Preventing Stroke Reocurrence: Strategies and Medications

The most important step to preventing a second stroke is knowing what caused the first stroke. The “2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack” directs healthcare professionals to perform diagnostic evaluations within 48 hours of symptom onset to determine the cause of the first stroke or TIA. In this way, strategies can be tailored to the patient’s particular healthcare needs to increase the effectiveness in preventing another stroke.

Determining the cause of stroke

The immediate cause of a stroke is what actually happened in your body to cause the stroke: an ischemic stroke is caused by a blood clot that completely prevents the flow of blood to some part of the brain; a hemorrhagic stroke is caused by a leak or rupture in an artery in the neck, brain, or around the brain; a transient ischemic attack (TIA) is often called a mini-stroke and is caused by a temporary blockage of blood flow. A TIA should be treated as seriously as a major stroke, since about one-third of people who experience a TIA subsequently have a stroke, sometimes within days. 

The question the doctors must then answer is what brought about the conditions to cause the blood clots or blood vessel rupture. While age and genetics are factors beyond the patient’s control, fortunately, most other factors are controllable, either by proper medication or by lifestyle changes, and often both. The most common risk factors include:

  • High blood pressure
  • Cardiovascular disease, including irregular heartbeat or AFib
  • Diabetes, Type 2 diabetes, or pre-diabetes
  • Elevated cholesterol, especially triglycerides
  • Smoking or substance abuse
  • Unhealthy diet, such as processed foods
  • Obesity or being overweight
  • Sedentary lifestyle, limited exercise
  • Living alone
  • Stress, anxiety, depression
  • Poor sleep habits, sleep apnea, snoring, and other sleep disorders 

There are also social determinants and environmental conditions which, while theoretically controllable, are not easy to control in reality. Such factors include living in an area with a poor healthcare system or in an environment that has high exposure to pollutants. If you have environmental or socio-economic factors that you cannot change, it is even more important to follow the doctor’s orders to decrease your risk of another stroke.

Addressing risk factors with medication

High blood pressure, or hypertension, is a top cause of both ischemic and hemorrhagic stroke. If your doctor determines that this is one of the causes of your stroke, you will be prescribed medications to bring your blood pressure into a healthy range. These may include diuretics to help you flush retained fluids, ACE inhibitors and calcium channel blockers to widen your blood vessels, or beta blockers to help control your heartbeat.

If you’ve had an ischemic stroke, you will probably be prescribed anticoagulants or antiplatelets to help prevent blood clots. If your cholesterol is elevated, your doctor may prescribe statins to bring your cholesterol down to a healthy level. And certainly, if you have diabetes, you must take your diabetic medications, including insulin. Type 2 diabetes and pre-diabetes should be monitored and lifestyle changes made to prevent developing diabetes. 

Making lifestyle changes

Lifestyle changes can help with virtually all the risk factors, and your doctor will probably recommend some along with the prescriptions. Do not depend solely on prescriptions, and unless your condition is mild, do not depend entirely on lifestyle changes. Both should be used in conjunction. Some of these changes include:

  • Quit smoking and avoid secondhand smoke as much as possible
  • Limit alcohol consumption, and certainly do not engage in other substance use such as recreational drugs
  • Lose weight, if necessary
  • Eat a healthy diet, low in added sugars and simple carbs; eliminate trans fats and vegetable oils such as corn oil and canola oil
  • Move your body every day, and exercise at least several times a week, beginning with walking and stretching exercises if you are not used to exercising
  • Get healthy sleep; address sleep disorders with the help of a medical professional, if necessary 

Remaining consistent for the long run

Remember, avoiding another stroke is not a short-term action that you can stop doing once you’re “in the clear.” While some of your conditions may improve over time, check with your doctor about changes to your medication rather than deciding on your own to stop taking them. The lifestyle changes are permanent – for life! Don’t go back to smoking or eating junk or being sedentary. Stay active and healthy. 

Make regular appointments with your doctor and keep them. While you are still at a high risk of stroke and until you can get your risk factors under control, consider using a Neuralert stroke detection monitor. Our state-of-the-art system looks like a smartwatch but is connected to an algorithm that can determine within minutes if there are signs of another stroke and can immediately alert your healthcare provider to rush medical help. Time is critical, because the quicker a stroke is caught, the better the chances of limiting long-term effects. Talk to your healthcare provider about adding Neuralert to your post-stroke health program.