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Guidelines highlight ways to lower stroke risk

By Jim Black for The 5 min read

Strokes are the fourth-leading cause of death in the United States, but they’re the leading cause of adult disability.

A number of stroke risk factors are beyond your control: advancing age (stroke risk doubles for each decade of life after age 55), gender (stroke affects more women), race (stroke risk is greater among African-Americans), and a family history of stroke.

However, most strokes are preventable. In fact, a large 2010 study found that about 90 percent of stroke risk can be attributed to 10 risk factors that are entirely within your control.

So, in the December 2014 issue of the journal Stroke, the American Heart Association and American Stroke Association have published updated guidelines aimed at preventing a first-time stroke. Here’s a look at some common stroke risk factors and what experts recommend that you do to reduce your stroke risk:

High blood pressure (hypertension): Hypertension (blood pressure greater than 140 mmHg systolic [the top number in the reading] and 90 mmHg diastolic) is the leading cause of stroke. The new guidelines recommend home blood-pressure monitoring for people with hypertension. Keeping tabs on your blood pressure may help guide treatment decisions about hypertension and, if your readings are abnormal, empower you to make lifestyle changes to help lower your blood pressure.

“In general, involving people in their own health care is a positive thing,” says Dr. Lawrence Wechsler, director of the University of Pittsburgh Medical Center Stroke Institute. “There’s even some evidence that when you get people involved in their own care they do better.”

Ask your physician how to check your blood pressure, how frequently you should check it, and what your target blood pressure level is. To ensure accurate readings, periodically calibrate your home monitor with the device your doctor uses in his or her office. Also, work with your doctor to control your blood pressure, and take any medications exactly as prescribed.

Diet: Overconsumption of fatty or processed foods, added sugars, sodium and calories contributes to obesity, hypertension, cardiovascular disease and increased stroke risk. The guidelines recommend a diet that emphasizes fruits, vegetables, whole grains, legumes, nuts and lean protein sources (e.g. fish and skinless chicken), while minimizing or avoiding consumption of saturated fat, trans fat, cholesterol and sodium.

Among these healthful eating plans are a Mediterranean-style diet and the Dietary Approaches to Stop Hypertension (DASH) diet. Talk to your health-care professional about ways to minimize your intake of unhealthy foods and adopt one of these healthful diets.

“It’s about choice,” says Lori Matthews, stroke coordinator at Uniontown Hospital. “It’s about sitting down and planning things out and making that conscious choice to eat healthy.”

Exercise/obesity: Physical inactivity is a leading contributor to cardiovascular disease, stroke and heart attack, largely due to the obesity that often accompanies a sedentary lifestyle. If you’re overweight, work with your physician to shed pounds through diet and appropriate exercise. Most experts recommend getting at least 30 minutes of moderate-intensity exercise-such as walking, biking or swimming, on five or more days a week, but ask your doctor what exercise regimen is right for you. And, take steps to incorporate more physical activity into your daily routine, such as parking farther away from the store entrance and walking, or taking the stairs instead of the elevator or escalator.

“Exercise, even just walking 30 minutes a day several times a week, is very important for cardiovascular health,” Wechsler says.

Diabetes: People with diabetes are twice as likely to suffer a stroke as non-diabetics, according to the National Stroke Association. A poor diet, physical inactivity and obesity are key contributors to diabetes, so addressing these risk factors may help you ward off the disease and also reduce your risk of stroke. If you already have diabetes, discuss with your doctor the best ways to monitor and control your blood-sugar levels.

Cholesterol abnormalities: Similarly, a fatty diet and sedentary lifestyle can cause increases in LDL (“bad”) cholesterol and declines in beneficial HDL (“good”) cholesterol-all of which contribute to atherosclerosis and elevated stroke and heart attack risk. If you haven’t already, have your doctor check your cholesterol level, and work to optimize your LDL and HDL levels through diet, exercise, weight control and, if necessary, medications.

Cigarette smoking: Smoking’s far-reaching effects on the body include increased stroke risk. If you smoke, ask your physician about medications, nicotine-replacement products and other ways to help you kick the habit. And, minimize or avoid exposure to secondhand smoke.

Atrial fibrillation (Afib): In this common irregular heart rhythm, the heart’s two upper chambers, the atria, beat rapidly and erratically instead of in a normal synchronized fashion. As a result, blood can pool and form clots in the atria. The clots may then break free, travel to the brain and cause strokes.

In the new guidelines, newer anticoagulants-apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto)-join warfarin (Coumadin) as medications recommended for preventing Afib-related strokes. If you have Afib, weigh the pros and cons of each of these medications with your doctor.

Report any potential Afib symptoms, such as sensations of fluttering or pounding in your chest that may be accompanied by tiredness or dizziness. And, optimize your weight, blood pressure, cholesterol, blood sugar and other cardiovascular risk factors to reduce your risk of Afib in the first place.

Sleep apnea: An emerging stroke risk factor, obstructive sleep apnea-characterized by brief, repeated interruptions in breathing during sleep-has been linked to a number of medical conditions, including hypertension, cardiovascular disease and stroke.

“I think obstructive sleep apnea is one risk factor that we really haven’t paid enough attention to and are just beginning to look at and correct,” Wechsler says. “I think that will have a significant impact.”

Inform your doctor of any sleep problems, including excessive daytime sleepiness, or if your bed partner notices that you snore loudly or experience interruptions in your breathing during sleep. Follow your doctor’s recommendations for treating sleep apnea with continuous positive airway pressure (CPAP) or other treatments.

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