American Heart Association

Photo from American Heart Association website

Stroke is the third leading killer in the United States and the No. 1 cause of adult disability. But according to the American Stroke Association, 80 percent of all strokes are preventable.

About 750,000 people suffer a new or recurrent stroke in the United States each year, and 160,000 die. Every 45 seconds in the U.S., someone has a stroke.

There are 5.5 million U.S. stroke survivors. While some stroke victims can recover completely, more than two-thirds of all survivors will have some type of disability.

Women account for 6 in 10 stroke deaths. Black Americans are affected by stroke more often than any other U.S. group. Black Americans are twice as likely to die from stroke as white Americans. Fifty percent of all nursing home admissions are stroke victims. The economic cost can be as much as $40 billion to $70 billion per year.

A stroke or “brain attack” occurs when a blood vessel that carries oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Ruptures and blockages prevent the brain from getting the blood and oxygen it needs, and nerve cells in the brain die within minutes.

When brain cells die during a stroke, the ability to control various areas of the brain is lost. These abilities can include speech, movement and memory. How a stroke patient’s brain is affected depends on where the stroke occurs in the brain and how much the brain is damaged.

A stroke is a medical emergency. You should know the warning signs of stroke. Half of all stroke victims have no warning signs. After the age of 55, the risks of stroke can double every 10 years. An estimated 97 percent of the U.S. adult population cannot identify the warning signs for a stroke.

These signs include:

Sudden numbness, weakness or paralysis of the face, arm or leg, especially on one side of the body.

Sudden confusion, trouble speaking or understanding.

Sudden trouble seeing in one or both eyes.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden, severe headache with no known cause.

An ischemic stroke is caused by a blocked artery. A hemorrhagic stroke is caused by the leaking or bursting of a blood vessel. A transient ischemic attack, or TIA stroke, can be a temporary disruption of blood flow to the brain.

Ischemic stroke

Eighty percent of all strokes are ischemic strokes. An ischemic stroke happens when the arteries to your brain become narrowed or blocked, causing a reduction of blood flow.

Ischemic strokes include:

Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot in most cases is caused by fatty deposits (plaque) that build up in arteries and cause a reduction in blood flow (atherosclerosis).

Embolic stroke. An embolic stroke occurs when a blood clot forms away from your brain and is swept through your bloodstream and lodges in a narrower brain artery. This type of blood clot is called an embolus.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels.

These include:

Uncontrolled high blood pressure (hypertension).

Overtreatment with anticoagulants (blood thinners).

Weak spots in your blood vessel walls (aneurysms).

Transient ischemic attack

A transient ischemic attack (TIA) is also called a ministroke. This is a temporary condition with symptoms similar to those you’d have with a stroke. A TIA can last as little as five minutes.

A TIA occurs when a clot or debris blocks blood flow to part of your nervous system. There is usually no permanent damage or lasting symptoms. But a TIA can be a good indicator of a future stroke.

Stroke Prevention Guidelines were established by National Stroke Association’s Stroke Prevention Advisory Board, a group of leading U.S. experts on stroke prevention. The guidelines were first published in a 1999 issue of Journal of the American Medical Association and have been updated to reflect current medical standards.

Stroke Prevention Guidelines

1. Know your blood pressure. Have it checked at least annually. If it is elevated, work with your doctor to keep it under control. High blood pressure (hypertension) is a leading cause of stroke.

You can check your blood pressure at your doctor’s office, at health fairs, at home with an automatic blood pressure machine, or at your local pharmacy or supermarket. If the higher number (your systolic blood pressure) is consistently above 120 or if the lower number (your diastolic blood pressure) is consistently over 80, talk to your doctor.

If your doctor decides that you have high blood pressure, the doctor may recommend some changes in your diet, regular exercise, or medicine. Blood pressure drugs have improved. Once you and your doctor find the right medicine for you, it should never cause side effects or interfere with your quality of life.

2. Find out if you have arterial fibrillation. Arterial fibrillation (AF) is an irregular heartbeat that changes how your heart works and allows blood to collect in the chambers of your heart. This blood, which is not moving through your body, tends to clot. The beating of your heart can move one of these blood clots into your blood stream, and can cause a stroke.

Your doctor can diagnose AF by carefully taking your pulse. AF can be confirmed or ruled out with an electrocardiogram (ECG), a recording of the electrical activity of the heart, which can probably be done in your doctor’s office.

