How To Prevent Another Stroke

Summarized by Robert W. Griffith, MD
January 22, 2007

The National Stroke Association (NSA) has published The Stroke Recovery Guide, which contains information about preventing a second stroke. This information is important for stroke victims and their caregivers. Here is an extract, along with a summary of the NSA's ten general prevention guidelines. Robert Griffith, Editor.

Preventing a Second Stroke

Now that you have experienced a stroke, it is common for you and your family to concentrate your efforts on rehabilitation and recovery. However, preventing a second stroke is a critical consideration. Of the estimated 750,000 Americans who experience a stroke each year, 5% to 14% will go on to have a second stroke within one year. Within the next five years, 24% of women and 42% of men who have had one stroke will have another. There are several methods to help you prevent another stroke. Talk to your doctor to find out which one is right for you.

Medication

Medication may help reduce stroke risk by controlling high blood pressure or high cholesterol, treating heart disease, or by interfering with the blood's tendency to form potential stroke-causing blood clots.

Blood Clot Prevention

After a stroke occurs, there are several clot prevention medications available to help reduce the risk of a second stroke. Aspirin is the least expensive and longest standing clot prevention medication. A newer, more effective option is a combination of aspirin and extended-release dipyridamole, called Aggrenox^®. Clopidogrel (Plavix^®) and ticlopidine (Ticlid^®) are other options your doctor might consider. Warfarin (Coumadin^®) is commonly prescribed to prevent clots from forming in patients with atrial fibrillation.

Surgery for Blocked Arteries

If your initial stroke was due to blockage in the carotid arteries (which carry blood from the heart to the brain), a surgical procedure known as carotid endarterectomy may be effective in reducing the risk of recurrent stroke. During the surgery, blockages and build-up in the arteries are removed to restore the free flow of blood. Your physician should determine whether this procedure is a good option for you.

Monitoring Blood Pressure

High blood pressure is one of the most important and easily controllable stroke risk factors. Often it can be controlled through diet and exercise, but medication may also be necessary. Several different kinds of medications are available to treat high blood pressure including the most common groups of drugs called calcium channel blockers and ACE-inhibitors. It is important to remember that you and your doctor may have to try several different drugs before you find the one that works best for you. This is common, so try not to be discouraged if it happens. Once you find a drug that works, be sure to take it exactly as prescribed, even when you feel fine.

Knowing about Heart Disease

Many forms of heart disease can increase your stroke risk. One condition - known as atrial fibrillation or AF - causes your blood to form clots that can travel to the brain and cause a stroke. Warfarin and aspirin are two medications commonly prescribed for the treatment of AF. Patients who are taking warfarin should be carefully monitored by a physician and be aware of foods rich in vitamin K such as green leafy vegetables, alfalfa, egg yolks, soy bean oil and fish livers, which may counteract the drug's effects. You should try to maintain a consistent level of vitamin K in your diet. If you alter your intake of Vitamin K drastically from one day to the next, be sure to tell your doctor.

Managing Cholesterol Levels

High levels of cholesterol may also increase stroke risk by not allowing blood to move freely through the arteries. Cholesterol build-up can break off causing a stroke to occur. Several drugs, including a class of drugs called statins, may help lower cholesterol levels. Some statins have also been proven effective in reducing the risk of stroke or TIA in patients who have had a heart attack, even if they have average or only slightly elevated cholesterol levels.

Lowering Your Stroke Risk

The key to lowering your risk for another stroke is simple: follow your doctor's recommendations regarding diet, exercise and weight loss, and be sure to take any medication exactly as directed. Your doctor's recommendations are based on your medical condition and your history of stroke risk factors. By understanding the basis for these recommendations, you'll be better able to follow them and make healthy, well-informed choices that will help reduce your risk of recurrent stroke.

NSA Prevention Guidelines

You have control over many stroke risk factors. NSA and its panel of stroke experts have developed ten simple guidelines to help you reduce your risk for stroke.
1. Know your blood pressure. If it is elevated, work with your doctor to keep it under control. A normal blood pressure reading is considered less than 140/90.
2. Find out if you have atrial fibrillation, which is an irregular heartbeat rhythm (also called AF). If you have AF, work with your doctor to manage it. 3. If you smoke, stop.
4. If you drink alcohol, do so in moderation.
5. Know your cholesterol number. If it is high, work with your doctor to control it.
6. If you are diabetic, follow your doctor's recommendations carefully to control your diabetes.
7. Include exercise in the activities you enjoy in your daily routine.
8. Enjoy a lower sodium (salt), lower fat diet.
9. Ask your doctor if you have circulation problems that increase your risk for stroke. If so, work with your doctor to control them.
10. If you have any stroke symptoms, seek immediate medical attention.

Source

• HOPE - The Stroke Recovery Guide. Part 3. Preventing Another Stroke. National Stroke Association (NSA). http://www.stroke.org/site/DocServer/hope_full.pdf?docID=921

Related Links
HOPE: The Stroke Recovery Guide - full text (66 pages)
Exercising Restraint in Stroke Therapy
How to Grade a TIA

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