Who Is at Risk for a Stroke? | Developments in Prevention

Who Is at Risk for a Stroke?

HCA image A stroke occurs when an artery in the brain becomes blocked or a blood vessel carrying blood to the brain bursts. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.

Many of the risk factors for stroke can be lowered or treated. Others, such as increasing age, family history of stroke, your race, or prior stroke cannot be. The more risk factors you control, the more you can reduce your risk of having a stroke.

Developments in Prevention

High Blood Pressure

High blood pressure is the most common and most preventable risk factor for stroke. High blood pressure is defined as having a systolic pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg. A good blood pressure is 120 mm Hg/80 mm Hg or lower. Blood pressure varies with age and normal values tend to increase with age. The American Heart Association recommends your blood pressure be measured on a regular basis starting at age 20. If you have normal blood pressure, you should get it checked at least once every 2 years or at every healthcare visit. If you have a certain condition, like diabetes, or repeated blood pressure readings that are elevated, your doctor may have stricter blood pressure goals for you. Reducing high blood pressure lowers your risk for stroke.

High Cholesterol

Lowering cholesterol levels with diet, exercise, and medication may help reduce the build-up of fatty arterial plaque (atherosclerosis) that can trigger a stroke. The American Heart Association recommends adults have a fasting cholesterol check at least once every 4-6 years starting at age 20. Your doctor will combine the cholesterol numbers with other risk factors to evaluate your lifetime (or 10-year) risk of a heart attack or stroke. If you have cardiovascular disease or diabetes, your doctor will have you follow stricter cholesterol guidelines and may check it more often.

Heart Arrhythmias

If you have atrial fibrillation (an irregular heart rhythm), a blood thinner (like warfarin) may be able to lower your risk for stroke. Blood thinners help reduce blood clots from forming. Blood clots can block arteries that feed the brain, causing a stroke. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.


If you have diabetes, keeping your blood pressure in a specified target range can reduce your risk of stroke. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors can be helpful for this purpose. If you are obese, following your treatment plan to control your blood glucose level is also important in decreasing stroke risk.

Smoking and Drinking

Smokers have twice the risk of suffering a stroke as nonsmokers. This risk is increased even higher if you are also taking oral contraceptive pills. However, if you stop smoking, your risk of stroke will fall—within about 5 years—to the same level as someone who never smoked. There are many smoking cessation aids available today, including online support groups, nicotine patches, sprays, gum, or certain drugs. Talk to your doctor if you need help to quit smoking.

Avoiding that other major vice, heavy alcohol use, may also be an independent factor in preventing stroke.

Antiplatelet Medication

Antiplatelet medications make blood platelets less sticky and less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a transient ischemic attack (TIA) may benefit from taking an antiplatelet agent. Medications like aspirin, clopidogrel, or the combination of aspirin plus dipyridamol, may be prescribed.

Carotid Artery Surgery

If you have fatty arterial deposits in your neck, which can lead to stroke, you may benefit from carotid artery surgery. The carotid arteries supply the brain with oxygen. The surgery is done to restore blood flow. If you have severe arterial blockage and a history of previous stroke or TIA, this surgery may significantly reduce your risk of a second stroke.


Exercising regularly can contribute to weight loss and reduce your risk of stroke. Work with your doctor to create an exercise routine that is safe for you.

Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke, discuss your options with your doctor. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes, the time to diagnosis and treatment is extremely important. If you think you are having a stroke, call for emergency medical services right away.