The first risk factor that I want to discuss is high blood pressure. High blood pressure is the number 1 risk factor for stroke. High blood pressure is very frequent, usually running in families, and it’s a problem we can do something about. It can be easily detected. People with high blood pressure don’t often know it -- it doesn’t cause symptoms. In fact, it is often referred to as 'the silent killer'. Many people think that headaches are frequently associated with high blood pressure. This is not typically the case. So it is extremely important to get your blood pressure tested. If you have high blood pressure, you can often lower it by simply modifying your diet: Losing weight, reducing fat intake, reducing overall calories. Reducing salt intake is important for some people. These dietary changes, along with a little exercise, can really help to reduce high blood pressure. Of course, sometimes you do need medicine to lower your blood pressure. It is not uncommon to need more than one medicine. If you do need to take medicine, take it every day and follow the prescribing directions. These medicines are extremely important in lowering your blood pressure and your risk of stroke.

Cigarette Smoking

Okay, let's move forward to something more seductive: smoking. Smoking is an important risk factor for stroke. It increases one's risk almost twofold. Just to put things in perspective, the number of Americans who die annually due to smoking-related causes is approximately equal to the number of deaths that would result if three jumbo jets crashed every single day for a year. The encouraging news is though, that there is a lot of good scientific data that shows that those who can quit smoking can reduce the risk of stroke. So remember, it is never too late to quit. Also, encourage your spouses and family members to quit as well. There is clear evidence that exposure to other people's smoke--passive smoking--is also dangerous. The bottom line is that smoking, either by you or anyone in your household, is simply bad news. If you do it, quit. If you haven’t, don’t start.

Alcohol

We have all probably heard some good things and bad things about alcohol. Let's start with the good news. It appears that if you drink a little bit--mild to moderate drinking--you can actually reduce your risk of stroke. My colleagues and I just completed a study in which we found that moderate alcohol use is associated with a significantly decreased risk of ischemic stroke. Ischemic stroke is the most common type of stroke and occurs when a blood clot blocks a blood vessel in the brain. This risk reduction was seen in a multi-ethnic population, including Caucasians, African-Americans, and Hispanics, and was independent of hypertension or smoking. The bad news is that heavy alcohol use increases the risk of stroke. The more you drink, the worse the risk of stroke. However, heavy drinkers who cut back to no more than two drinks a day can reduce this risk. Of course, these studies are not implying that physicians should recommend to their patients to have two drinks a day in order to reduce their risk of stroke. No study has shown a benefit in recommending alcohol use to people who don't drink. What the studies are suggesting is that among those people who are moderate drinkers, continued consumption might provide a reduction of ischemic stroke risk. However, they may have other medical conditions that need to be considered which may be aggravated by alcohol. Therefore, every patient's situation is different and the risk and benefits of alcohol must be balanced.

Physical Activity

Most people are aware of the overall benefits of physical activity. Getting patients to do it is the hard part. I would like to emphasize is that you don't have to be a marathon runner to benefit from exercise. Doing some physical activity can reduce the risk of stroke. Walking is just as good as running. Walking briskly for 20 minutes a day, 3 days a week, is something that can really make a difference. Elderly people and younger adults benefit from physical activity in similar ways. These benefits are far reaching, and can improve your entire cardiovascular profile, including positively affecting cholesterol levels.

Cholesterol

Elevated levels of HDL, the good cholesterol, can reduce your risk of heart attack and stroke. The other type of cholesterol, LDL, is the kind that actually can build up in arteries, and increase the risk of heart attack and stroke.

High cholesterol can run in families. Some people, regardless of diet, have high cholesterol. Most people do not require medicine to control their cholesterol. However, not everybody can do it with dietary changes. We recognize that. And that’s why there are good medications out there, for people who may need it. These cholesterol-reducing medications can also reduce the chance of death, heart attack, and stroke.

Conclusion

I hope that I demonstrated that there is a great deal each one of us can do to reduce our risk of getting a stroke. If we would even just focus on one risk factor, such as hypertension, or smoking, for example, we can really make a difference in our lives. Let's look at it on a broader scope. There are about 500,000 strokes per year in the United States. If the blood pressure of the entire population was controlled, we would eliminate 246,500 strokes each year. If we all reduced cholesterol levels, we would eliminate 100,000 strokes. If the entire country stopped smoking, 61,500 strokes would not occur. If we treated every case of atrial fibrillation, a special medical condition of the heart that we did not discuss above, we would eliminate 47,000 strokes. And if we eliminated heavy alcohol use, and consumed only a moderate amount of alcohol, 23,500 strokes would be eliminated.

These numbers give us an idea of how much we can really do to decrease our stroke risk. Know what the risk factors are. Do what you can to modify your lifestyle. Think of the good things that can be done, that can be enjoyable, and that you can adopt into your day-to-day routines. If you need medications, don't forget to take them as prescribed. Remember that even small changes can make big differences.