The INTERSTROKE study, a large case-control study of stroke, established in 2010 the top 10 risk factors for stroke: hypertension, hyperlipidemia, smoking, physical inactivity, abdominal obesity, heart disease, diet, alcohol, diabetes mellitus, and psychologic factors; of these, hypertension is the most important risk factor; the above 10 risk factors explain about 90% of the risk of stroke. In fact, there are many risk factors for stroke, divided into modifiable risk factors and non-modifiable risk factors. 1. Modifiable risk factors – High blood pressure – Smoking – Heart disease – High cholesterol level – Excessive alcohol consumption – Obesity – Sedentary habits – Diabetes mellitus – Elevated hematocrit (i.e., erythrocytosis) – Oral contraceptives (especially in women who smoke) – Stress – Drug use and long-term use of narcotics – Asymptomatic Carotid artery stenosis – Hyperuricemia – Hyperhomocysteinemia 2. Unmodifiable Risk Factors – Age – Sex – Ethnicity – History or family history of stroke and TIA? How can stroke risk be reduced? Most of the controllable risk factors are related to cardiovascular status, and since stroke is a type of cardiovascular disease, all measures to maintain a healthy heart and blood vessels are effective in reducing the risk of stroke. The following are some of the most important measures that can be taken to control the risk of stroke, including reducing the risk of stroke through medication and good lifestyle habits. -Regular medical checkups: Risk factors such as heart disease, high blood pressure, elevated cholesterol and lipid levels can be detected through regular medical checkups. These risk factors can be modified or controlled with the right medication and proper diet and lifestyle habits. -Control blood pressure: High blood pressure is the single most important risk factor for stroke. People with high blood pressure are four to six times more likely to have a stroke than normal people, and the risk of stroke increases even when blood pressure is mildly elevated. Hypertension promotes the development of atherosclerosis and also increases the pressure on the walls of the blood vessels, which may lead to rupture of the weak parts of the walls. Hypertension is often referred to as the “invisible killer” because there are no visible symptoms. In general, blood pressure should be kept below 140/90 mmHg. Regular blood pressure checks are important, and controlling blood pressure through a low-salt diet, weight control, stress reduction and/or medication can reduce the risk of stroke. Remember that blood pressure can only be effectively controlled by adhering to regular long-term medication. It should be noted, however, that in the elderly, a sudden drop in blood pressure can also lead to a stroke. Therefore, drug therapy for hypertension in the elderly needs to start with small doses and gradually control blood pressure. In general, blood pressure should not be lower than 160/90 mmHg in people over the age of 60. -Quit smoking: Studies have shown that smoking increases the risk of stroke by 50%, but that the risk decreases dramatically after 2 years of cessation of smoking. -Treat heart disease: Many heart conditions, including arrhythmias (e.g., atrial fibrillation), myocardial infarction, and heart valve disease, can increase the risk of stroke by preventing the heart from pumping blood properly, which slows down blood flow and makes it more likely that blood clots will form. Treating these heart conditions can reduce the risk of stroke. -Dietary changes: Diets high in fat, cholesterol, and salt can increase the risk of stroke. The following medical advice is important for stroke prevention. If necessary, consult your doctor for more help in developing a diet that is right for you. 1. Avoid excess fat: Excessive intake of fat, especially saturated fatty acids and cholesterol, can promote the development of atherosclerosis, which is strongly associated with stroke. Ways to limit dietary fat and cholesterol include reducing the amount of cooking oil, eating less fatty meat, consuming low-fat or fat-free foods, eating fewer fried foods, and limiting the amount of eggs (no more than 3 per week). 2. Avoid excessive salt: A diet high in salt is strongly associated with high blood pressure, and table salt is the most important source of salt in the diet. There is a large amount of “hidden” salt in most processed or canned foods, such as disodium phosphate, monosodium glutamate, sodium nitrate, or similar compounds that contain high levels of sodium. Therefore, we recommend not to eat too much salt and to eat more fresh food. 3. Limit alcohol consumption: The risk of stroke is increased in people who drink excessive amounts of alcohol and is even higher for heavy drinkers. Heavy drinking can increase the risk of stroke in healthy young people as well as in older people. It is best to stop drinking, and if you must, it is recommended that you have only one drink