How to reduce your risk of having a second stroke

In addition to potentially leaving you with long-term neurological deficits, having a stroke also increases the risk of having another one—significantly. One in four people who have a stroke experience a second stroke, according to the American Stroke Association.

To avoid that second stroke and protect brain cells, stroke prevention is key. But to prevent a second stroke, we have to first understand what contributed to the initial stroke.

Identifying the cause of stroke

”When someone presents in the hospital with an ischemic stroke, the real impetus, besides treating them acutely and doing everything we can to reduce expansion of the stroke, is really focused on trying to identify the underlying cause of the stroke,” said Blake Freeman, MD, a neurologist on the medical staff at Baylor Scott & White Medical Center – Lakeway.

Once that’s identified, treatments to address those specific factors can begin. The same is true for those who experience a transient ischemic attack (TIA), often called a mini stroke.

“Having a TIA certainly puts you at higher risk for stroke,” Dr. Freeman said. “There are ways we can lower that risk based on your symptoms and other factors. But, in general, we approach a TIA very similarly to if someone does have a stroke.”

The workup is often essentially the same, with a focus on preventing a subsequent stroke.

For ischemic, or clotting strokes, the three most common causes are:

• Atherosclerosis of the large arteries, which generally forms over years. Plaque in the arteries can destabilize or break off and travel further down bloodstream into arteries in the brain. In those smaller arteries, they cut off blood supply, which results in a stroke.
• Small vessel disease, which is a similar process to atherosclerosis but involving smaller caliber arteries. Blockages there can cause smaller strokes that can still have significant symptoms.
• Cardioembolic-related strokes, which can occur when a person has atrial fibrillation, abnormal heart rhythm or other heart-related conditions, such as valve malformations or infections.

Hemorrhagic, or bleeding, strokes often have different underlying causes than ischemic strokes, but one risk factor they share is uncontrolled hypertension, or high blood pressure.

Stopping strokes at the source

Once neurologists have identified an underlying cause, prevention of a subsequent stroke involves getting to the root of the cause. Often that means managing a chronic condition such as elevated blood pressure or cholesterol, type 2 diabetes or obstructive sleep apnea.

Conditions like these don’t develop overnight—and they’re not solved overnight either. The recommendations to address these potentially modifiable risk factors probably sound familiar:

• Engage in regular physical activity. At least 30 minutes of vigorous physical activity at least five times a week.
• Eat a healthy diet. Dr. Freeman recommends the plant-based Mediterranean diet, which emphasizes fruits, vegetables, whole-grains, nuts and legumes.
• Quit smoking, including vaping.
• Manage obstructive sleep apnea, which is a potential risk factor for stroke. If left untreated, it also can lead to the exacerbation of other medical conditions, such as hypertension.
• Make sure to meet regularly with your primary care physician to keep tabs on your high blood pressure, cholesterol and blood sugar. That might include medication management in addition to the lifestyle changes already mentioned.
• Follow-up with your neurologist is generally recommended in all cases of stroke or TIA. The frequency of evaluations, imaging or other testing is decided on a case-by-case basis.

“It’s very important that you follow the advice of your medical providers, and that you take any medications that are prescribed,” Dr. Freeman said. “You should also never stop taking a prescribed medication unless you’ve discussed it with your physician.”

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