Preventing stroke: A guide to lowering your risk and achieving a healthier life
There are many things one can do to achieve a stroke-free life
STROKE remains one of the leading causes of death worldwide. However, the far-reaching impact of stroke is not limited to those who succumb to it, but also extends to the survivors who often require substantial societal resources to reintegrate into society and achieve independence. This new year presents an ideal opportunity to make meaningful lifestyle changes to lower the likelihood of experiencing a stroke.
Diet: The foundation of stroke prevention
The prevention of stroke starts with the choices we make in our daily lives, particularly with regard to our diet. While numerous diets claim to offer health benefits, one diet stands out for its proven ability to reduce the risk of stroke: the Mediterranean diet.
Endorsed by the American Heart Association (AHA), the Mediterranean diet has consistently shown benefits in stroke prevention. This diet is rich in fruit, vegetables, whole grains, fish, olive oil and nuts while being low in red meat and processed foods. Another essential dietary adjustment is reducing salt intake. Excessive sodium in the diet is linked to high blood pressure, a major risk factor for stroke.
As for supplements, it is crucial to note that many commonly taken vitamins, including vitamin C, vitamin E, selenium, antioxidants and calcium (either with or without vitamin D), have shown no benefits in preventing stroke.
A large study of over 14,000 male physicians revealed that taking supplements like Centrum Silver for over a decade did not lower the risk of stroke. Similarly, despite the widespread popularity of fish oil supplements, meta-analyses of multiple trials have consistently shown no stroke prevention benefits from long-chain fatty acids.
However, there is good news for those who prefer vitamin supplementation. The B-complex vitamins, which include vitamin B6, folic acid and vitamin B12, have shown promise in reducing stroke risk. A review of 12 trials published in the 2024 AHA/ASA (American Stroke Association) guidelines found that B-complex supplementation was associated with a reduced risk of stroke in nine of the studies reviewed.
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Physical exercise: A powerful stroke prevention tool
Exercise is another vital component in preventing stroke. A study published in 2024 in Shanghai, which followed over 42,000 adults, found that the risk of stroke began to increase after individuals spent more than 3.7 hours per day sitting. The risk increased by 6 per cent for each additional hour spent in sedentary behaviour above 6.5 hours a day, and by 21 per cent for each hour beyond 11 hours a day.
The message is clear: reducing sedentary behaviour and incorporating physical activity into daily life is essential for stroke prevention. Importantly, any level of physical activity is better than none. Even small amounts of physical activity (starting at just one to 150 minutes per week) can yield significant benefits, with the impact growing as the duration of exercise increases.
The current exercise guidelines recommend at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity activity each week. For stroke prevention, the key takeaway is to get moving and reduce sedentary time.
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Weight and obesity: Addressing a growing risk factor
Obesity, defined by a body mass index (BMI) of 30 or higher, is a well-established risk factor for stroke. A 2018 meta-analysis of 44 studies published in Nutrition, Metabolism and Cardiovascular Diseases found that each 5 kg/m² increase in BMI was associated with a 10 per cent higher risk of stroke. Conversely, weight loss has been shown to reduce stroke risk.
For individuals with obesity, significant weight loss through weight-loss surgery can reduce the risk of stroke by one-third. The benefits of weight loss go beyond reducing stroke risk, by improving overall health outcomes and enhancing quality of life.
Obstructive sleep apnea: A silent risk factor
Obstructive sleep apnea (OSA) is a condition characterised by repeated interruptions in breathing during sleep, leading to lowered oxygen levels and fragmented sleep. OSA is a known independent risk factor for stroke, primarily because it contributes to hypertension, which in turn increases stroke risk. Individuals with OSA may also experience daytime sleepiness, memory problems and difficulty concentrating.
Continuous positive airway pressure (CPAP) therapy is the standard treatment for moderate to severe OSA, and has been shown to reduce symptoms such as daytime sleepiness and high blood pressure. While studies on CPAP’s direct impact on stroke risk have produced mixed results; the therapy is effective in improving the overall health of individuals with OSA by reducing blood pressure and promoting better sleep quality.
Blood glucose: Managing diabetes to reduce stroke risk
With the rise in urbanisation and modern lifestyles, elevated blood sugar has become an increasingly common issue. Blood sugar is considered elevated (prediabetes) when fasting plasma glucose exceeds 100 mg/dl, or when the haemoglobin A1c (HbA1c is a blood test that measures the average blood sugar level over the past three months) level reaches 5.7 per cent or more. Diabetes is diagnosed when fasting blood glucose is 126 mg/dl or higher, or the HbA1c level is 6.5 per cent or more.
Both prediabetes and diabetes significantly increase the risk of stroke. In fact, for each 1 per cent increase in HbA1c, the risk of stroke rises by 12 per cent. Managing blood glucose through diet, exercise and when necessary, medication, can substantially reduce the risk of stroke.
Blood pressure: The leading stroke risk factor
Elevated blood pressure (BP), particularly systolic BP, is the most significant modifiable risk factor for stroke. The goal for most individuals is to keep BP below 140/90 mm Hg, although many will need two or more medications to achieve this target.
BP trials show that single drug therapy can only achieve a BP target of less than 140/90 mm Hg in less than or equal to 30 per cent of patients. This emphasises that managing blood pressure, especially in individuals at high risk, often requires multiple drug therapy to ensure optimal control.
Lipid management: Lowering cholesterol to prevent stroke
Cholesterol management is another critical aspect of stroke prevention. Though stroke-specific, lipid-lowering trials are limited, studies show that managing cholesterol, particularly through statins, reduces the risk of a first stroke in at-risk populations.
Recent studies have also debunked the myth that lowering low-density lipoprotein cholesterol (LDL-C or “bad” cholesterol) increases the risk of brain haemorrhage. On the contrary, statins have been shown to reduce stroke risk without increasing the incidence of brain bleeds, further supporting the need for cholesterol management in stroke prevention.
Smoking: A major risk factor for stroke
Tobacco use is one of the most significant modifiable risk factors for stroke, responsible for approximately 18 per cent of stroke-related deaths and disabilities globally. Smoking-related strokes occur regardless of age, sex or race, and contribute significantly to stroke mortality.
The good news is that quitting smoking can dramatically lower stroke risk. Smoking cessation, when combined with pharmacotherapy and behavioural counselling, is the most effective way to reduce stroke risk. Even those who have been smoking for years can benefit from quitting, with the risk of stroke decreasing significantly over time.
Conclusion: Starting the year on the right foot
Adopting a healthy diet, engaging in regular physical activity, managing weight, controlling blood pressure and blood glucose, and quitting smoking are all critical steps towards achieving a stroke-free life. Let this be the year that we start making decisions that will lead to a healthier, longer life.
This article is part of a monthly series on health and well-being, produced in collaboration with Royal Healthcare
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