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August 20, 2014, 4:44 am

Guidelines on how to prevent strokes

What is a stroke? Can I prevent myself from falling victim? I have two family members who have had strokes.

Lois, Atlanta, Ga.

Stroke is the third leading killer in the United States and the No. 1 cause of adult disability. Some 750,000 people suffer new or recurrent strokes in the United States each year, and 160,000 of these people will die. There are 5.5 million US stroke survivors. While some stroke victims can recover completely, more than 2/3 of all survivors will have some type of disability. Every 45 seconds in the U.S., someone has a stroke. The economic impact can cost as much as $40–$70 billion per year. While women account for 6 in 10 stroke deaths, Black Americans are affected by stroke more often than any other U.S. group. Black Americans are twice as likely to die from stroke as white Americans. Half of all nursing home admissions are stroke victims. The number one reason for nursing home admissions is stroke. According to the American Stroke Association, 80 percent of all strokes are preventable.

A stroke or “brain attack” occurs when a blood vessel that carries oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Ruptures and blockages prevent the brain from getting the blood and oxygen it needs. Without them, nerve cells in the brain die within minutes.

When brain cells die during a stroke, the brain’s ability to control various areas of the brain are lost. These abilities can include speech, movement and memory. How a stroke patient’s brain is affected depends on where the stroke occurs in the brain and how much the brain is damaged.

A stroke is a medical emergency. You should know the warning signs of stroke. 50 percent of all stroke victims have no warning signs. After the age of 55, the risks of stroke can double every 10 years. 97 percent of the US adult population cannot identify the warning signs for a stroke.

These signs include:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

Sudden confusion, trouble speaking or understanding.

Sudden trouble seeing in one or both eyes.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden, severe headache with no known cause.

Any of these symptoms can be temporary and can last for as little as a few minutes. This condition is called a “mini-stroke” or a “transient ischemic attack” (TIA). TIAs can be good indicators of a future stroke.

“Stroke Prevention Guidelines” were established by National Stroke Association’s Stroke Prevention Advisory Board, an elite group of the U.S.’s leading experts on stroke prevention. The guidelines were first published in a 1999 issue of the Journal of the American Medical Association (JAMA) and have been updated to reflect current medical standards.

Stroke Prevention Guidelines

1. Know your blood pressure. Have it checked at least annually. If it is elevated, work with your doctor to keep it under control. High blood pressure (hypertension) is a leading cause of stroke. You can check your blood pressure at your doctor’s office, at health fairs, at home with an automatic blood pressure machine, or at your local pharmacy or supermarket. If the higher number (your systolic blood pressure) is consistently above 120 or if the lower number (your diastolic blood pressure) is consistently over 80, talk to your doctor.

If your doctor decides that you have high blood pressure, he or she may recommend some changes in your diet, regular exercise, or medicine. Blood pressure drugs have improved. Once you and your doctor find the right medicine for you, it will almost never cause side effects or interfere with your quality of life.

2. Find out if you have arterial fibrillation. Arterial fibrillation is an irregular heartbeat that changes how your heart works and allows blood to collect in its chambers. This blood, which is not moving through your body, tends to clot. The beating of your heart can move one of these blood clots into your bloodstream, and can cause a stroke. Your doctor can diagnose this by carefully taking your pulse. It can be confirmed or ruled out with an electrocardiogram (a recording of the electrical activity of the heart), which can probably be done in your doctor’s office. If you have atrial fibrillation, your doctor may choose to lower your risk for stroke by prescribing medicines called blood thinners. Aspirin and warfarin (Coumadin) are the most commonly prescribed treatments

3. If you smoke, stop. Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will immediately begin to drop. Quitting smoking today can significantly reduce your risk of stroke from this factor.

4. If you drink alcohol, do so in moderation.

Studies now show that drinking up to two alcoholic drinks per day can reduce your risk for stroke by about half. More alcohol than this each day can increase your risk by as much as three times, and can also lead to liver disease, accidents and more. If you drink, we recommend no more than two drinks each day, and if you don’t drink, don’t start!

