Preventing a stroke

Every year, more than 10,000 people in Ireland have a stroke. Stroke is the biggest cause of acquired disability and the third biggest cause of death in this country. Stroke can happen at any age. One third of strokes happen in people under sixty-five years of age.

Your risk of having a stroke is increased by certain things in your lifestyle which you can change, such as stopping smoking and managing your weight. Your risk of stroke is also increased by certain things which you cannot change, such as your age and family history.

Some people are more at risk of having a stroke if they have certain medical conditions. It is important that these conditions are carefully monitored and treated.

The good news is that by making small changes to your lifestyle and by taking medications for certain conditions as directed by your doctor, you can reduce your risk of stroke.

Life style factors – risk for stroke that you can change

High blood pressure (Hypertension)

High blood pressure or hypertension is the leading cause of stroke. High blood pressure causes your blood vessels to lose their elasticity. The stiffening and narrowing of arteries can result in a blockage or clot forming. The weakening in the walls of small vessels can cause bleeds to occur. Clots and bleeds can cause strokes.

High cholesterol

Cholesterol is a type of fat found in your blood. You need a certain amount of cholesterol in your body. There are two main types of cholesterol – HDL or good cholesterol and LDL or bad cholesterol. Good cholesterol mops up the cholesterol left behind in your arteries and carries it to the liver where it is broken down. Bad cholesterol sticks to the walls in your arteries making them narrow. If an artery to the brain is completely blocked it can cause a stroke.

Smoking

Smoking doubles your risk of stroke. Smoking causes your blood vessels to narrow and makes your blood more likely to clot. Fatty deposits build up faster in the blood vessels of smokers compared to non-smokers. Second-hand smoke also increases your risk of stroke. Five years after you stop smoking your risk of a stroke is similar to that of a non-smoker.

Poor diet

A diet high in salt increases your risk of developing high blood pressure. Eating foods high in saturated fats (butter, hard margarine, lard, cream, fatty meat, cakes, biscuits and chocolates) can raise your cholesterol levels. Too many extra calories in your diet can lead to weight gain, obesity, high blood pressure and Type 2 diabetes mellitus.

Alcohol

Drinking too much alcohol raises your blood pressure and can cause damage to your liver and heart.

Physical inactivity

Not being active on a regular basis increases your risk of stroke by 50%.

Diabetes

If you have diabetes you have a greater risk of stroke. Diabetes occurs when your blood sugar (glucose) is too high. Insulin, a hormone produced by your body, helps to control your blood glucose. If your body does not produce enough insulin, or your body does not respond well to insulin the sugar levels in your blood rise.

Atrial fibrillation (irregular heartbeat)

Atrial fibrillation causes an irregular heart-beat. This can cause blood to clot. A blood clot can enter your bloodstream and get stuck in a blood vessel supplying your brain. This blockage may then cause a stroke to occur.

Risk factors for stroke that you cannot change

As you get older your blood vessels harden and become less elastic which puts you at increased risk of stroke and heart disease. Two thirds of strokes occur in people aged 65 years and older.

Gender

Stroke is more common in men under 75 years of age than in women of the same age. However, in those over 75 years of age more women than men have strokes.

Family history

You are more at risk of having a stroke if one or more of your parents, grandparents, sisters or brothers have had a stroke.

Ethnicity (race)

People of African, Asian and African-Caribbean have higher risk of having high blood pressure and diabetes which are risk factors for stroke.

Medical conditions

A number of medical conditions increase your risk of stroke. Your doctor may prescribe medications to manage these conditions.

Other diseases of the heart

Having heart disease or heart failure increases your risk of stroke. Dilated cardiomyopathy (enlarged heart) and disease of the heart valves also increases the risk of stroke.

How can you reduce your risk of stroke?

By making small changes to your lifestyle you can reduce your risk of having a stroke and can prevent repeat strokes.

Know your blood pressure

The only way to find out if you have high blood pressure is to have it measured. If you are over 30, you should have your blood pressure checked every two or three years.

