Risk factors that can be modified, treated, or controlled:^1,3-7

High blood pressure (hypertension) is the most important risk factor for stroke. Your blood pressure is considered "high" if either or both blood pressure numbers are 140/90 or more.

Smoking is a major preventable risk factor for stroke. Heavy smokers (40 cigarettes/day) have twice the risk for stroke as light smokers (less than 10 cigarettes/day). The nicotine and carbon monoxide in cigarettes raise the blood pressure and reduce the amount of oxygen. This damages the blood vessels and makes it easier to make blood clots. Combining birth control pills and cigarette smoking dramatically raises the risk of stroke.

Diabetes mellitus is a major risk factor for stroke and is the leading risk factor for stroke in women. The diagnosis of diabetes is made when you have a fasting blood sugar reading of 126 mg/dL or more on 2 different occasions. Many people with diabetes also have high blood pressure, high cholesterol, and are overweight.

Carotid artery disease is a blockage (plaque build up) or narrowing (stenosis) in the carotid arteries in the neck that supply blood to the brain. The arteries may become blocked by clot or send a clot to the brain. People with peripheral artery disease have a higher risk of carotid artery disease, which increases their risk for stroke. Peripheral artery disease is caused by plaque build up, causing a narrowing in the arteries in the legs and arms. Cigarette smoking and diabetes mellitus are the primary causes of peripheral artery disease.

Atrial fibrillation is an abnormal heart rhythm and increases the risk of stroke by 5 times. In atrial fibrillation the upper chambers of the heart fibrillate, or quiver rather than beating. This allows clots to form on the wall of the heart. If the clot breaks off, it is sent through the arteries to the brain and causes a stroke.

Other heart diseases and heart attack increase the risk of stroke. Dilated cardiomyopathy (enlarged heart), heart valve disease, and some types of congenital heart defects (defects you are born with) can also raise your risk for stroke.

Transient ischemic attacks (TIA) dramatically increase the short-term stroke risk. A large health plan noted that of 1707 patients evaluated in an emergency department for TIA, 5% went on the have a stroke in the next 2 days and 10% had a stroke in the next 90 days.

Some blood disorders, particularly ones with a high red blood cell count causes the blood to be thick and makes it easier to make clots. Sickle cell disease is a genetic disorders primarily in African-Americans. The abnormally shaped or "sickle" shaped red blood cells tend to stick to the walls of the blood vessels that can block arteries to the brain and cause stroke.

High blood cholesterol (total cholesterol of 240 mg/dL or more) is a major risk for heart disease, which raises the risk for stroke. High levels of LDL or "bad" cholesterol (more than 100 mg/dL) and high levels of another type of blood fat called triglycerides (150 mg/dL or more) also increase the risk of stroke in people who have had a heart attack, ischemic stroke, or TIA. Low levels of HDL or "good" cholesterol (less than 40 mg/dL) may also increase the risk of stroke.

Physical inactivity, obesity, or both can increase the risk for high blood pressure, high cholesterol, diabetes, heart disease, and stroke. Physical inactivity has also been linked to an increased ability to make blood clots. Obesity has nearly overtaken cigarette smoking as the #1 cause of preventable death in the United States. Abdominal obesity (waist circumference of 40 inches or more) was associated with a higher risk of stroke in men and weight gain with a body mass index (BMI) of 27 or more was associated with a higher risk of stroke in women.

Excessive alcohol intake can raise the blood pressure, which is the most important risk factor for stroke. More than one alcoholic drink per day for women and two drinks per day for men are considered excessive.

Intravenous drug use carries an increased risk for stroke. Cocaine use has also been linked to stroke and heart attack. Some have been fatal for first time users.

Risk factors that can’t be changed:^1,3-7

People of all ages have strokes, including children. However, the older you are, the greater your risk for stroke.

In most age groups, stroke is more common in men than women in any given year. However, more women die from stroke. Women who are pregnant also have a higher risk of stroke.

