Health Matters: Stroke: Knowing and Lowering Your Risk


By Paul Kaiser, MD

More than 795,000 people have a stroke each year in the United States, according to the American Heart Association, making it a leading cause of death and disability.

But did you know that an estimated 80% of strokes are preventable, according to the American Heart Association?

By knowing and lowering your risk factors, you can stay healthy and help prevent a stroke.

How Stroke Occurs

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, and brain cells die.

The vast majority — 87% — of strokes are related to clots. These are called ischemic strokes and are primarily caused by atherosclerosis or fatty deposits that line the vessel walls.

These deposits can cause clots to form directly in the vessels of the brain or they can cause clots to form elsewhere in the circulatory system, usually the heart and large arteries of the chest and neck. If the clot breaks free, it can travel to the brain and block a vessel, causing a stroke.

Are You at Risk?

There are several risk factors for stroke, some that are beyond your control and others that can be managed, treated or prevented altogether.

Risk factors that you can’t control include:

  • Age. Stroke can occur at any age, but is more common in those over age 60. However, nearly 15% of strokes happen in people under age 60.
  • Family history. If your parent, grandparent, sister or brother has had a stroke — especially before reaching age 65 — you may be at greater risk.
  • Race. Those who are Hispanic or Black tend to experience strokes more frequently than other ethnicities.
  • Gender. Women have strokes more than men and are more likely to die from strokes, according to the American Heart Association.
  • Prior stroke or transient ischemic attack, also referred to as a mini stroke. The American Heart Association reports that a person who had a transient ischemic attack is almost 10 times more likely to experience a stroke than someone the same age and gender who has never had one.

Risk factors that are within your control or can be managed or treated include:

  • High blood pressure. High blood pressure is a leading cause of stroke, according to the American Heart Association, and the most significant controllable risk factor.
  • High cholesterol. High cholesterol can lead to blood clots, which can lead to a stroke.
  • Obesity. Being overweight increases the risk of high blood pressure, high cholesterol, and diabetes, all of which are risk factors for stroke.
  • Diabetes. In addition to being associated with other risk factors such as high blood pressure and obesity, diabetes itself is a risk factor.
  • Physical inactivity. Lack of physical activity puts you at greater risk for stroke and other associated risk factors.
  • Carotid artery disease. Found in your neck, your carotid arteries supply blood to your brain. If a carotid artery is narrowed from atherosclerosis, it could become blocked by a clot and cause a stroke. People with peripheral artery disease are at greater risk for carotid artery disease.
  • Atrial fibrillation. Atrial fibrillation or AFib is a heart rhythm disorder that can lead to blood clots and stroke. Sleep apnea is often linked with AFib.
  • Smoking. Smoking can damage your cardiovascular system, cause blood clots to form and lead to stroke.

Lowering Your Risk

While some risk factors are beyond your control, you can work to control and manage the others to reduce your chances of having a stroke. Here are some ways to lower your risk:

  • Make sure your blood pressure, cholesterol, diabetes and other heart conditions are under control. Know your numbers and follow your doctor’s recommendations, including taking medicine as prescribed.
  • Eat a healthy diet. Choose foods low in saturated fats, trans fat, and cholesterol and high in fiber. Limit salt in your diet and eat a wide range of fresh fruits and vegetables.
  • Maintain a healthy weight. If you are overweight, losing as few as five to 10 pounds can make difference.
  • Get regular physical activity. The American Heart Association recommends aiming for 150 minutes of physical activity a week. If that seems like too much, start by committing to moving more.
  • Don’t smoke. If you do smoke, quitting will lower your risk for stroke and many other health conditions.
  • Limit alcohol. Too much alcohol can raise your blood pressure. The Centers for Disease Control and Prevention recommends that men have no more than two drinks per day and women should have no more than one per day.
  • Go for an annual checkup. Talk with your doctor about any medical issues you’ve been having and your risk factors for stroke.

Time is Brain

Though prevention is the best way to avoid complications from a stroke, if caught early enough, patients can benefit from advanced treatment that may reverse the stroke. For example, the clot-busting drug t-PA must be administered within three hours of the onset of symptoms to prevent some of the disabilities caused by stroke.

Signs of a stroke can include:

  • Numbness, weakness or paralysis of the face, arm or leg (often one side of the body).
  • Sudden confusion.
  • Difficulty speaking or difficulty understanding.
  • Vision problems in one or both eyes.
  • Trouble walking.
  • Dizziness.
  • Loss of balance or coordination.
  • Sudden, severe headache.

If any of these signs are present, call 911 immediately. Remember, time is brain.

Penn Medicine Princeton Medical Center (PMC) is designated as a Primary Stroke Center by the state of New Jersey and the Joint Commission, signifying that PMC maintains neurology and Emergency Department personnel trained in the diagnosis and treatment of acute stroke, as well as offers acute care rehabilitation services. PMC has also earned the American Heart Association/American Stroke Association’s Get with the Guidelines-Stroke Gold Plus Quality Achievement Award, recognizing a commitment to the latest evidence-based guidelines for diagnosing and treating patients.

For more information about the PMC Stroke Center, or to find a physician affiliated with Princeton Health, call 888-742-7496 or visit

Paul Kaiser, MD, is board certified in neurology and vascular neurology. He is medical director of the Penn Medicine Princeton Medical Center Stroke Center.