3 Strategies to prevent a second stroke

Prevention Stroke Wellness

You are only 52 years old and in a state of disbelief. “How could this happen to me?”

You knew that older people had strokes, but it was never anything you thought could happen to you, especially before the age of 60. One thing is certain: you want to do everything you can to make sure it doesn’t happen again.

What are the odds?

It is important that you and your doctor start working on prevention as soon as possible. Most people, and even many doctors, don’t realize that the risk of a recurrent stroke is as high as 12.8 percent in the first week after a TIA (transient ischemic attack). If you do not change certain lifestyle factors, the risk of a second stroke within the next five years can be as high as 30 percent. Waiting is not an option Ten risk factors that account for 90 percent of all strokes (in no particular order). 

  • High blood pressure
  • Smoking
  • Waist size-obesity
  • Poor diet
  • Lack of physical activity
  • Diabetes Mellitus
  • Excessive alcohol consumption
  • Psychosocial stress/depression
  • Atrial fibrillation or previous heart attack
  • High cholesterol 

Fortunately, 80 percent of recurrent strokes can be prevented with diet modification, exercise, blood pressure control, cholesterol reduction with the help of statins, and treatment with anti-platelet medications. Ideally, you will focus on every possible risk factor. However, that can be overwhelming, so let’s  start with the big three.

Blood pressure control

Hypertension is the single most common cause of stroke and it is estimated that 75 million people—that’s one-fourth of the United States population—have high blood pressure.  When you control your blood pressure through the use of antihypertensive medication you reduce the risk of a first stroke by 32 percent. In patients who have had a TIA or a stroke, treatment of high blood pressure reduces the risk of a recurrent stroke by 28 percent. The exact blood pressure number you need to shoot for is a decision unique to each person and should be made in consultation with your physician. 

Statins to lower cholesterol

Statins are a group of medications that have revolutionized the treatment of high cholesterol.  They have been touted for the treatment of many disorders, but the facts are clear: statins reduce the risk of a recurrent stroke by 25 percent. 

Statins lower LDL— our “bad cholesterol.”  Over the last few years doctors have steadily lowered the ideal level for LDL in people who are at risk for stroke or have an elevated LDL. The latest goal is less than 70mg/dl.  Most physicians now add statin therapy to the discharge instructions that you receive when you leave the hospital after a stroke. An exception may be hemorrhagic strokes, an event where the stroke is caused by bleeding in the brain.   

Anti-platelet agents

Commonly referred to as “blood thinners,” anti-platelet agents attack the tiny platelets and make the blood less sticky and less likely to form blood clots.  This is good if you are trying to prevent a blood clot from forming in an artery in the brain or heart. More good news—anti-platelet agents reduce the risk of a recurrent stroke by 25 percent.

The most commonly used medication is low-dose aspirin (25mg to 325mg), which is just as effective as higher doses and has fewer side effects. Clopidogrel (Plavix®) and aspirin plus dipyridamole (Aggrenox®) both decrease the risk of recurrent stroke to the same degree as aspirin. All three are acceptable forms of treatment, but low dose aspirin is much less expensive.  A study looked at whether the combination of aspirin and clopidogrel might be more effective, but the study was discontinued because of excessive episodes of bleeding in the brain and death. As a result, combination therapy is only recommended for the first 90 days after an ischemic stroke. 

The obvious question, “Should I take a daily low dose aspirin even if I have not had a stroke or heart attack?”

The less than satisfying answer is, “It depends.”  

As a rule the answer is “no,” unless you have multiple risk factors that put you at high risk for stroke or heart disease.

It is easy to revert back to your old habits and continue to put yourself at a high risk for another stroke or heart attack. Take a few moments, meet with your doctor and start changing the way you live—it just may save your life. 

It can be difficult to stay positive after a stroke or serious illness, but there are still many things in our lives that bring us happiness. How can you nurture as sense of gratitude at a difficult time in your life? 

Gratitude is defined as a positive, social emotion that is positively associated with features of high quality, healthy social relationships and fosters socially productive behaviors. That may sound confusing, but ask yourself, “Why is it that the person earning $30,000/year may be happier than a millionaire?” It may be that they are thankful for what they have, while the unhappy millionaire may only see the glass as half full, wanting a bigger house or fancier car. Cultivating gratitude and directing it toward other people is integral to satisfying social relationships, health and well being. Grateful people are more optimistic and happy, deal better with difficult experiences, while benefiting their health, immune system and sleep.

What can you do?

So, how can you nurture gratitude in your life? Try starting a Gratitude Journal. Each morning write down three things you are grateful for. Many mornings it may be the same three: your spouse, your family and your friends. At the end of each day repeat the same exercise plus look for specific things that happened during the day for which you are grateful. You can purchase a gratitude journal on line, but you can also just use a blank notebook or the notes section of your smartphone.  

You may be thinking, “I don’t have time for this.” But, it is like the old story that if you say you don’t have time to meditate, you need to meditate.  Here’s another opportunity to help yourself. It is time to start a “Gratitude Journal.” You will be surprised how many ways you can still express gratitude. You and the people around you will feel better. 

Encompass Health is a national sponsor of the American Heart Association/American Stroke Association’s Together to End Stroke. For more information on stroke prevention visit our Life After Stroke guide for patients and caregivers.