Remember that alcohol is a drug and it can interact with some other drugs. It’s a good idea to ask your doctor or pharmacist if any of the medicines you are taking could interact with alcohol.

5. Find out if you have high cholesterol (a soft, waxy fat in the bloodstream and in all body cells). Know your cholesterol number. If your total cholesterol level (LDL and HDL) is over 200, talk to your doctor. You may be at increased risk for stroke. LDL, known as the “bad” cholesterol, is the form that builds up and causes plaque, which may narrow arteries and limit or stop blood flow. LDL can be inherited from your family members or be a result of your body chemistry. It can also be the result of a diet high in saturated fats, lack of exercise, or diabetes. HDL is the “good” cholesterol that sweeps the blood and removes plaque. Lowering your cholesterol (if elevated) may reduce your risk for stroke. High cholesterol can be controlled in many individuals with diet and exercise. Some individuals with high cholesterol may require medicine.

6. If you are diabetic, follow your doctor’s advice carefully to control your diabetes. Often, diabetes may be controlled through careful attention to what you eat. Work with your doctor and your dietitian (a health-care professional who helps promote good health through proper eating) to develop a healthy eating program that fits your lifestyle. Your doctor can prescribe lifestyle changes and medicine that can help control your diabetes. Having diabetes puts you at an increased risk for stroke; by controlling your diabetes, you may lower your risk for stroke.

7. Exercise. Include exercise in your daily activities. A brisk walk for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke. Try walking with a friend; this will make it more likely that you’ll make it a habit. If you don’t enjoy walking, choose another exercise or activity that you do enjoy, such as biking, swimming, golf, tennis, dance, or aerobics. Make time each day to take care of yourself by exercising.

8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most important, lower your risk for stroke. Work toward a balanced diet each day with plenty of fruits, vegetables, grains, and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu and some beans). Adding fiber, such as whole-grain bread and cereal products, raw, unpeeled fruits and vegetables and dried beans to the diet can reduce cholesterol levels by 6 to 19 percent.

9. Circulation (movement of the blood through the heart and blood vessels) problems. Ask your doctor if you have circulation problems, which increase your risk for stroke.

Strokes can be caused by problems with your heart (pump), arteries and veins (tubes), or the blood which flows through them. Together, they are your circulation. Your doctor can check to see if you have problems in the circulation supplying blood to your brain.

Fatty deposits caused by atherosclerosis (a hardening or buildup of cholesterol, plaque and other fatty deposits in the arteries) or other diseases can block the arteries, which carry blood from your heart to your brain. These arteries, located on each side of your neck, are called carotid and vertebral arteries. This kind of blockage, if left untreated, can cause stroke. Doctors can test for this problem. They can listen to your arteries just as they listen to your heart, or look at X-rays called ultrasound or MRI images.

If you have blood problems such as sickle cell disease, severe anemia (lower than normal number of red blood cells), or other diseases, work with your doctor to manage these problems. Left untreated, these can cause strokes.

Circulation problems can usually be treated with medicines. If your doctor prescribes aspirin, warfarin (Coumadin), ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Aggrenox), or other medicine for circulation problems, take it exactly as prescribed.

Occasionally, surgery is necessary to correct circulation problems such as a blocked artery.

10. Symptoms. If you have any stroke symptoms, seek immediate medical attention.

If you think someone may be having a stroke, act F.A.S.T. and do this simple test:



Ask the person to smile.


Does one side of the face droop?


Ask the person to raise both arms.


Does one arm drift downward?


Ask the person to repeat a simple sentence.


Are the words slurred? Can he/she repeat the sentence correctly?


If the person shows any of these symptoms, time is important.


Call 911 or get to the hospital fast. Brain cells are dying.

Eighty percent of all strokes are preventable.


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