Session 5 – Prevention of Stroke
Around 80% of strokes could be prevented. Three in ten stroke survivors will go on to have a recurrent stroke
or TIA. The greatest risk of recurrent stroke is in the first 30 days after the cardiovascular event.
There are a number of risk factors associated with the condition, some of which can be changed (modifiable) and others that are fixed (unmodifiable).
Unmodifiable risk factors
- Age is the single most important risk factor, only 26% of strokes occur in people <65 years old
- Men are at a 25% higher risk of having a stroke at a younger age compared to women, however, as women live longer there are more total incidences of stroke in women
- Black people are twice as likely to have a stroke compared to white people and black and South Asian people have strokes at a younger age compared to white people. This is partly due to a higher prevalence of high blood pressure, diabetes, sickle cell disease and high cholesterol in these populations. 24% of people with sickle cell disease will have a stroke by the age of 45 years
- People from the most economically deprived areas of the UK are around twice as likely to have a stroke than those from the least deprived area and are also three times more likely to die from a stroke than those from the least deprived
Modifiable risk factors
- Around half of strokes are caused by high blood pressure
- Atrial Fibrillation is a major risk factor and resulting strokes tend to be more serious. Many patients remain undetected, with others not anticoagulated or poorly medically managed.
- Diabetes almost doubles the risk of stroke and is a contributing factor in 20% of strokes in England, Wales and Northern Ireland
- Reducing cholesterol level by 1mmol/L reduces the risk of stroke by >21%
- Leading an unhealthy lifestyles also increases the risks including: being sedentary and sitting down too much; obesity and excessive alcohol intake
- A body mass index of over 25kg/m2 is associated with increased risk of stroke
- 1 in 4 strokes are due to smoking. It doubles the risk of death, trebles the risk of stroke and doubles the risk of recurrent stroke. The risk of stroke is normalised after stopping smoking for 5 years
Find out more in the Stroke Association State of the Nation report or on our website here.
SUMMARY OF MEDICAL MANAGEMENT AND SECONDARY PREVENTION MEASURES
ATRIAL FIBRILLATION (AF)
Around 20% of strokes are caused by AF and the risk of stroke increases five-fold for people with AF. Men have a 1.5 times greater risk of developing the condition than women and AF-related strokes in women are more devastating than in men – it is not clear why.
It is estimated that around of third of people with AF remain undetected in the UK, with potentially a third of these not prescribed or optimised on anticoagulants.
Nationally, work continues to implement the detect, protect and perfect initiative:
- Detect– Raising awareness of AF and the importance of pulse rhythm testing to identify those with undiagnosed AF
- Protect– Supporting healthcare professionals to offer optimal anticoagulation medication to all those who would benefit
- Perfect– Supporting patients with their anticoagulation medication and supporting clinicians to review patients with AF
AF detection devices can be used opportunistically screen patients to identify new cases (e.g. at flu clinics).
British Heart Foundation: Atrial Fibrillation
AF Association – Information for clinicians
BLOOD PRESSURE
Hypertension is a contributing factor in half of strokes. Around 14% of the UK population have high blood pressure and a significant proportion remain undiagnosed.
People with stroke or TIA should have their blood pressure checked regularly. Treatment should consistently achieve a clinic systolic blood pressure below 130 mmHg, equivalent to a home systolic blood pressure below 125 mmHg. The exception is for people with severe bilateral carotid artery stenosis where a target of 140–150 mmHg is appropriate.
Treatment for high blood pressure should be commenced prior to discharge from hospital after a stroke or within 2 weeks of going home.
Stroke survivors discharged home from hospital should be regularly reviewed in the community, especially during the first few weeks when their risk of another stroke is highest.
ANTIPLATELETS
Patients with acute ischemic stroke are given aspirin in hospital which should be continued for up to 2 weeks followed by Clopidogrel daily in the longer term
DIABETES
Diabetics are twice as likely to have a stroke than those without the disease, and so early diagnosis and effective management of the disease can reduce the risks of a cardiovascular event.
HIGH CHOLESTEROL
Raised lipid levels, especially hypercholesterolaemia, are a risk factor for stroke. Statins are the most common
medical treatment used to treat the condition, although this may need to be supported with dietary and healthy lifestyle advice. Treatment should begin with a high intensity statin such as atorvastatin 20-80mg daily and use an alternative statin at the maximum tolerated dose if a high intensity statin is unsuitable or not tolerated. A greater than 40% reduction in non-HDL cholesterol should be aimed for.
HEALTHIER LIFESTYLE
Research shows that effective lifestyle interventions reduce the primary risk of stroke and other cardio vascular conditions, and may also reduce secondary risks although there is less evidence for this.
Key changes that people can make to their lifestyles include:
- Leading an active lifestyle in order to manage body weight
- Reducing the amount of time spent sitting
- Making healthy food choices
- Stopping smoking
- Drinking alcohol in moderation only
Stroke survivors may have special needs that may need to be considered to ensure they can access activities that support a healthier lifestyle. Their community stroke team may be able to best advise on more tailored support.
The NHS Better Health, Let’s Do This Campaign provides online support aimed at the public for many aspects of improving lifestyle including weight loss, being active, smoking and alcohol.
You will need to successfully complete this multiple choice quiz to progress to the next session. The pass mark is 75% and you have 3 attempts