Preventing a stroke

Every  year, more than 10,000 people in Ireland have a stroke.  Stroke is the biggest cause of acquired disability and  third biggest cause of death in this country. Two thirds of those who have a stroke are aged 65 years and older, but stroke can occur at any age.

Your risk of getting a stroke is increased  by certain things in your  lifestyle which you can change, and by certain things about you, such as your age or your family history, which you cannot change.

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. The health benefits of stopping smoking, reducing your cholesterol and blood pressure, eating a healthy diet and being more active have a big impact on reducing your risk of stroke and preventing further strokes.

Risk factors for stroke that you can change

High blood pressure

High blood pressure is the leading cause of stroke; it causes your blood vessels to lose their elasticity and encourages the build up of fatty deposits inside your blood vessels.

Smoking

Smoking doubles your risk of stroke; it causes your blood vessels to narrow and makes your blood more likely to clot. Passive smoking also increases your risk of stroke.

High cholesterol

Having a high cholesterol level leads to a build up of fatty deposits in your blood vessels causing them to narrow and harden.

Poor diet

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

Read the Irish Heart Foundation's Good eating leaflet. 

Alcohol

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

Physical inactivity

Not being active on a regular basis at a moderate intensity increases your risk of stroke by 50%. Moderate intensity causes an increase in your breathing and heart rate, similar to a brisk walk.

Read the Irish Heart Foundation's Be active leaflet.

Diabetes

Diabetes damages your blood vessels and raises your risk of high blood pressure.

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

Risk factors for stroke that you cannot change

Age

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 a parent, grandparent, sister or brother has had a stroke.

Ethnicity (race)

People of African, Asian and African-Caribbean origin are more at risk of stroke as they have higher risk of having high blood pressure and diabetes.

Other medical conditions

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

Atrial fibrillation (irregular heartbeat)

Atrial fibrillation causes an irregular heart beat which can cause the blood to clot. A blood clot can enter the bloodstream and lodge in your blood vessel  supplying your brain, causing a stroke.

Other diseases of the heart

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

How can you reduce your risk of stroke?

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 blood pressure. One records blood pressure at its highest as the heart muscle squeezes out the blood from the heart - this is called systolic pressure. Then the heart relaxes, which 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 140 over 90, you should discuss this with your doctor. One high reading does not necessarily mean you have seriously 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 include age, family history, eating too much salt, not eating enough fruit and vegetables, drinking too much alcohol, being overweight, not doing enough physical activity, diabetes, smoking, high cholesterol.

Read the Irish Heart Foundation's Love your heart, lower your blood pressure magazine.

Read the Irish Heart Foundation's What is blood pressure all about? leaflet.

Medication

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

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, the chance of you suffering a stroke begins to fall.

Tips for stopping smoking   

Prepare to stop smoking
Write down your reasons for stopping and keep the list to hand.

Make a date to stop
Pick your day to stop and stick to it.

Get support
Ask friends or family for support or to stop smoking with you.

Think positive
You may find you experience withdrawal symptoms once you stop smoking. Withdrawal symptoms are positive signs that your body is recovering from the effects of tobacco and they will disappear within a week or two.

Learn to deal with cravings
Cravings can happen during the first few days after stopping. They get worse for three to five minutes and then begin to disappear. So when cravings start, apply the 4D’s: Delay at least three minutes - the urge will pass; Drink a glass of water; Distract yourself; Deep breathe.

If you need extra help with stopping smoking
For extra help with stopping smoking contact call the National Smokers’ Quitline on 1850 201 203 or visit www.giveupsmoking.ie. Ask your doctor or pharmacist for advice about products to help you stop smoking such as nicotine replacement products (NRT) or non- nicotine medication such as Zyban and champix which are only available on prescription from your doctor, if you find stopping smoking difficult.

Read the Irish Heart Foundation's Stop smoking for a healthy and happy heart leaflet.

Eat a balanced diet

Healthy eating can reduce your risk of stroke.  Aim to eat a wide variety of foods. Using the Food Pyramid as a guide will help make sure you get all the vitamins, minerals, fibre  and goodness you need from your food. Choose most foods from the bottom two shelves, smaller amounts from the next two shelves and a very small amount from the top shelf.

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

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

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.

Salt
Avoid adding salt when cooking or at the table. Use herbs, spices or lemon juice for flavour instead. Too much salt in your diet can increase your blood pressure level which increases your risk of stroke. An acceptable maximum level of salt is 6 grams or 1 teaspoon of salt. However many people exceed this and eat on average about 9-10 grams per day.  Most of the salt we eat (about 75%) comes from processed foods, fast food, or canteen / restaurant food. 

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

Saturated Fat 
Fats in food are  mixture of saturated and unsaturated fats. Saturated fats are found in foods like butter, hard margarine, lard, cheese, fatty meat, cakes, biscuits and chocolates. Unsaturated fats which can help lower cholesterol 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 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, heart disease and diabetes – all of which increase stroke risk.  Even losing a small amount of excess weight, say 10% 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, keep some days alcohol-free and do not drink more than the recommended upper limits: for men 21 standard drinks a week. For women, 14 standard drinks a 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  

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. 

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. Moderate intensity activity causes an increase in breathing and heart rate, similar to a brisk walk.  You can break up your minutes of activity throughout the day for example 2x 15 minutes – 15 minutes walking, 15 minutes 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 for a happy heart leaflet.

To lose weight    

To lose weight, you need to do more physical activity than  is recommended for adults at a healthy weight. Aim to be active for at least 60 -75 minutes per day at a moderate intensity.

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

Tips for being more active

• Choose an activity your enjoy
• Get active with a friend
• Set yourself a goal which is achievable, for example a walk during lunch three times a wee
• Listen to your body - 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.

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, too many of these hormones continuously and over time, can damage your blood vessels and may lead to high blood pressure. Also when life becomes pressurised, you are 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 stressors
Many life events such as moving house, changing jobs, redundancy, family problems and bereavement can cause stress. Daily hassles such as being stuck in traffic, deadlines or conflicts can also cause stress. Identify your stressors 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.

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