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14 Stroke Risk Factors You Can Control (and 5 You Can’t)

"A stroke can happen to anyone at any time," warns the National Stroke Association. That's why you need to understand which stroke risk factors you can improve—and the ones you can't.

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Your brain is starving for blood

A stroke is a blockage of blood flow to an area of your brain. Deprived of oxygen, your brain cells in the area begin to die, and that means you begin to lose abilities—limb control, sight, speech, or even memory. According to the National Stroke Association (NSA), for the 800,000 people in the United States who have a stroke for the first time or a recurrent one, the effects vary. A mini-stroke may only raise minor issues, such as temporary weakness of an arm or leg; a major stroke can cause permanent damage or death. Every four minutes in the United States, a person dies from a stroke, and that’s tragic because 80 percent of those strokes are preventable. Read on to learn how to reduce your stroke risk factors.

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High blood pressure

Shazam Hussain, MD, director of the Cerebrovascular Center at Cleveland Clinic, says high blood pressure is the most significant preventable risk factor for stroke. “If blood pressure could be controlled in the United States, half of strokes would be eliminated,” says Dr. Hussain. High blood pressure wreaks havoc on your arteries. When they weaken or suffer damage, they can burst or clog more easily. That’s why doctors push patients to hit a healthy blood pressure number: “The newest guidelines recommend blood pressure be less than 130/80,” says Dr. Hussain. One way to lower your blood pressure is to limit salt intake to less than 1500 milligrams per day. The American Heart Association recommends following the DASH (Dietary Approaches to Stop Hypertension) to lower blood pressure. Here are 11 things everyone should know about the DASH Diet.

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High cholesterol

Cholesterol in the arteries can block normal blood flow to the brain, causing a stroke. That’s one reason to watch your cholesterol. Ideal total cholesterol is 200. Once you hit 240, you’re at higher risk for stroke. It’s especially important to ask your doctor about your very low-density lipoprotein—VLDL—levels. High levels of VLDL cholesterol are associated with developing plaque deposits on artery walls, which can narrow the artery, restricting blood flow. “Eat a healthy diet; limiting the amounts of saturated fats and trans fats is very important,” says Dr. Hussain. “Due to the beneficial fats in fish, eating fish twice a week is recommended.” In addition cut back on sugar and refined carbohydrates, as eating more of these than you burn can lead to excessive amounts of triglycerides and high levels of VLDL. Finally, daily exercise is also essential. Keep in close collaboration with your doctor in regards to medication and diet to lower cholesterol Dr. Hussain says. Here’s what doctors do to lower their cholesterol.

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Heart disease

“Many heart conditions increase the risk of having a stroke. In particular, a rhythm disturbance of the heart known as atrial fibrillation can substantially increase stroke risk,” says Dr. Hussain. You can control this stroke risk factor by asking your doctor about using blood thinners to reduce your risk. Other heart conditions linked to a build-up of plaque in the arteries can also increase stroke risk. Improve your odds by following a healthy diet, exercising, and potentially taking medication; be sure to follow your doctor’s recommendations and care. If you’re over 50, your heart is changing—here’s what you should know about keeping it healthy.

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Diabetes

Diabetes comes with increased risk of related health complications, including heart disease, kidney damage, nerve damage—and stroke. The chances of having a stroke for someone diagnosed with the condition are 1.5 times higher than in people who don’t have diabetes. But you can reduce your risk by keeping your blood sugar, blood pressure, and cholesterol levels in check. Eat a healthy diet that strictly limits sugar and refined carbohydrates, exercise daily, reduce stress, and keep up with your scheduled meds or insulin. And if you smoke, find a program to help you quit. Above all, don’t go it alone, advises Dr. Hussain: “Close collaboration with physicians with expertise in managing diabetes is important.” Be sure to avoid these eating mistakes when you’re trying to lower your blood sugar.

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Sickle cell disease

This inherited condition makes red blood cells that are misshapen and defective, so they can’t deliver sufficient oxygen to the rest of the body. The red blood cells may also clump together and clog up blood vessels in the brain; this can cause a stroke, even in children. Patients and their doctors can monitor the condition using a special ultrasound test called a transcranial Doppler, explains Dr. Hussain. “They may also need prophylactic transfusions,” he says. Read about a new drug that provides hope for sickle cell disease.

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Heavy alcohol use

Some studies suggest a little bit of booze might be healthy, but there’s pushback when it comes to stroke, says Dr. Hussain. “While mild use of alcohol is controversial—newer studies suggest that even low amounts of alcohol can increase the risk of heart attack or stroke—it is certain that heavy alcohol use can substantially increase stroke risk,” warns Dr. Hussain. For women, that means more than a drink a day; for men, more than two will begin to raise stroke risk. (A drink is one shot of hard liquor, one 5-ounce serving of wine, or one 12-ounce beer.) If you have known stroke risk factors, it’s a good idea to reduce or eliminate alcohol. Check out these 17 easy ways to drink less.

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Diet drinks

A brand new study published in Stroke suggests that downing just one artificially sweetened drink a day nearly triples the risk of stroke. The researchers tracked the health of post-menopausal women—some of whom drank artificially sweetened beverages. Those who drank at least one artificially sweetened beverage daily had almost three times the risk of stroke or dementia compared to women who had artificially sweetened beverages less than once a week. “This study adds to the evidence that limiting the use of diet beverages is the most prudent thing to do for your health,” said Rachel K. Johnson, PhD, RD, a member of the American Heart Association’s science advisory committee on low-calorie sweetened drinks in a press release. Here are the surprising things that happen to your body when you break the diet soda habit.