What is high blood pressure?

About half of Irish adults over 50 years of age have high blood pressure. Blood pressure shows the amount of work your heart has to do to pump blood around the body. Two numbers measure the level of a person’s blood pressure. One number records blood pressure at its highest point as the heart muscle squeezes out the blood from the heart. This is called systolic pressure. The other number records the blood pressure as the heart relaxes and allows the blood to flow back into the heart. This is called diastolic pressure.

What is a normal level of blood pressure?
The normal level of blood pressure is usually about 120 (systolic) over 80 (diastolic), but this can vary with age, how you feel and your level of activity. If your blood pressure is higher than 135 over 85, you should discuss this with your doctor. One high reading does not necessarily mean you have high blood pressure. Your doctor will usually want to check your blood pressure several times, before deciding whether or not you have high blood pressure.

What causes high blood pressure?
A number of factors combine to cause high blood pressure. These include age, family history, eating too much salt, not eating enough fruit and vegetables, drinking too much alcohol, being overweight and not taking enough physical activity. Your blood pressure can be measured by your doctor.

Medication
If you have been prescribed medication for high blood pressure, you will usually have to take it for your whole life. Medication that lowers blood pressure prevents early ageing of the blood vessels and heart and reduces your risk of stroke.

Manage or reduce cholesterol

Your cholesterol can be measured by your doctor. If you need to change any aspects of your cholesterol, your doctor will advise you on changes in lifestyle and may recommend medication.

Stop smoking

Stopping smoking will almost halve your chances of having a stroke regardless of how long you have been a smoker, or how old you are. Within 24 hours of stopping smoking, your risk of having a stroke begins to fall.
Read the Irish Heart Foundation's Stop smoking for a healthy and happy heart leaflet.

Call the Irish Heart Foundation Heart & Stroke Helpline on 1890 432 787 to speak to someone about quitting smoking.

Eat a balanced diet

Healthy eating can reduce your risk of stroke. Aim to eat a wide variety of healthy foods. Using the Food Pyramid can help make sure you get all the vitamins, minerals, fibre and goodness you need.

Read the Irish Heart Foundation's Good eating for a happy heart leaflet.

Oily fish
Eat oily fish, such as sardines, mackerel or salmon, at least twice a week. Oily fish contains omega fatty acids which improves blood circulation, reduces the stickiness of your blood and prevents your blood from clotting. Oily fish can help lower your triglyceride levels (a type of fat in your blood).

Fruit and vegetables
Aim to eat at least five portions of fruit and vegetables each day. Eating a variety of fruit and vegetables will help control your weight and your blood pressure.

Avoid salt
Too much salt in your diet can increase your blood pressure level, which increases your risk of stroke. Avoid adding salt to your food. Instead add flavour to food by using herbs, spices, garlic, pepper or lemon juice.
A person should eat less than 6 grams of salt in a day. This includes salt naturally found in food and snacks, as well as the salt added during cooking or at the table. Many people exceed the recommended amount and eat 9-10 grams of salt per day. Most of the salt we eat comes from processed foods, fast food, or restaurant food.
Read the Irish Heart Foundation's Time to cut down on salt leaflet.

Read the Irish Heart Foundation's Time to cut down on salt leaflet.

Saturated Fat
Fats in food are a mixture of saturated and unsaturated fats. Saturated fats are also called animal fats. Saturated fats are found in foods like butter, hard margarine, lard, cheese, fatty meat, cakes, biscuits and chocolates. Unsaturated fats can help lower cholesterol. Unsaturated fats are found in oily fish, sardines, mackerel trout and salmon and pure vegetable oils such as sunflower, olive and rapeseed oils.

Cut down on saturated fat. You can do this by choosing lean cuts of meat, avoiding snack foods, processed foods and ready-made meals whose labels show they contain saturated fats and by using low fat dairy products and spreads.

Cut down on saturated fat which increases cholesterol. Avoid processed foods and ready-made meals whose labels show they contain saturated fats.

Read the Irish Heart Foundation's A healthy cholesterol for a happy heart leaflet.

