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Experts say diet, exercise, stress reduction, and adequate sleep are all lifestyle changes that should be adopted. Azman Jaka/Getty Images
  • The American Heart Association and American Stroke Association have released guidelines for people who have had a stroke.
  • The organizations encourage doctors to consult with other medical professionals to help determine the cause of a person’s stroke to reduce their risk of a second one.
  • They also advise people who have had a stroke to adopt a regular exercise program, eat a healthy diet, get adequate sleep, and reduce stress.

Having had a stroke or transient ischemic attack (TIA) increases your risk of another one.

But you can take steps to lower that risk.

Each year, about 795,000 people in the United States have a stroke. About 185,000 strokes occur in people who’ve already had at least one stroke.

In addition, approximately 240,000 people have a TIA, or ministroke, each year. About 9 to 17 percent of those people will have a stroke within 90 days.

Stroke is a leading cause of long-term disability. And someone dies of stroke every 4 minutes.

New guidelines from the American Heart Association (AHA) and American Stroke Association (ASA) outline recommendations for doctors to help their patients avoid another stroke.

“Approximately 80 percent of strokes can be prevented by controlling blood pressure, eating a healthy diet, engaging in regular physical activity, not smoking, and maintaining a healthy weight,” said Dr. Amytis Towfighi, vice chair of the guideline writing group for the AHA and director of neurological services at the Los Angeles County Department of Health Services, in a statement.

The first step in lowering the risk of a second stroke is to quickly pinpoint the cause of the first.

The AHA-ASA guidelines call on healthcare professionals to have diagnostic testing completed or underway within 48 hours of the onset of stroke symptoms. Other recommendations for healthcare professionals include:

  • using multidisciplinary care teams, shared decision making, and personalized care
  • screening for and treating atrial fibrillation (AFib)
  • prescribing blood thinners or aspirin in specific people
  • placing stents or surgically removing blockages when applicable
  • aggressively managing risk factors

Dr. Andrew Freeman is a cardiologist at National Jewish Health in Denver. He told Healthline that AFib is the most common cause of stroke.

“Atrial fibrillation is epidemic, particularly in those who are older, because the risk goes up with age. We look for this. And we almost always get an echocardiogram of the heart to make sure there are no other abnormalities,” Freeman said.

Neurologists look for damage in the brain, so they might do a CT scan or MRI.

“There’s a lot of coordination between the neurologist and the cardiologist. We’ll do an exhaustive search for a cause,” Freeman said.

“There’s significant variability in how stroke presents and how debilitating it is. Once you have a stroke due to atrial fibrillation, we’re aggressive about blood thinners to reduce clots. We’re also pretty aggressive about blood pressure control and statins to lower cholesterol when appropriate,” he added.

For those who have had a stroke or TIA, secondary prevention guidelines include managing risk factors such as high blood pressure, type 2 diabetes, cholesterol and triglyceride levels, and not smoking.

The guidelines say that stroke survivors should limit salt intake and follow a Mediterranean diet. Those who are physically able should engage in moderate-intensity aerobic activity for at least 10 minutes, four times a week, or vigorous-intensity aerobic activity for at least 20 minutes twice a week.

“A vascular event of any sort is a systemic, whole body process. It behooves you to make significant changes like not smoking,” Freeman said.

Freeman offers five important lifestyle changes to help lower the chances of a second stroke:

  • Daily exercise. Once your cardiologist gives you the all clear, aim for 30 minutes of “breathless” walking or similar activity you enjoy every day. The goal is to get a bit breathless (not struggling to breathe) as you exercise.
  • Diet. Eat a predominantly low fat, whole food, plant-based diet. This type of diet has been shown to halt progress of coronary disease and vascular disease, and can help maintain a moderate weight.
  • Stress. Stress has a big impact on blood pressure, and it’s important to get both under control.
  • Connectedness. There’s data to show that connectedness with family and friends markedly improves vascular outcomes.
  • Sleep. Getting at least 7 hours of uninterrupted sleep is best for overall cardio and cerebrovascular outcomes.

“Collaborative teamwork between the neurologist and the cardiologist is important. We also need a much stronger push in the lifestyle space, which is not really taught to neurologists and cardiologists. But it’s an incredible, powerful way to minimize cost and side effects, and to improve outcomes,” Freeman said.