Primary Stroke Prevention
Preventing Stroke: A Guide to Primary Prevention
Hornik Neuroscience Associates
Understanding Stroke Prevention
Stroke is a leading cause of disability and death, but the good news is that up to 80% of strokes can be prevented with the right lifestyle choices and medical care. The 2024 Guidelines for the Primary Prevention of Stroke from the American Heart Association provide clear recommendations to help individuals lower their stroke risk.
This guide outlines key strategies for stroke prevention, covering lifestyle changes, medical management, and risk reduction for high-risk individuals.
What is Primary vs. Secondary Stroke Prevention?
• Primary Stroke Prevention focuses on preventing a first stroke from occurring. This involves identifying and managing risk factors such as high blood pressure, high cholesterol, diabetes, and unhealthy lifestyle habits before any stroke has happened.
• Secondary Stroke Prevention is aimed at individuals who have already experienced a stroke or transient ischemic attack (TIA). The goal is to prevent another stroke by aggressively managing risk factors and addressing underlying causes, such as blockages in blood vessels or atrial fibrillation.
This guide focuses on primary stroke prevention—the steps you can take to reduce your risk before a stroke occurs.
1. Healthy Lifestyle Habits for Stroke Prevention
Healthy Eating and Diet
A heart-healthy diet is one of the most effective ways to reduce stroke risk. The Mediterranean diet is recommended, which includes:
✔ Plenty of fruits and vegetables
✔ Whole grains, nuts, and legumes
✔ Healthy fats such as olive oil
✔ Lean proteins, including fish and poultry
Avoiding processed foods, excessive salt, and added sugars is also crucial. Diets that are low in fat have not been shown to reduce stroke risk significantly.
Physical Activity and Exercise
Regular exercise improves heart and brain health. The recommendation is:
✔ At least 150 minutes per week of moderate-intensity exercise (such as brisk walking)
✔ Or 75 minutes per week of vigorous exercise (such as jogging or cycling)
✔ Reducing sitting time throughout the day
Even small increases in activity make a difference—any movement is better than none!
Smoking and Alcohol
✔ Quit smoking completely—this is one of the most effective ways to lower stroke risk. Secondhand smoke exposure should also be avoided.
✔ Limit alcohol consumption—heavy drinking increases the risk of stroke, so moderation is key.
Sleep and Stress Management
✔ Aim for 7–9 hours of quality sleep per night. Poor sleep, including obstructive sleep apnea, is linked to higher stroke risk.
✔ Managing stress and mental health is important, as chronic stress and depression can contribute to stroke risk.
2. Managing Medical Conditions That Increase Stroke Risk
Blood Pressure Control
High blood pressure (hypertension) is the number one modifiable risk factor for stroke. The goal is to keep blood pressure below 130/80 mmHg. This may require:
✔ Lifestyle changes such as diet and exercise
✔ Medications, often in combination, as most people need more than one medication to achieve good control
Cholesterol and Lipid Management
✔ Statin therapy is recommended for individuals at high cardiovascular risk to lower LDL cholesterol and reduce stroke risk.
✔ For those who cannot tolerate statins, alternatives such as PCSK9 inhibitors or bempedoic acid may be considered, but their effectiveness in stroke prevention is still being studied.
Diabetes and Blood Sugar Control
✔ Strict glucose control can help reduce cardiovascular events in diabetes, though its effects on stroke prevention are still being researched.
✔ Glucagon-like peptide-1 (GLP-1) receptor agonists can help control blood sugar and may reduce stroke risk in diabetic patients at high cardiovascular risk.
Atrial Fibrillation (AFib) and Heart Disease
✔ People with AFib (an irregular heartbeat) have a significantly higher risk of stroke.
✔ If you have AFib, your doctor will assess your risk using the CHA₂DS₂-VASc score to determine if you need blood thinners (anticoagulants) to prevent stroke.
3. Who is at Higher Risk? Special Populations & Stroke Prevention
Some people have additional risk factors that require special attention:
Women’s Health & Stroke Risk
✔ Pregnancy-related high blood pressure, endometriosis, and early menopause increase the risk of stroke. Women should be screened for these conditions and take steps to control other risk factors.
✔ Women with migraine with aura should avoid combined hormonal contraception, as it increases stroke risk.
Sickle Cell Disease & Stroke
✔ Individuals with sickle cell disease should be monitored for stroke risk early in life. Chronic blood transfusions may be necessary in high-risk cases.
Transgender Health
✔ Transgender women taking estrogen therapy have a higher stroke risk. It is important for healthcare providers to monitor and manage other risk factors.
4. Medications & Stroke Prevention: What You Need to Know
Aspirin & Antiplatelet Therapy
✔ Aspirin is NOT recommended for stroke prevention in most healthy adults.
✔ In some cases (such as those with coronary artery disease), a doctor may recommend aspirin or ticagrelor for stroke prevention, but this should be discussed on an individual basis.
Anticoagulation for High-Risk Patients
✔ Blood thinners (anticoagulants) such as warfarin or direct oral anticoagulants (DOACs) are recommended for patients with atrial fibrillation and other high-risk conditions.
5. The Role of Social and Environmental Factors
Social and economic factors also play a role in stroke risk. Access to healthy food, healthcare, and medication can be limited by financial barriers. If you or a loved one face challenges in managing stroke risk, consider:
✔ Speaking with a healthcare provider about affordable treatment options
✔ Seeking community support programs for nutrition, exercise, and smoking cessation
Screening for food insecurity, transportation barriers, and healthcare access can help identify and address risks beyond medical conditions.
6. Take Action Today!
Preventing a stroke starts with making informed choices today. Whether it’s improving diet, increasing physical activity, controlling blood pressure, or discussing risk factors with your doctor, small changes can make a big difference