Manage your weight

Being overweight increases your risk of high blood pressure and diabetes, which increases stroke risk. Even losing a small amount of excess weight can help lower your blood pressure. Aim for a gradual weight loss of one to two pounds a week and watch the size of your food portions. The best way to lose weight is to cut down on the amount of fat, sugar, sweet foods and sugary drinks and aim to be more physically active.

Drink less alcohol
If you do drink, spread your drinking over the week and keep some days alcohol-free. Experts recommend that adult women should drink less than 14 standard alcoholic drinks per week. Adult men should drink less than 21 standard drinks per week.

Remember that alcohol is a drug and may be a risk for other health problems.
1 standard drink (10 grams of alcohol)
= one half pint of beer, stout or lager
= one small glass of wine
= one pub measure of spirits (whiskey, vodka or gin)

Prevent or manage diabetes

If you have diabetes you have a greater risk of stroke. Diabetes occurs when your blood sugar (glucose) is too high. Insulin, a hormone produced by your body, helps controls your blood glucose. If your body does not produce enough insulin (described as Type 1 diabetes) or when your body does not respond as well to insulin (described as Type 2 diabetes). Prevent or manage diabetes by watching your diet, being more physically active, controlling your weight and managing your blood pressure.

Be more physically active

Having an active lifestyle can reduce your risk of having a stroke. Regular physical activity helps lower blood pressure, maintain a healthy weight and control blood sugar levels, and also increases levels of ‘good’ (HDL) cholesterol.

How much activity?
To reduce your risk of stroke all adults and older people need to be active for at least thirty minutes five days a week, at a moderate intensity. An activity of moderate intensity causes an increase in breathing and heart rate. Just like when you go for a brisk walk. You can break up your 30 minutes of activity throughout the day into smaller chunks, for example15 minutes of walking and15 minutes of dancing. If you are breaking up your minutes of activity each session needs to be for 10 minutes or longer to get the health benefits.

Read the Irish Heart Foundations Be active leaflet.

To lose weight
To lose weight, you need to increase your physical activity levels. Aim to be active at a moderate intensity for 60-75 minutes 5 days a week.

Read the Irish Heart Foundation's Are you ready to lose weight? leaflet.

Tips for being more active

Choose an activity you enjoy.
Get active with a friend.
Set yourself a goal which is achievable, for example a walk during lunch three times a week.
Listen to your body and stop exercising if you feel unwell, have pain or feel dizzy.
Consult your doctor before exercising if you are unsure or have a health problem.
Prevent or manage diabetes

You can prevent or manage diabetes by following a healthy diet low in fat and rich in fruit & vegetables, being more physically active, controlling your weight and managing your blood pressure.

Manage your stress

The link between stress and stroke is complex and not fully understood. If you feel stressed, your blood will produce more hormones. Although useful in small amounts, over time too many of these hormones can damage your blood vessels and may lead to high blood pressure. When life becomes pressurised, you are also more like likely to smoke more cigarettes, drink more caffeine, drink too much alcohol and be less physically active. All of these increase your risk of stroke.
Types of stress
Many life events such as moving house, changing jobs, losing a job, family problems and bereavement can cause stress. Daily hassles such as being stuck in traffic, deadlines or arguments can also cause stress. Identify what makes you stressed and learn to manage them as best you can or talk to a professional.
Stress busters

Work off stress by being more physically active.
Talk to someone you really trust.
Learn to accept what you cannot change.
Get enough sleep and rest to recharge your batteries.
Take one thing at time.
Agree with somebody. Life doesn’t have to be a constant battleground.
Manage your time better.
Plan ahead and learn to say ‘no’.
Take up a hobby.
Eat a variety of foods.
Learn to relax. Try going to the cinema, listening to music or reading.

Regular physical activity helps lower blood pressure, keeps cholesterol at a healthy level, prevents blood clotting, maintains a healthy weight and controls blood sugar levels.

Read the Irish Heart Foundation's Manage your stress leaflet.