Medically Reviewed by Minesh Khatri, MD on November 15, 2021 A stroke happens when blood flow to a part of your brain is cut off. Without the oxygen in blood, brain cells start dying within minutes. To help prevent a stroke, learn about the causes and the things that can raise your odds of getting one. A stroke can happen in two main ways: Something blocks the flow of blood, or something causes bleeding in the brain. Ischemic stroke. In 8 out of 10 strokes, a blood vessel that takes blood to your brain gets plugged. It happens when fatty deposits in arteries break off and travel to the brain or when poor blood flow from an irregular heartbeat forms a blood clot. Hemorrhagic stroke. It's less common than an ischemic stroke but can be more serious. A blood vessel in your brain balloons up and bursts, or a weakened one leaks. Uncontrolled high blood pressure and taking too much blood thinner medicine can lead to this kind of stroke. Some people have what's called a transient ischemic attack (TIA). This "mini stroke" is due to a temporary blockage. It doesn't cause permanent brain damage, but it raises your odds of having a full-scale stroke. You can treat some conditions that make you more likely to have a stroke. Other things that put you at risk can't be changed: High blood pressure. Your doctor may call it hypertension. It's the biggest cause of strokes. If your blood pressure is typically 130/80 or higher, your doctor will discuss treatments with you. Tobacco. Smoking or chewing it raises your odds of a stroke. Nicotine makes your blood pressure go up. Cigarette smoke causes a fatty buildup in your main neck artery. It also thickens your blood and makes it more likely to clot. Even secondhand smoke can affect you. Heart disease. This condition includes defective heart valves as well as atrial fibrillation, or irregular heartbeat, which causes a quarter of all strokes among the very elderly. You can also have clogged arteries from fatty deposits. Diabetes. People who have it often have high blood pressure and are more likely to be overweight. Both raise the chance of a stroke. Diabetes damages your blood vessels, which makes a stroke more likely. If you have a stroke when your blood sugar levels are high, the injury to your brain is greater. Weight and exercise. Your chances of a stroke may go up if you're overweight. You can lower your odds by working out every day. Take a brisk 30-minute walk, or do muscle-strengthening exercises like pushups and working with weights. Medications. Some medicines can raise your chances of stroke. For instance, blood-thinning drugs, which doctors suggest to prevent blood clots, can sometimes make a stroke more likely through bleeding. Studies have linked hormone therapy, used for menopause symptoms like hot flashes, with a higher risk of strokes. And low-dose estrogen in birth control pills may also make your odds go up. Age. Anyone could have a stroke, even babies in the womb. Generally, your chances go up as you get older. They double every decade after age 55. Family. Strokes can run in families. You and your relatives may share a tendency to get high blood pressure or diabetes. Some strokes can be brought on by a genetic disorder that blocks blood flow to the brain. Gender. Women are slightly less likely to have a stroke than men of the same age. But women have strokes at a later age, which make them less likely to recover and more likely to die as a result. Race. Strokes affect African-Americans and nonwhite Hispanic Americans much more often than any other group in the U.S. Sickle cell disease, a genetic condition that can narrow arteries and interrupt blood flow, is also more common in these groups and in people whose families came from the Mediterranean, the Middle East, or Asia.
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention. References
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