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Man holding his head in pain.Strokes usually aren’t medical mysteries that strike at random. High blood pressure and other preventable risk factors account for 90 percent of strokes, a huge international study confirms. Even so, you don’t have to live like a monk, eat like a dietitian or train like an elite athlete to avoid a devastating brain attack. Making modest changes in your life and incorporating healthy habits can help you stave off stroke. Below are your top 10 evidence-based areas for self-care improvement:

1. Blood Pressure: Lower It

If you have high blood pressure, you can reduce your stroke risk with a small investment of time and money and a little help from your health care provider. In developed countries like the U.S., tools to stay on top of blood pressure are readily available, says Martin O’Donnell, lead author of the 32-country study published in The Lancet, a medical journal. People have easy access to regular blood pressure measurements, whether it’s a quick reading at the supermarket or buying an inexpensive machine to use at home.

So much is already known about lifestyle approaches to lowering blood pressure, says O’Donnell, an associate clinical professor at NUI Galway, in Ireland, and at McMaster University in Ontario, Canada. When lifestyle tweaks aren’t enough, he adds, people have access to generic, low-cost medications.


2. Physical Inactivity: Move It

Carving out leisure time for regular exercise – such as playing sports, going to the gym or taking walks – was more common in higher-income countries and tied to lower stroke risk in the new study. That isn’t a big surprise.

“A lot of these risk factors have been established for decades now,” says Dr. Hugo Aparicio, a neurologist with Boston Medical Center and an assistant professor at Boston University School of Medicine. Aparicio is part of the research team for the famedFramingham Heart Study, now following a second generation of Massachusetts participants. What the new global study does, he says, is confirm that the top suspected stroke risk factors in Western society also play the biggest role in risk in different regions of the world.

3. Unhealthy Diet: Balance It

Dietary guidelines have it right, O’Donnell says. Emphasizing a balanced diet packed with fruits and vegetables and including fish – while avoiding processed foods and limiting red meat and fried and salted foods – works to prevent stroke. The Mediterranean eating pattern is one example, he says.

One surprise from the global results: Eating vegetables was not stroke-preventing in South Asia, a finding that needs more confirmation, O’Donnell says. One possible reason is vegetables are consumed differently in various parts of the world. So that raw spinach in your salad may be healthier – if less tasty – than prepared spinach in the Indian dish saag paneer.

4. Obesity: Lose It

Exercise and healthy eating help reduce obesity, which further lowers your risk of stroke. Stroke risk factors don’t exist in isolation – they’re highly interconnected, Aparicio points out. The same lifestyle changes that stave off stroke may also contribute to reduced risk of having a heart attack or developing diabetes, cancer or dementia.


5. Smoking: Quit It

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Not only is smoking tied to many types of cancer, such as lung cancer and stomach cancer, it’s also a top risk factor for stroke. Call a quit line, get your health provider on board and do your best to kick the habit.

6. Heart Risk: Treat It

Heart disease and stroke risk go hand in hand. A heart-rhythm problem called atrial fibrillation is a major risk factor for stroke if left untreated. Many people can control their a-fib with treatment involving regular checkups and anticlotting medication, along with incorporating lifestyle changes.

7. Diabetes: Manage It

When it comes to cutting stroke risk, “other parts of it are a little harder for the individual to do, like monitoring or treating your blood pressure or diabetes,” Aparicio says. “But that’s where the role of the health care provider can come in to help you measure these things and treat them if you need it.” The risk of stroke is 1.5 times higher for people withdiabetes, according to the American Diabetes Association. Keeping blood sugar levels on target helps lower that risk.

8. Alcohol: Moderate It

Whether people should consume alcohol at all or limit it is one of the trickier stroke risk factors to pin down. O’Donnell says while excess and binge drinking clearly contribute, the role of low or moderate drinking is less certain. Types of alcohol people drink and reasons for drinking vary widely. Binge drinking, which may contribute to stroke risk by raising blood pressure, is associated with the most common type of stroke – ischemic stroke, he adds.


9. Stress: Ease It

Easier said than done, but if you can subtract stress from your life, your brain and body will thank you. Among his patients, Aparicio says, “Once people learn about stroke and the causes of stroke, they often talk about how the wish they had had better control of their risk factors. A healthier lifestyle, or had less stress in their lives,” he says. “But on the other hand, they realize this is a red flag for them, and they have this opportunity now to own their own health.”

10. Cholesterol: Control It

When you have a blood test to measure cholesterol, it’s broken down into several categories. Stroke risk is only weakly tied to total cholesterol counts, O’Donnell says. However, HDL and LDL cholesterol levels are important, he says, especially HDL – the good cholesterol. Eating foods high in HDL – such as olive oil, legumes, beans and high-fiber fruits – and having your cholesterol checked are good ways to help tamp down stroke risk by keeping blood vessels clear of plaque.

Doable, Not Drastic

You don’t have to do everything at once. First, it’s a matter of tackling top stroke contributors like high blood pressure and smoking, Aparicio says. Then, as patients see success, he talks with them about lifestyle adjustments like changing their diet and incorporating more physical activity into the their routines.

The unrealistic concept of “You’ve got to be a perfect body weight; you’ve got to exercise all the time; you’ve got to lead this almost monkish life,” can be put to rest, O’Donnell says: “What our study suggests is most of these risk factors are on a continuum. So if you can’t achieve perfection, modest, imperfect changes in these risk factors will reduce your risk of stroke.”

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