Our image of strokes is that they come out of the blue. But the reality is that most strokes come after plenty of warning signs that you're at risk. And according to the National Stroke Association, 80 percent of strokes are preventable. How? By paying attention to the warning signs and taking steps to control or reverse the underlying health issues that up your stroke risk. Here are 10 key factors that experts believe directly contribute to stroke risk -- plus what you can do to control them before it's too late.
Why Heart Rhythm Problems (Atrial Fibrillation) Put You at Risk for Stroke
When you're diagnosed with an arrhythmia -- a heart rhythm abnormality -- one of the first things your doctor will warn you about is increased stroke risk. That's because atrial fibrillation, the most common type of arrhythmia, makes you five times more likely to have a stroke than the average person. A-fib slows blood flow as it moves through the two upper chambers of your heart, allowing it to pool and clot. And once clots begin to travel through the bloodstream, they can lodge in the brain or arteries and cause a stroke.
Lower your risk: The increased stroke risk from A-fib isn't an inevitability; three out of four A-fib-related strokes are preventable. All you have to do is keep your A-fib under control by following your treatment plan carefully and routinely checking your pulse to make sure your heartbeat is regular.
Why High Blood Pressure Puts You at Risk for Stroke
High blood pressure is very, very common in America, where 73 million people, or one in four adults, have blood pressure above the recommended level for stroke safety. When you have high blood pressure, also called hypertension, your heart has to pump harder to move your blood through your veins and arteries. Over time, the walls of blood vessels weaken, increasing the chance for stroke. High blood pressure can also lead to brain and organ damage.
Lower your risk: Knowing your blood pressure and monitoring it regularly are the most important things you can do to take control of stroke risk, and your cardiovascular health in general. If your blood pressure is over 120/80 on more than three occasions, you have prehypertension and it's time for treatment. (Blood pressure of 140/90 is the lowest level of hypertension). There are a number of medications and combinations of medications that can control your blood pressure, though you should continue to monitor it regularly.
Why Smoking Puts You at Risk for Stroke
It's as simple as can be: Smoking doubles your risk of stroke, according to the American Stroke Association. This happens because lung damage from smoking over time reduces the amount of oxygen in your blood, increasing clotting risk. A second cause is plaque buildup in your arteries, which reduces blood flow to your brain.
Lower your risk: Quit smoking, and you halve your stroke risk instantly. This is one of the fastest and most basic ways to prevent strokes. Yes, quitting is difficult, but you can do it with motivation, a plan, and these tricks from experts to quit smoking. Your entire body will thank you, as will your concerned friends and family members.
Why Extra Weight Puts You at Risk for Stroke
Those extra pounds and extra inches weigh down more than the scale -- they put extra pressure on your circulatory system, making it work harder round the clock. Being overweight also sets you up for three other stroke risk factors: high blood pressure, high cholesterol, and diabetes.
Lower your risk: Losing just 10 pounds can make a big difference in your risk of stroke and heart disease, experts say. Start with exercise, which, independently of weight loss, benefits your cardiovascular system. Just 30 minutes of physical activity a day, five days a week, has been shown to lower stroke risk. Gradually modify your diet to include more fruit, vegetables, and lean meat such as chicken and fish. Replace red meat as much as possible with other sources of protein such as beans, legumes, and nuts. Try not to eat white flour, and switch to whole grains as much as you can.
Why High LDL Cholesterol Puts You at Risk for Stroke
You know high cholesterol is bad for you, but do you know why? When too many particles of "bad" LDL cholesterol are circulating in your blood, they slowly accumulate along the walls of blood vessels, thickening and hardening them. Eventually, blood vessels narrow and stiffen enough that less blood can pass through, making it easier for a blood clot to lodge and cause a stroke.
Lower your risk: Cholesterol numbers are like a seesaw; you want your HDL ("good" cholesterol) to go up while your LDL goes down, because HDL actually protects you from stroke. Exercise boosts HDL, so does eating lots of fiber, greens, and good monounsaturated fats, like olive oil and omega-3 fats from fish. Meanwhile, cut out saturated fat (from meat and dairy) and lose weight to lower LDL.
