Do You Know The Causes of a Stroke?


When it comes to a stroke, there’s good news and bad news. The good news is that it can be prevented. The bad news is that many people don’t know how to do it.

“The common causes of stroke are still undertreated—and awareness of stroke risk factors is low," points out Michael Mullen, MD, Assistant Professor of Neurology at Penn Medicine.  "There are simple steps that people can take to drastically reduce their risk of having a stroke.”

About 795,000 Americans have a stroke each year, and approximately 160,000 die from stroke-related causes, making it the fifth-leading cause of death, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Key causes of stroke and how to prevent one

A stroke happens when part of the brain is robbed of the oxygen and blood supply it needs to function. This happens when an artery or other type of vessel to the part of the brain either has a clot or bursts.

Under pressure

High blood pressure, or hypertension, is the leading cause of strokes in the US. Yet, it’s also one of the common risk factors that can be prevented.

High blood pressure can damage or weaken arteries in the brain, raising a person’s risk of having a stroke, says the American Heart Association (AHA).

“Hypertension is called the silent killer, because people often don’t know they have it,” Dr. Mullen notes. “You can’t feel it. It doesn’t cause pain. So, people need to see their primary care doctor and have their blood pressure checked. That’s critical.”

Clean out the wax

The same is true for getting your cholesterol checked, Dr. Mullen says. Cholesterol is a waxy, fat-like substance that travels through your bloodstream in the form of lipoproteins, the National Heart, Lung, and Blood Institute explains.

High LDL ("bad cholesterol"), low HDL ("good cholesterol"), and high triglycerides can increase your risk of heart disease and stroke.

stroke and high blood presure

“You can’t feel whether you have high cholesterol, so you need to have that checked, too,” Dr. Mullen says.

The power in food

“A lot of people are surprised to know that how you eat can affect your risk factor for a stroke,” Dr. Mullen says. “There’s good data showing that a Mediterranean-style diet can help reduce your risk.”

In general, the Mediterranean diet focuses on lots of fruits and vegetables, with 5 or more servings of these per day.  There is also a focus on healthy fats, like those in olive oil, nuts, and seafood.

More than half the fat calories in a Mediterranean diet come from monounsaturated fats. These healthy fats, which are often plant-based, don’t raise blood cholesterol levels like saturated fats, which comes from animal sources (beef, pork, poultry), the US National Library of Medicine explains. A Mediterranean-style diet also means eating fewer carbohydrates in general, such as bread, pasta and rice, and opting for whole grains when you do.

Don’t forget to move

“Exercising is, of course, also very important to keeping your risk of a stroke low,” Dr. Mullen adds.

It’s recommended that you get at least 150 minutes of at least moderate-intensity physical activity each week, and do muscle-strengthening exercises 2 days a week, the Centers for Disease Control and Prevention (CDC) says. It’s okay to break your aerobic activity into a series of 10-minute intervals.

Examples of moderate activity, the CDC says, include:

  • Fast walking
  • Water aerobics
  • Bike-riding on level ground
  • Doubles tennis
  • Mowing a lawn with a push mower

Your specific risk for a stroke

Do you know your specific risk for having a stroke? If not, ask yourself these key questions:

1. Have I had a prior stroke or " mini-stroke"?

Having a history of a stroke makes it more likely that you might have another, Dr. Mullen notes.

The same is true if you’ve ever had a “mini-stroke,” which is also known as a transient ischemic attack (TIA). These brief episodes have similar symptoms of a stroke, but the difference is they tend to go away quickly, Dr. Mullen says.

“People who have TIA, though, are also at higher risk of a subsequent stroke, and should be aggressively controlling their stroke risk factors,” he explains.

2. What were my most recent blood pressure and cholesterol readings?

The American Heart Association says having blood pressure that is less than 120/80 mm Hg is ideal for adults who are 20 years and older. Your blood pressure is considered high if it’s at least 140/90 mm Hg. As your blood pressure rises, so does your risk of a stroke.

If you already are at high risk for a stroke, you should strive to keep your systolic blood pressure, the top number, at less than 120 to 125 mm Hg, Dr. Mullen says. Your systolic blood pressure measures the force on your arteries when your heart beats, the American Heart Association explains.

For people who are not at an elevated risk of stroke, the National Institutes of Health (NIH) recommends that your LDL cholesterol—known as “bad” cholesterol, because it can lead to blockage in your arteries—be less than 100 mg/dL.

If you are above this line, your physician might recommend a cholesterol-lowering medication, a diet low in saturated fat, an exercise regimen, or a combination of the three. If you have had a heart attack or a stroke in the past, LDL control is very important, and statin medications are recommended to reduce your chance of having another event.

3. Do I have diabetes?

Having diabetes can be a risk factor for having a stroke, Dr. Mullen says. You should see your doctor regularly and identify whether you have diabetes or are at risk for getting it.

“And if people have diabetes, they need to make sure it’s controlled,” says Dr. Mullen.

4. Do I smoke?

In addition to increasing your risk of cancer, cigarette smoking makes you 2 to 4 times more likely to have a stroke, according to the CDC. For that and a myriad of other reasons, it’s best to quit. Penn Medicine has a smoking cessation program that can help.

You can learn more about your personal risk of having a stroke by visiting the American Heart Association’s Life’s Simple 7 and taking My Life Check.

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