Heredity and race are also factors in your risk for stroke. Your risk is higher if a primary relative (grandparent, parent, brother, or sister) has had a stroke. African-Americans have almost twice the risk for first-ever strokes compared to Caucasians. They are also at a much risk for death from a stroke.

Having had a stroke puts you at a higher risk for another stroke. Having a heart attack also increases your risk for stroke.

What can you do to reduce your risk for stroke?^6-9

Have your blood pressure checked frequently. The are usually no symptoms or early warning signs for high blood pressure so the only way to know is to check. You should have a screening with a health care provider at least every 2 years.

If you smoke, get help to QUIT! Complete cessation of the use tobacco products is your goal. Please contact your health care provider or local, state, and national organizations dedicated to help people quit smoking or using other tobacco products.

If you have diabetes, work closely with your health care provider to treat and control it. It is important to control the blood sugar to reduce damage to small blood vessels (microvascular disease). It is also extremely important to control blood pressure and reduce cholesterol levels to prevent or reduce blockage in large blood vessels, especially blood vessels to the heart, brain, and kidneys. Check with your health care provider regarding the use of medications in the Angiotensin Converting Enzyme Inhibitors (ACE-I) or Angiotensin Receptor Blocker (ARB) drug classes. You will also want to consult your health care provider regarding the need for tighter cholesterol management.

Your health care provider can use a stethoscope do an initial evaluation of the carotids and other large arteries during a physical exam. If the exam is abnormal, additional non-invasive (no needles) testing may be recommended.

People with atrial fibrillation, that is not caused by heart valve disease, should be considered for anti-thrombotic therapy with a "blood thinner" called warfarin (Coumadin®) or aspirin. Your health care provider will determine your risk for developing blood clots and risk of bleeding complications when deciding the best treatment for you.

If you have an enlarged heart, heart valve disease, or congenital heart disease, discuss the need for anti-thrombotic treatment with your health care provider.

Immediate evaluation and appropriate treatment of the cause of a transient ischemic attack (TIA) or "mini-stroke" is extremely important to reduce the risk of stroke and permanent damage. If you think you have had a TIA, notify your health care provider immediately or seek emergency care, even if your symptoms go away.

To determine their risk of stroke, children with sickle cell disease should be screened with transcranial Doppler ultrasonography every 6 months.

If you have diabetes, carotid or peripheral artery disease, or have had a stroke, your cholesterol level should be reduced to the same level as someone that has heart disease or has had a heart attack. That means that the your cholesterol goals are:

Total Cholesterol: < 200 mg/dL

LDL Cholesterol: < 100 mg/dL

HDL Cholesterol: > 40 mg/dL for men

> 50 mg/dL for women

Triglycerides: < 150 mg/dL

Work with your health care provider to determine if you will need medication to reach these goals.

The activity guidelines endorsed by the Centers for Disease Control and Prevention and the National Institute of Health is for at least 30 minutes of moderate-intensity physical activity on most days of the week. Increasing physical activity decreases the risk of stroke across all racial/ethnic and age groups and for each gender. Before starting a physical activity program, consult your health care provider.

There is some evidence that light-to-moderate alcohol intake can reduce the risk for coronary artery disease and stroke. It is not recommended that non-drinkers should start drinking alcohol. However, elimination of heavy drinking and a reduction to moderate levels of alcohol intake (2 drinks/day for men and 1 drink/day for women) for those who are already drinking will probably do no harm and may reduce the risk of stroke.

¹American Heart Association/American Stroke Association: Heart Disease and Stroke Statistics - 2004 Update

²Heart attack, Stroke, and Cardiac Arrest Warning Signs - www.americanheart.org

³Common Symptoms and Treatments for stroke - www.stroke.org

⁴National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov

⁵Stroke Risk Factors - www.americanheart.org

⁶AHA Scientific Statement: Primary Prevention of Ischemic Stroke. Circulation 2001; 103:163.