Prevention
Sutter Stroke Center

It is a great myth that strokes cannot be prevented.  Some strokes do result from congenital defects and age, sex and genetic factors can put one person more at risk than another, but the vast majority of strokes are caused by conditions within the patient’s control: high blood pressure, heart disease, smoking, diabetes and high cholesterol. 

Sutter Stroke Center offers exceptional diagnostic and treatment tools, as well as surgical skills to help prevent stroke even in those patients at risk through birth defects, trauma, unruptured aneurysms and other serious conditions.  As part of Sutter Neuroscience Institute, the center has access to Sutter Gamma Knife Radiosurgery Center for non-invasive treatment of arteriovascular malformations.  Sutter Stroke Center also offers the skill of a endovascular surgical neuroradiology specialist who can treat aneurysm through endovascular coiling techniques [link to 2.4 Treatment section on Hemorrhagic Stroke] before they rupture and cause damage. 

Uncontrollable risk factors
In addition to birth defects, risk factors beyond our control include:

• Increasing age – Strokes can happen at any age, but after age 55 the risk of stroke doubles with every decade.
• Gender – Men are at greater risk for stroke, but more women than men die of stroke each year.
• Race and ethnicity – Studies show that the risk of stroke for African-Americans is almost double that of white Americans, and African-Americans who have a stroke are twice as likely to die from the event compared to white Americans.  After age 55, the difference evens out.  Hispanics, Native Americans and Asian-Americans share comparable rates of stroke and resulting death as white Americans.
• Stroke family history – Some families have a higher incidence of stroke than others, which may result from genetic tendencies toward diabetes, high-blood pressure or other related conditions.  In other instances, the tendency could be associated with shared eating and lifestyle habits known to put a person at risk of stroke. 

Even patients genetically predisposed to stroke can take measures to prevent stroke from happening.  Talk with your doctor about your genetic risk factors and find out what steps you can take.  The earlier you begin a program to control your risk, the better your chances of avoiding a stroke.

Risk factors you can modify
Many of the risk factors associated with stroke are the same as those for heart disease.  The following list offers the most common controllable factors:

• High blood pressure – The great preventable contributor to stroke is high blood pressure (hypertension), which can lead to atherosclerosis and brain aneurysms. Medication to control high blood pressure can reduce the risk of stroke by nearly 40 percent.
• Atrial fibrillation and other heart conditions – The second greatest risk factor is atrial fibrillation, where one chamber of the heart beats faster than the others, causing blood to pool and clot within the heart.  When those clots leave the heart and travel to the brain, strokes can result.  Other heart conditions, including valve problems and muscle malformations can cause similar problems.
• High cholesterol – Cholesterol and calcium create a fatty buildup in blood vessels called plaque.  Plaque narrows the arteries and can break off and travel to the brain.  A healthy diet and exercise are the best ways to control cholesterol, though medications can also bring cholesterol levels under control and significantly reduce the risk of stroke.  
• Diabetes – Due to the circulation problems related to diabetes, people with diabetes have three times the risk for stroke and about one-quarter of people with diabetes will die from strokes.  Controlling body weight and monitoring blood sugar levels can protect against the risk of stroke.

Medical treatment of stroke risk factors, along with a healthy diet and exercise can significantly reduce the risk of stroke.  If you haven’t been checked for diabetes, high blood pressure or high  cholesterol, or if you have experienced any heart palpitations or irregular pulse, make an appointment to see your doctor to find out where you stand in relation to stroke risk.

Risk factors you can eliminate
Certain habits that put people at great risk of stroke are completely under their control. 

• Smoking – Smoking is directly responsible for the greatest percentage of strokes in young people.  The more a person smokes, the greater the risk.  Even exposure to second-hand smoke increases a person’s risk.  The message is simple—if you smoke, quit. 
• Heavy alcohol consumption – Heavy drinkers and especially binge drinkers (those who consume five or more drinks in a short time) are at far greater risk for stroke than light drinkers or those who don’t drink at all. 
• Illicit drugs – Certain illegal drugs, such as cocaine and crack cocaine, can constrict blood vessels and cause heart beat irregularities that lead to strokes—even in young adults with no other risk factors.  Amphetamines, marijuana, and even legal drugs such as caffeine and pseudoephedrine (found in many decongestants), have been found to contribute to stroke risk. 
• Hormones – Birth control pills and hormone replacement therapy can increase the chance of stroke, especially in women with a history of clotting disorders.     

Changing poor lifestyle habits, combined with understanding and controlling risk factors can make the difference in whether or not you become one of the 750,000 people who experience a stroke each year.

Find out more
For additional information, please see stroke in our health information section.  You can find additional information by calling the American Stroke Association at 1-888-4STROKE or by visiting their Web site at www.strokeassociation.org.  If you or someone you know has had a stroke, please call the American Stroke Association “Warmline” at 1-800-553-6321.  Ask about how you can receive their award-winning Stroke Connection Magazine.  In addition, the National Institute of Health’s National Institute of Neurological Disorders and Stroke offers booklets and additional information.  You can also find useful information on the National Stroke Association Web site.