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Smoking

You know that smoking is unhealthy, but did you realize how much it raises your risk of stroke? Smoking drives down levels of HDL cholesterol while raising LDL cholesterol, which when too high can damage the cells that line blood vessel walls and make blood cells sticky and more likely to clot and block blood flow to the heart and brain. That’s a deadly combo, says Dr. Hussain: “Stopping smoking is critical in the prevention of stroke.” If you need a little help quitting, these 23 tips will help you kick the habit for good.

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Obesity

“Obesity increases multiple risk factors, including high blood pressure, high cholesterol, and diabetes,” Dr. Hussain says. But what weight is considered obese? According to the Centers for Disease Control, a BMI of 30 or higher is in the obese range. You can easily determine your BMI using a calculator. The good news: Every little bit of weight you lose will drive down your stroke risk, says Dr. Hussain. Check out these 30 tiny diet changes that will add up to big weight loss.

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Hormone replacement therapy

Experts have been debating the safety of hormone replacement therapy (HRT) for years. A study from the Women’s Health Initiative suggests that women taking menopausal hormone therapy with estrogen plus progesterone are at an increased risk of stroke. Women who reached menopause early (younger than 45) also had elevated risk. HRT can give relief from the symptoms of menopause—hot flashes and night sweats, for example—but the 2017 Hormone Therapy Position Statement from the North American Menopause Society recommends that doctors follow a patient-specific approach and invite neurologists to assess stroke risk when patients are considering HRT. If you’re looking for non-medical therapies, these natural remedies for menopause symptoms may bring relief.

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Stress

Everyone knows stress is hard on you, and yes—it also raises your risk of stroke. “Some of this effect may be due to increased blood pressure when under stress,” says Dr. Hussain. He recommends exploring stress-management techniques like mindful meditation, yoga, and massage—experiment to find what works for you. Even a daily walk can do wonders for your stress levels and blood pressure. For quick relief, try one of these 15 five-second strategies for shutting down stress.

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Illicit drug use

“Multiple types of illicit drugs can increase the risk of stroke, especially cocaine and amphetamines,” Dr. Hussain says. Amphetamines (a stimulant) are legally prescribed to treat conditions such as ADHD, obesity, and narcolepsy. Studies show an increased risk of stroke in young adults who abuse cocaine and amphetamines. “Cessation of drug use is critically important,” he says.

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Birth control pills

Talk to your doctor about the side effects and risks of your birth control pills—depending on your other lifestyle habits, you may be able to switch to a safer type. According to the National Stroke Association: “The greatest concern about using oral contraceptives is for women with additional risk factors, such as age, cigarette smoking, high blood pressure, or diabetes.” Lifestyle changes such as kicking the habit can help lower the risk. But if you have high blood pressure or diabetes, a different method of birth control or prescription may be necessary.

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Migraines with aura

Heads up, women: According to the National Stroke Association, women in the United States suffer more migraines than men—and migraines with aura are the worst kind, bumping up stroke risk two and half times. An aura can be a migraine warning sign, and it comes with some scary symptoms like seeing spots and flashes, feeling numbness in the face, body, or hands, and even having trouble speaking. Work closely with your doctor to treat or modify any existing stroke risk factors. And watch for these sneaky triggers that may be causing your migraine.

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Risks you can’t control

If a member of your immediate family—parent, sibling, or child—has had a stroke, then you’re at increased risk. That risk climbs higher if the family member was younger than 65 when the stroke hit, points out Dr. Hussain. Also, simply having had a stroke elevates your risk for another. “In particular, the first three months following a stroke is when patients are at increased risk; it declines over time, but anyone who has had a stroke is at higher risk than the general population,” adds Dr. Hussain. Read how a healthy 21-year-old still grieving over her mother’s death from a heart condition found herself in the ER, having suffered a stroke.

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Age

“Age is the most significant risk factor overall for stroke,” Dr. Hussain says. According to the American Stroke Association, the risk doubles for each decade past your 55th birthday. You can’t do anything about aging, says Dr. Hussain, but you can maintain healthy lifestyle habits—and that will help minimize your risk.

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Gender

The numbers are grim for women: Each year, 55,000 more women have a stroke than men, reports the National Stroke Association. “One reason is that women live longer than men, so they have more years during which they can have a stroke,” adds Dr. Hussain. And the outcomes aren’t so wonderful either. “Because women tend to be more likely to be living alone when they have a stroke, they don’t get medical attention as quickly,” he says. Learn about the 15 stroke symptoms women are likely to ignore.

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Race

If you’re African American, Asian American, or Hispanic American, your odds of having a stroke are higher, according to the National Stroke Association. African Americans are twice as likely to die from a stroke as Caucasians. Despite having lower risk factors in general, Asian Americans are 20 percent more likely to have a stroke—though they’re less likely to die from one. Research suggests that Hispanic Americans are more likely to suffer a stroke at a younger age—around 67 on average—compared to 80 for non-Hispanic Caucasians. High blood pressure, diabetes, and obesity are the leading reasons. Read on to learn about 14 foods that can cut your risk for stroke.

Lisa Marie Conklin
Lisa Marie Conklin is a Baltimore-based writer who writes regularly about pets and home improvement for Reader's Digest. Her work has also been published in The Healthy, HealthiNation, The Family Handyman, Taste of Home, and Realtor.com., among other outlets. She's also a certified personal trainer and walking coach for a local senior center. Follow her on Instagram @lisamariewrites4food and Twitter @cornish_conklin.