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Prevention

By Mayo Clinic staff

Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a TIA, these measures may also help you avoid having another one. Many stroke prevention strategies are the same as for preventing heart disease. In general, a healthy lifestyle means that you:

  • Control high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you've had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting the amount of sodium and alcohol you eat and drink are all ways to keep high blood pressure in check. Adding more potassium to your diet may also help. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat high blood pressure, such as diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
  • Lower the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a statin such as simvastatin (Zocor) or atorvastatin (Lipitor) or another type of cholesterol-lowering medication.
  • Don't smoke. Smoking raises the risk of stroke for both the smoker and nonsmokers exposed to secondhand smoke. Quitting smoking reduces your risk — several years after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.
  • Control diabetes. You can manage diabetes with diet, exercise, weight control and medication.
  • Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
  • Eat a diet rich in fruits and vegetables. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke.
  • Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL, or "good") cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
  • Drink alcohol in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Binge drinking and heavy alcohol consumption increase your risk of high blood pressure and of ischemic and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol can increase your HDL cholesterol and decrease your blood's clotting tendency. Both factors can contribute to a reduced risk of ischemic stroke.
  • Don't use illicit drugs. Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke.

Preventive medications
If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another. These include:

  • Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.

    Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. If aspirin doesn't prevent your TIA or stroke or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).

  • Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different manner than do anti-platelet medications. Heparin is fast acting and is used over the short term in the hospital. Slower acting warfarin is used over a longer term.

    Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and watch for side effects. Your doctor may prescribe these drugs if you have certain blood-clotting disorders; certain arterial abnormalities; an abnormal heart rhythm, such as atrial fibrillation: or other heart problems.

Coping and support
References
  1. Caplan LR. Overview of the evaluation of stroke. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  2. Caplan LR. Etiology and classification of stroke. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  3. Caplan LR. Clinical diagnosis of stroke subtypes. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  4. Oliveira-Filho J, et al. Initial assessment and management of acute stroke. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  5. Oliveira-Filho J, et al. Antithrombotic treatment of acute ischemic stroke. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  6. Kistler PJ, et al. Treatment for specific causes of stroke and transient ischemic attack. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  7. Oliveira-Filho J. Fibrinolytic (thrombolytic) therapy for acute ischemic stroke. http://www.uptodate.com/home/index.html. Accessed March 15, 2010.
  8. Landmark NIH clinical trial comparing two stroke prevention procedures shows surgery and stenting equally safe and effective. National Institute of Neurological Disorders and Stroke. http://www.nih.gov/news/health/feb2010/ninds-26.htm. Accessed March 15, 2010.
  9. del Zoppo GJ, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: A science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40:2945.
  10. Easton JD, et al. Definition and evaluation of transient ischemic attack. Stroke. 2009;40:2276.
  11. Adams RJ, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008;39:1647.
  12. Ederle J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomised controlled trial. The Lancet. 2010;375:985.
  13. Stroke risk factors. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=risk. Accessed March 16, 2010.
  14. Effects of stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=EFFECT. Accessed March 16, 2010.
  15. Stroke symptoms. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed March 16, 2010.
  16. Recovery and rehabilitation. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=REHABT. Accessed March 16, 2010.
  17. Pain. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=pain. Accessed March 16, 2010.
  18. STARS (steps against recurrent stroke). National Stroke Association. http://www.stroke.org/site/PageServer?pagename=STARS. Accessed March 16, 2010.
  19. Recovery after stroke: Thinking and cognition (fact sheet). National Stroke Association. http://www.stroke.org/site/DocServer/NSAFactSheet_Cognition.pdf?docID=986. Accessed March 16, 2010.
  20. Rehabilitation services (fact sheet). National Stroke Association. http://www.stroke.org/site/DocServer/Choose_Rehab.pdf?docID=1101. Accessed March 16, 2010.
  21. Recurrent stroke (fact sheet). National Stroke Association. http://www.stroke.org/site/DocServer/NSAFactSheet_RecurrentStrokerevised.pdf?docID=998. Accessed March 16, 2010.
  22. Carotid endarterectomy. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=carotid. Accessed March 16, 2010.
  23. Life after stroke: Survivor and caregiver. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=las. Accessed March 16, 2010.
  24. Controllable risk factors: Obesity. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=dietexercise. Accessed March 16, 2010.
  25. Recovery after stroke: Social support (fact sheet). National Stroke Association. http://www.stroke.org/site/DocServer/NSAFactSheet_SocialSupport.pdf?docID=1003. Accessed March 16, 2010.
  26. Heart disease and stroke statistics: 2009 update. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3037327. Accessed March 17, 2010.
  27. Post-stroke rehabilitation fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm. Accessed March 19, 2010.
  28. Greelish JP, et al. Carotid endarterectomy in symptomatic patients. http://www.uptodate.com/home/index.html. Accessed March 19, 2010.
  29. Greelish JP, et al. Carotid endarterectomy in asymptomatic patients. http://www.uptodate.com/home/index.html. Accessed March 19, 2010.
  30. Greelish JP, et al. Carotid angioplasty and stenting. http://www.uptodate.com/home/index.html. Accessed March 19, 2010.
  31. Furie KL, et al. Secondary prevention of stroke: Risk factor reduction. http://www.uptodate.com/home/index.html. Accessed March 19, 2010.
  32. Know stroke brochure. National Institute of Neurological Disorders and Stroke. http://stroke.nih.gov/materials/actintime.htm. Accessed March 22, 2010.
  33. Flemming KD, et al. Secondary prevention strategies in ischemic stroke: Identification and optimal management of modifiable risk factors. Mayo Clinic Proceedings. 2004;79:1330.
  34. Caplan LR. Patient information: Hemorrhagic stroke treatment. http://www.uptodate.com/home/index.html. Accessed March 19, 2010.
  35. Intracerebral hemorrhage. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec16/ch211/ch211c.html?qt=hemorrhagic%20stroke&alt=sh. Accessed March 26, 2010.
  36. Subarachnoid hemorrhage. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec16/ch211/ch211d.html. Accessed March 26, 2010.
  37. Post-stroke rehabilitation. American Stroke Association. http://www.strokeassociation.org/presenter.jhtml?identifier=1041. Accessed March 26, 2010.
  38. Being a communication partner: Stroke communication tips. American Stroke Association. http://www.strokeassociation.org/presenter.jhtml?identifier=3030113. Accessed March 29, 2010.
  39. Physical activity and healthy diet. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=eathealthy. Accessed March 29, 2010.
  40. Stroke risk reduction: A healthy nutrition guide. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=STARS. Accessed March 29, 2010.
  41. Goldstein LB, et al. Primary prevention of ischemic stroke. Stroke. 2006;37:1583.
  42. Rordorf G, et al. Spontaneous intracerebral hemorrhage: Prognosis and treatment. http://www.uptodate.com/home/index.html. Accessed March 29, 2010.
  43. Singer RJ, et al. Treatment of aneurysmal subarachnoid hemorrhage. http://www.uptodate.com/home/index.html. Accessed March 29, 2010.
  44. Brott TG, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine. In press. Accessed May 26, 2010.
DS00150 July 1, 2010

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