Of the estimated 795,000 Americans who will suffer a stroke this year, at least one in four will have another stroke at some point in their lives.
That is especially troublesome because the brain might not be as resilient with each subsequent stroke. The impact on people’s lives can be dramatic. They may not be able to drive anymore. They might have to quit work. Their loved ones might have to give up activities they enjoy in order to take care of them.
The type of stroke the person suffered directly impacts the strategies for preventing a second stroke.
There are two main categories of stroke: hemorrhagic and ischemic.
If it was a hemorrhagic, or bleeding stroke, we recommend good blood pressure control. To do this, we can prescribe medication, as well as lifestyle behaviors, including reducing salt, eating healthy and exercising, such as walking or bicycling.
If it was an ischemic, or clotting stroke, we have to determine what caused the clot to form. To determine this, we look at the blood vessels in the head and neck, and we look at how the heart functions, among other variable. We typically recommend aspirin and cholesterol medication to reduce the risk of ischemic stroke. Aspirin keeps the platelets in blood from sticking together. Cholesterol medications lower LDL (or “bad” cholesterol). Statins, in particular, are known to work in concert with aspirin to reduce ischemic stroke risk.
5 ways to prevent a second stroke
1. Take your medications.
Take your medications as instructed by your doctor. Don’t take less if you are feeling better, and don’t take more if you are not feeling well. Follow the instructions exactly.
2. Eat a healthy diet.
The American Heart Association recommends embracing a Mediterranean diet. That means white meats instead of red meats, fruits and vegetables instead of bread and carbohydrates. Don’t fry foods, and take it easy on the sweets. Limit your alcohol intake to less than two drinks a day. And if you do indulge, red wine is the healthier option.
3. Get support.
Get support from your family and the community. Lots of folks get depressed after they have a stroke. Often, they are frustrated if there is a difference in their cognitive abilities, such as not being able to do math as well or recall information as quickly as usual. Speech, occupational and physical therapy can help. And if you are feeling depressed, your doctor can prescribe medications that can get you over a rough patch. Stroke survivors and their loved ones also can benefit from support groups.
4. Don’t smoke.
If you smoke, stop — right now. Smoking increases the risk of stroke, as well as the risk of a number of cancers. If you are around people who smoke, it’s more difficult to quit. I counsel partners who smoke to kick the habit, too.
5. Treat other stroke risk factors.
Atrial fibrillation (afib), an irregular and sometimes rapid heartbeat, greatly increases the risk of stroke. It’s a serious condition that can cause blood clots in the heart, which can travel and trigger ischemic strokes.
We treat afib with medications to reduce blood clots and work closely with our cardiology colleagues to be sure that the heart rate is well controlled. We also recommend a heart-healthy diet, exercising, maintaining a healthy weight and avoiding excess alcohol.
People who have diabetes, high blood pressure and high cholesterol also are at greater risk for stroke compared to the general population. It’s important to work with doctor to manage these stroke risk factors.
Don’t ignore the warning signs
If you experience any signs of stroke, call 911 right away.
Symptoms might include losing vision in one eye or half your field of vision; numbness or weakness on one side of the body; or problems sitting up straight.
A severe headache or feeling continuously super dizzy can be warning signs, too.
If you experience any of these signs, get help immediately. Don’t ask family and friends for advice. Don’t wait, thinking your symptoms will go away.
We have a tight window of time, 4.5 hours, to administer medications to treat ischemic strokes — so seek medical attention without delay.