Q. Your recent discussion about preventing heart attacks made me wonder about tips to prevent a stroke. I imagine that many of the steps to take are similar, but wondered whether there were any special ways to prevent a stroke from occurring.

A. You're right--a lot of the preventive measures are similar for heart attack and stroke. But there are a couple of additional steps you can take to lower your risk of stroke.

Heart attacks and strokes mainly stem from blockages to the circulation in the heart or brain. To highlight this similarity, and to emphasize the need for urgent treatment, many physicians now refer to stroke as a "brain attack."

Keeping your circulation healthy--whether in the heart, brain, legs or elsewhere--involves basic preventive steps. These were recently highlighted by the National Stroke Association in the March 24/31 issue of the Journal of the American Medical Association.

These steps include: 1) avoiding smoking or exposure to secondhand smoke; 2) keeping your blood pressure, blood sugar and cholesterol under control; 3) taking aspirin and a statin-type medicine to lower your cholesterol if you've had a heart attack; 4)avoiding drinking too much alcohol; and 5) exercising regularly.

In addition, people at risk for stroke should be evaluated for surgery to open up blockages in the arteries of the neck. This procedure, known as carotid endarterectomy, lowers the risk of stroke in people with significant blockages, whether or not they've had any symptoms or warning signs of a stroke. These warnings are called TIAs, or transient ischemic attacks.

With a TIA, you experience temporary symptoms of a stroke, such as paralysis, slurred speech, loss of sensation and so forth. Early treatment can help keep a TIA from recurring or turning into a full-blown stroke.

Finally, people with the irregular heart rhythm called atrial fibrillation are at high risk for stroke. In most cases, you should take the blood thinner medicine known as Coumadin (warfarin). Younger people with atrial fibrillation have a lower risk of stroke; for them aspirin may be all that's needed.

Although Coumadin can occasionally lead to internal bleeding problems, this medicine will lower your risk of stroke. After a heart attack, some people also have an increased risk of stroke. If so, taking Coumadin can help lower it.

So, the main additional step for preventing stroke--as opposed to heart attack--is taking blood thinners if you have atrial fibrillation or, in some cases, if you've had a heart attack. Also, you may benefit from surgery that removes blockages in the carotid artery in your neck.

Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.

Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071. Questions cannot be answered personally.