What's your stroke risk?

Stroke rates are rising, with over half a million Americans having a first stroke every year. But up to 80% of strokes may be preventable, which is why it’s so important to understand and mitigate your risk factors.

That’s according to the American Stroke Association, which this week released its first new clinical guidelines for strokes in a decade.

The “2024 Guideline for the Primary Prevention of Stroke,” published in the journal Stroke and replacing the 2014 version, focuses on identifying and managing risk factors—particularly for women—and highlights healthy lifestyle behaviors that can lower stroke risk.

“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention,” said the chair of the guideline writing group, Cheryl D. Bushnell, M.D., in a news release. “Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.”

What is a stroke?

A stroke is what happens when a blood vessel ruptures or is blocked by a blood clot, interrupting blood flow to the brain. The brain doesn’t receive enough oxygen to function properly, resulting in brain damage that, depending on the severity, can lead to trouble thinking, talking, walking, or other disability.

Stroke is the fifth leading cause of death in the U.S., resulting in nearly 160,000 deaths annually.

Stroke risk factors for women

For the first time, the stroke guidelines include specific recommendations and outline risk factors—which are largely uncontrollable but helpful to be aware of for prevention and monitoring reasons—for women. They include:

Having had preeclampsia (high blood pressure) during pregnancy
Other pregnancy complications including premature birth
Endometriosis
Using oral contraceptives
Premature ovarian failure (before 40)
Early onset menopause (before 45)
Having severe vasomotor symptoms (such as hot flashes) in menopause
Taking estrogen-containing hormone-replacement therapy (HRT) for menopause after age 60, more than 10 years after natural menopause
Taking estrogen, as a transgender woman or gender-diverse individual, for gender affirmation

Stroke risk factors for everyone

The most common, most controllable lifestyle behaviors—dubbed Life’s Essential 8 cardiovascular health metrics by the Stroke Association—will, when left unchecked, become factors that are known stroke risks. They include:

Having poor nutrition
Using tobacco
Being sedentary
Being overweight
Poor sleep
High cholesterol
High blood pressure
High blood sugar

To counteract these risks, the new guidelines recommend:

Eating a Mediterranean diet—consisting largely of fruits, vegetables, beans, nuts, whole grains, and olive oil, and minimal amounts of dairy, eggs, fish, and poultry—even if you have no other risk factors
Getting at least 150 minutes weekly of moderate-intensity aerobic activity or 75 minutes weekly of vigorous aerobic activity—or a combo of both—spread throughout the week
Getting enough sleep
Not smoking
Monitoring cholesterol, blood pressure, and blood sugar levels and keeping them within healthy ranges

What else can you do to prevent a stroke?

When it comes to stroke prevention, the guideline stresses the need for risk assessment—including with a risk assessment calculator that estimates 10-year and 30-year stroke and heart disease risk starting at age 30; knowing the results can help inform preventive treatment decisions.

It can help to be aware of new treatment options—such as Ozempic and other GLP-1 drugs to reduce stroke risk in people with diabetes and a high risk of heart disease—and asking your doctor about what might be right for you.

Further, it’s important to know the warning signs of a stroke. The American Stroke Association uses the acronym FAST—for face drooping, arm weakness, speech difficulty, and time to call 911, fast.
“Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke,” noted Bushnell. Plus, there’s a bonus: “Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain.”