Why Diabetes Puts You at Risk for Stroke
According to the National Institute of Neurological Disorders and Stroke, having diabetes is equal to adding 15 years to your biological age. Luckily, though, it's not that simple. Much of the increased stroke risk from diabetes comes from hypertension, which is common among diabetics. And fluctuating levels of glucose in the blood can damage blood vessel walls, including those in the neck and brain, which are directly vulnerable to stroke.
Lower your risk: Like many of the complications of diabetes, stroke risk is directly related to blood sugar levels. For example, if you have a stroke when your blood sugar is high, the brain damage tends to be more severe. Keep your diabetes under good control, and your risk of stroke and other complications decreases significantly.
Why Sleep Apnea Puts You at Risk for Stroke
The latest research on sleep apnea and stroke has been very convincing. According to the National Institutes of Health, men with moderate to severe sleep apnea were nearly three times more likely to have a stroke, and even mild sleep apnea raises stroke risk. And once you've had a stroke, apnea increases your chances of a second stroke.
Lower your risk: If you have sleep-impaired breathing, it's important to take steps to increase your oxygen intake while you sleep. You can prevent or reduce sleep apnea by sleeping on your side, losing weight, and avoiding alcohol and sedatives like sleeping pills, which relax your airways just as they relax you. But if that's not enough, you'll want to use a dental device to reposition your jaw and hold airways open, or a CPAP system to force more air into your lungs.
Why Heavy Drinking Puts You at Risk for Stroke
How does drinking alcohol up stroke risk? This is one risk factor that researchers are still exploring. Studies have demonstrated that drinking more than two alcoholic drinks can increase stroke risk by as much as 50 percent. And in women, the limit is one drink a day before stroke risk rises. But exactly how the connection works isn't understood. Confusingly, some studies have shown that mild to moderate drinking (less than two drinks for men, one for women) may lower stroke risk. But this is true only in healthy people with no other risk factors for alcohol-related health problems. Alcohol's protective effects in some people may be due to its ability to boost the level of "good" HDL cholesterol.
Lower your risk: The relationship between alcohol intake and health is very individual; talk to your doctor to determine if it's safe for you to consume one to two alcoholic drinks a day. (Many studies have shown that more than two is bad for everyone.) If you have diabetes, you'll likely be encouraged to decrease your drinking or cut out alcohol altogether.
How Birth Control Pills, Pregnancy, and Hormone Therapy Put You at Risk for Stroke
Higher levels of the female hormones estrogen and progesterone from birth control pills and hormone therapy are associated with stroke. The risk of stroke also goes up toward the end of pregnancy and just after giving birth. But in most cases, it's the interaction between hormones and other factors you need to worry about. For example, low-dose birth control pills are safe for most women under 40, but if you smoke or have high blood pressure, the combination is a stroke risk, and stroke risk goes up with age. Stroke risk is primarily a concern for women who develop high blood pressure during pregnancy.
Lower your risk: Talk to your doctor about stroke risk and your additional risk factors when making decisions about birth control and menopause-related hormone therapy. For example, if you smoke, be honest about it, and about how much you smoke. Your doctor needs a clear picture to help you make the safest decisions. During pregnancy and after giving birth, it's important that your blood pressure be monitored frequently and that you get treated if it's too high.
How Stress, Anxiety, and Depression Put You at Risk for Stroke
It might not seem like your moods and your relationship to stress have much to do with a medical condition like stroke, but experts are increasingly aware of the strong connection between mind and body. When you're worried or under a lot of stress, your body goes into "high alert" mode, releasing adrenaline that raises your heart rate and stimulates the release of the stress hormone cortisol. A recent study published by the Endocrine Society revealed that elevated cortisol levels over time were linked with a higher rate of death from stroke, cardiovascular disease, and heart attack. Meanwhile, the National Institute of Mental Health warns that depression is linked to a number of serious illnesses, including stroke. Depression has also been found to slow recovery from stroke.
Lower your risk: Living with anxiety, depression, and constant stress is not healthy. And no matter how busy and overwhelmed you feel, there are options available that can help you minimize your reactivity to stress and cope more effectively with depressive symptoms. Mindfulness meditation has the most proven track record for lowering anxiety and stroke risk (as well as blood pressure and cardiovascular risk). For depression and anxiety (which often go together), it's important to see a professional who can help you decide on effective treatment.