Lower your blood pressure
High blood pressure damages arteries so they clog or burst more easily, escalating the risks of both types of stroke: ischemic, caused by blockage of a blood vessel that supplies part of the brain; and hemorrhagic, the less common but deadlier stroke that occurs when a blood vessel bursts inside the brain. Treatment to lower blood pressure, including lifestyle changes and medication, can reduce those risks by a third.
Recommendations: Have your blood pressure checked at least once every two years, more often if you’re 50 or older. If your reading is high-normal — above 120/80 mmHg but below 140/90, the cutoff for hypertension — try to lower it by adopting the lifestyle measures listed below. If your reading is 140/90 or higher, talk with your doctor about adding an antihypertensive drug.
LDL (bad) cholesterol, a fatty substance in the blood, builds up plaque on artery walls, causing arteries to narrow. If plaque ruptures, a blood clot can form and block a blood vessel to the brain, causing a stroke.
Recommendations: Get a fasting lipid profile every five years, and talk with your doctor about your cardiovascular risk based on family history, blood pressure readings and other factors.
Rein in diabetes
High blood-sugar levels damage blood vessels over time. In addition, people with diabetes are likely to have hypertension, high cholesterol and excess weight. All told, diabetes increases the risk of ischemic strokes by as much as 600 percent.
Recommendations: Have your blood-sugar level tested every three years if you’re 45 or older and at least once a year if you’re pre-diabetic, which is defined as having a fasting glucose level between 100 and 125 milligrams per deciliter (mg/dL). If you have diabetes, keep your blood pressure below 130/80 mmHg with lifestyle approaches and medication if needed.
Have your pulse checked
Atrial fibrillation, a heart-rhythm disorder, can lead to blood clots that can travel to the brain, amplifying the risk of an ischemic stroke. The blood thinner warfarin (Coumadin and its generic cousins) reduces that risk by 64 percent, yet it might be underprescribed.
Recommendations: Your doctor should check your pulse for irregular rhythms at every visit and follow up with an electrocardiogram or other heart monitoring if necessary.
Neck surgery: think twice
If either of the carotid arteries, located on each side of the neck, becomes clogged, a stroke can result. People with severe carotid narrowing that has caused a stroke or transient ischemic attack (TIA) — a strokelike episode that doesn’t cause permanent damage — are at high risk for a second stroke, and surgery to scrape out the blockage significantly reduces that risk. But those with a narrowed carotid artery that hasn’t triggered symptoms are at much lower risk, and the benefit of surgery is small.