Why Stroke Prevention Is Critical

Each year about 600,000 Americans suffer from their first stroke, with nearly three-quarters of these occurring in people over the age of 65. Strokes are the fourth leading cause of death in this country, accounting for more than 133,000 deaths in 2008 (the last year for which data are available). Sadly, as many as 30 percent of stroke victims remain permanently disabled. Moreover, a first stroke greatly increases the risk of a second one, and the likelihood of a stroke grows steadily with increasing age. With strokes, prevention is the best option. 

What can you do to prevent a stroke?

Controlling high blood pressure is the most important preventive measure. Hypertension raises the danger of both hemorrhagic (bleeding) strokes and ischemic strokes. For hemorrhagic strokes this is due to the rupture of a blood vessel. The much more common ischemic strokes result from the complete blockage of an artery narrowed by plaque.

The good news is that you can make lifestyle changes that can help lower blood pressure:

  • Lower intake of sodium
  • Increase dietary potassium
  • Drink alcohol moderately – no more than one drink a day for women and two drinks a day for men
  • Exercise regularly
  • Reach and maintain a normal body weight

If these measures do not bring your blood pressure lower than 140 mm Hg, antihypertensive medications--often two or even three combined--will be needed to control hypertension.

Aspirin and other prevention measures

Many older Americans are taking a daily aspirin, either on their own or on their doctor’s advice, in an effort to prevent a heart attack or stroke. This practice is appropriate for those with either a previous cardiovascular event or with multiple risk factors for such an event. However, new stroke prevention guidelines from the American Heart Association and the American Stroke Association recommend that you take a daily aspirin only if your risk factors indicate that your ten-year risk of a heart attack or stroke is ten percent or more. Those at a lower risk should ask their doctors whether they should be taking aspirin because it raises the danger of serious gastrointestinal bleeding and even a hemorrhagic stroke.

In addition, atrial fibrillation, the most common heart rhythm abnormality among older individuals, greatly increases the risk of stroke. A blood clot that forms in the left atrium can break off and travel through the bloodstream to block off an artery in the brain and cause a stroke. Such blood clots must be prevented in people with atrial fibrillation. Treatment would include either aspirin or the blood thinner warfarin (Coumadin) in those with valvular heart disease, or people with additional risk factors such as hypertension, or those older than age 75.

More prevention measures

Additional stroke prevention measures include smoking cessation and lowering blood cholesterol levels. Lower cholesterol can be accomplished with a diet low in saturated fats and treatment with one of the statin drugs if the LDL cholesterol exceeds 100 mg/dL.

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