per day, no more than 1.5 tael of liquor, no more than 4 tael of wine, and no more than 1 bottle of beer. -Maintain your weight: Obesity puts a heavier burden on the heart and blood vessels and is very closely related to high blood pressure. Obese people are also prone to heart disease and diabetes, the latter two of which increase the risk of stroke. Keeping your weight within the normal range can prevent strokes. You should improve your diet and take regular physical activity. Eat less food rich in fat and cholesterol and more vegetables, fruits and grains. -Regular exercise: Body fat content tends to increase with age, and regular physical activity can minimize this fat gain. Studies have proved that there is an inverse relationship between physical activity and atherosclerosis, and that heavy exercise reduces atherosclerosis levels. Regular exercise also strengthens the heart and improves the condition of the blood vessels, as well as lowering high blood pressure and cholesterol levels. It is also helpful in controlling weight and improving mental stress. If you have not exercised regularly before and now want to start an exercise program, or have certain diseases or have a family history of some serious illnesses, then you should consult with your doctor before starting an exercise program and choose the most suitable one for you. Experts suggest that you should do aerobic exercises such as jogging, swimming and ball games for at least 20 to 30 minutes three to four times a week to get and maintain the right amount of exercise. -Treat diabetes mellitus: Diabetes mellitus can accelerate the rate of development of atherosclerosis and increase the risk of stroke by two times. Good control of diabetes through proper diet, regular exercise, weight control and medication can reduce the cardiovascular complications of this disease. -Relaxation: Stress is indirectly linked to stroke risk because it can raise blood pressure. A single episode of stress rarely leads to stroke, but prolonged stress can lead to high blood pressure. Management of stress, including relaxation, biofeedback, exercise, and counseling, can be helpful in the treatment of high blood pressure, and can therefore reduce the risk of stroke. -Oral contraceptives: Oral contraceptives, especially those with high levels of estrogen, can increase the risk of blood clots, which can increase the risk of stroke, especially in women over 30 and those who smoke. If you have other risk factors for stroke and are currently using oral contraceptives, you should talk to your doctor about choosing an alternative method of birth control. -Avoid drug use: Many illicit drugs such as cocaine, heroin, or amphetamines can increase the risk of stroke by causing a sudden increase in blood pressure, weakening blood vessels in the brain, and causing the heart to beat irregularly. -Asymptomatic carotid artery stenosis: The carotid arteries are arteries located on both sides of the neck that supply blood to the brain, which is a favored site for atherosclerosis. Deposits of atherosclerotic plaques may lead to narrowing of the arteries, which reduces the blood supply to the brain. The patient may not have any first symptoms, but as the narrowing increases, the blood supply decreases to a certain point, or possibly when the plaque dislodges and forms an embolus, an ischemic stroke can occur. The formation of a clot on top of the plaque can be prevented by taking anticoagulant medications such as aspirin, ticlopidine or warfarin, or if the stenosis is too severe, it can be treated with surgery. High blood pressure is the first risk factor for stroke For Chinese people, high blood pressure is the first risk factor for stroke. However, there are always hypertensive patients who are reluctant to take medication to control their blood pressure, fearing that “once they take medication, they will not be able to get rid of it for the rest of their lives”. The incidence of stroke in young and middle-aged people is on the rise The incidence of stroke in young and middle-aged people is on the rise, and surveys have shown that the risk factors are more related to their lifestyles. Risk factors meet trigger conditions leading to stroke onset. Patients may not necessarily suffer from every factor, but only some of them may meet the trigger conditions, such as endocrine changes due to sudden cold weather, prolonged infections, and changes in vascular endothelial cells due to prolonged overtime work. People at high risk should have their cerebral and carotid arteries checked. They should be screened for stroke risk against the ten factors, and those at high risk should visit their doctor for a basic checkup. For the first visit of people at risk of stroke, it is recommended that they receive cerebrovascular imaging and carotid artery ultrasound, and depending on the condition of the blood vessels, the frequency of subsequent examinations should be recommended by the doctor.