the risk of bleeding in the brain.”

Dr. Kim says that reducing the number of people with high blood pressure could bring about a huge reduction in the number of strokes—and indeed, a study published in Stroke, March 27, suggests that controlling blood pressure after suffering a stroke can reduce the odds of having another stroke by more than half. However, less than one-third of stroke patients maintain a consistently low blood pressure more than 75 percent of the time, according to the two-year study.


  • Control your blood pressure by getting at least half an hour of exercise each day and limiting salt consumption.
  • Lower your cholesterol and saturated fat intake by cutting back on red meat and switching to half-fat dairy products.
  • Take blood pressure and cholesterol lowering medications as directed.
  • If you are diabetic, modify your diet and use medications as directed to control your blood sugar.
  • Maintain a healthy weight, as overweight (a body mass index, or BMI, of 25 or higher) and obesity (a BMI of 30 or higher) can raise blood pressure and put you at risk of cardiovascular disease and diabetes, all risk factors for stroke.
  • Quit smoking.

While there’s no “ideal” blood pressure, a reading above 140/90 is usually considered high. However, underlying medical conditions may mean that your target BP is lower or higher than this, so ask your doctor what you should aim for. “Losing weight can be an effective blood pressure treatment,” Dr. Kim notes. “Shedding just five pounds can benefit blood pressure.” A healthful diet can help you achieve that weight loss, and the effects on your blood pressure can prevent stroke. Dr. Kim suggests you ask your doctor about the DASH (dietary approaches to stop hypertension) diet, which is specifically designed to reduce blood pressure, and is associated with a lower risk of stroke. The DASH diet prioritizes foods that are high in potassium, calcium and magnesium, nutrients that have all been associated with lower blood pressure.

Keep cholesterol in check

There are two different types of cholesterol—high-density lipoprotein (HDL or “good cholesterol”) and low-density lipoprotein (LDL or “bad cholesterol”). “LDL is a risk factor for stroke because any excess is deposited in the linings of blood vessels, as a waxy substance called plaque,” says Dr. Kim. “If plaque accumulates, it can narrow the arteries and restrict blood flow, thus contributing to the high blood pressure that raises stroke risk. It also can break away, causing a blood clot that may travel to the brain, resulting in stroke.”

Keeping LDL low is vital—but raising HDL is equally important, since it performs the beneficial function of removing plaque deposits. Aerobic exercise can raise HDL and lower LDL simultaneously, so Dr. Kim advises that you engage in walking, bicycling, or swimming at least five times a week for at least 30 minutes a day. The right foods also can help bring LDL down, and Dr. Kim says the Mediterranean diet is an ideal eating plan to follow. It limits foods that are high in saturated fat and cholesterol (for example, red meat), and prioritizes foods that are high in monounsaturated and polyunsaturated fats and low in cholesterol (such as olive oil, walnuts and almonds, and fatty fish rich in omega-3 fatty acids). Dr. Kim adds that medications can help you maintain healthy cholesterol levels if lifestyle changes don’t go far enough.

Control high blood sugar

Numerous studies have shown that diabetics are at greater risk for stroke compared to people without diabetes. “This is likely because many diabetics have other health problems that are also stroke risk factors,” Dr. Kim observes. “For example, as many as two in three diabetics also have high blood pressure, and high cholesterol also is common alongside diabetes.” Diabetics also are at higher risk of heart attack and atrial fibrillation (an abnormal heart rhythm), both of which increase stroke risk.

If you are diabetic, it is vital that you take the medications your doctor prescribes to help you control your blood sugar. A healthful diet also is key—and a study presented at the American College of Cardiology annual meeting in March found that the Mediterranean diet was associated with a 21 percent lower risk of diabetes compared with other eating patterns.

Quit smoking

Smoking doesn’t just put you at risk for cancer—a study published online April 29 in PLoS Medicine suggests that the habit is another major risk factor for stroke. Cigarette smoke contains carbon monoxide, which displaces oxygen in the blood, and nicotine, which constricts the blood vessels, raising blood pressure. Smoking also lowers HDL, which can result in more plaque building up in arteries.

The physical and mental symptoms that occur with nicotine withdrawal can make smoking cessation difficult, but research suggests that older adults are more successful at quitting than their younger counterparts. If willpower isn’t enough to help you quit, your doctor can prescribe drugs that reduce the craving and you also can opt for nicotine replacement gum, nasal spray, or patches.

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