If you have AF, your doctor may choose to lower your risk for stroke by prescribing medicines called blood thinners. Aspirin and warfarin (Coumadin) are the most commonly prescribed treatments.

3. If you smoke, stop. Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will immediately begin to drop. Quitting smoking today can significantly reduce your risk of stroke from this factor.

4. If you drink alcohol, do so in moderation. Studies now show that drinking up to two alcoholic drinks per day can reduce your risk for stroke by about half. More alcohol than this each day can increase your risk for stroke by as much as three times and can also lead to liver disease, accidents and more. If you drink, we recommend no more than two drinks each day, and if you don’t drink, don’t start!

Remember that alcohol is a drug and it can interact with some drugs. It’s a good idea to ask your doctor or pharmacist if any of the medicines you are taking could interact with alcohol.

5. Find out if you have high cholesterol, a soft, waxy fat in the bloodstream and in all body cells. Know your cholesterol number. If your total cholesterol level (LDL and HDL) is over 200, talk to your doctor. You may be at increased risk for stroke.

LDL, known as the “bad” cholesterol, is the form that builds up and causes plaque, which may narrow arteries and limit or stop blood flow. LDL can be inherited from your family members or be a result of your body chemistry. It can also be the result of a diet high in saturated fats, lack of exercise, or diabetes. HDL is the “good” cholesterol that sweeps the blood and removes plaque.

Lowering your cholesterol, if it’s elevated, may reduce your risk for stroke. High cholesterol can be controlled in many individuals with diet and exercise. Some individuals with high cholesterol may require medicine.

6. If you are diabetic, follow your doctor’s advice carefully to control your diabetes.

Often, diabetes may be controlled through careful attention to what you eat and exercise. Having diabetes puts you at an increased risk for stroke; by controlling your diabetes, you may lower your risk for stroke.

Work with your doctor and your dietitian, a health care professional who helps promote good health through proper eating, to develop a healthy eating program that fits your lifestyle. Your doctor can prescribe lifestyle changes and medicine that can help control your diabetes.

7. Exercise. Include exercise in your daily activities. A brisk walk for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke. Try walking with a friend; this will make it more likely that you’ll make it a habit.

If you don’t enjoy walking, choose another exercise or activity that you do enjoy, such as biking, swimming, golf, tennis, dance or aerobics. Make time each day to take care of yourself by exercising. Don’t forget to lift weights.

8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.

Work toward a balanced diet each day with plenty of fruits, vegetables and grains and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu, and some beans).

Adding fiber to the diet, such as whole grain bread and cereal products, raw, unpeeled fruits and vegetables and dried beans, can reduce cholesterol levels by 6 to 19 percent.

9. Circulation problems. Ask your doctor if you have problems with circulation — the movement of the blood through the heart and blood vessels — which increase your risk for stroke.

Strokes can be caused by problems with your heart, arteries and veins, or the blood that flows through them. Together, they are your circulation. Your doctor can check to see if you have problems in the circulation supplying blood to your brain.

Fatty deposits — caused by atherosclerosis (a hardening or buildup of cholesterol plaque and other fatty deposits in the arteries) or other diseases — can block the arteries, which carry blood from your heart to your brain. These arteries, located on each side of your neck, are called carotid and vertebral arteries. This kind of blockage, if left untreated, can cause stroke. Your doctor can test you for this problem. Your doctor can listen to your arteries, just as he or she listens to your heart, or look at scans called ultrasound or MRI images.

If you have blood problems such as sickle cell disease, severe anemia (lower than normal number of red blood cells), or other diseases, work with your doctor to manage these problems. Left untreated, these can cause stroke.

Circulation problems can usually be treated with medicines. If your doctor prescribes aspirin, warfarin (Coumadin), ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Aggrenox) or other medicine for circulation problems, take it exactly as prescribed.

Occasionally, surgery is necessary to correct circulation problems such as a blocked artery.

10. Symptoms. If you have any stroke symptoms, seek immediate medical attention.

If you think someone may be having a stroke, act F.A.S.T. :

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?

Time: If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.

Remember, 80 percent of all strokes are preventable.

If you have a fitness question or concern, write to “Tips to be Fit,” PO Box 53443, Philadelphia, PA 19105 or send an email to Past articles can be found at by searching “Tips to be Fit.”

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