A stroke often seems to happen without warning, but there are tests that may help assess your stroke risk. Theses tests include an ASCVD risk score and a carotid ultrasound, but there’s debate over the use of the latter.

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A stroke occurs when blood flow to part of the brain is blocked. The blockage prevents the affected area of the brain from getting oxygen and nutrients, which can damage and destroy brain cells.

There are two primary types of stroke: ischemic and hemorrhagic. About 87% of all strokes in the United States are ischemic strokes, in which blood flow to the brain is blocked. A hemorrhagic stroke is caused by a blood vessel rupture in the brain.

Strokes can vary in severity, and some strokes can result in serious disability. Timely treatment is critical. Getting treatment as soon as possible, ideally within 3 hours of the first stroke symptoms, is your best chance at avoiding serious brain injury.

This article takes a closer look at whether there’s a way to screen for a stroke before it happens.

A stroke often seems to happen without warning, but there are a couple of tests that may help provide a clearer picture of your stroke risk.

ASCVD risk score

The American College of Cardiology and the American Heart Association recommend using risk calculators to determine your risk of atherosclerotic cardiovascular disease (ASCVD). Atherosclerosis is the narrowing of your arteries caused by the buildup of a fatty substance known as “plaque.”

One such calculator that healthcare professionals use is the ASCVD Risk Estimator. The estimator provides a 10-year and lifetime risk of heart attack and stroke. It uses information such as your:

  • age
  • sex
  • race
  • blood pressure
  • cholesterol levels (LDL, HDL, and total cholesterol)
  • smoking status and history
  • medication use

An ASCVD risk score uses a percentage scale to rank your chance of having a stroke or heart disease in the next 10 years. Depending on your score, a doctor may have specific treatment recommendations.

  • Less than 5%: This percentage is considered low risk. Medication is generally not recommended.
  • 5% to less than 7.5%: This range is considered a borderline risk. A doctor may recommend statin medication if you have certain risk factors.
  • 7.5% to less than 20%: This range is considered an intermediate risk. The general recommendation is to start moderate-intensity statin therapy.
  • Greater than 20%: This percentage is considered high risk. To lower your risk of stroke or heart disease, you may want to consider high-intensity statin therapy.

Carotid ultrasound

A test called a “carotid ultrasound” may also help predict an impending stroke. A carotid ultrasound is a noninvasive imaging test that can detect the buildup of plaque in the carotid arteries in your neck. These arteries supply blood to your brain.

A carotid ultrasound is a painless procedure that uses sound waves to identify narrowing in the carotid arteries. This ultrasound is recommended for people who have symptoms of stroke or transient ischemic attack (TIA), also known as a “ministroke.”

The Society of Vascular Surgery believes carotid ultrasound could also be a helpful screening tool for asymptomatic people who are at very high risk of stroke, but the U.S. Preventive Services Task Force advises against carotid ultrasound stroke screening as a preventive measure.

A 2014 review of studies indicates that only about 1% of the general population has carotid artery narrowing, and false positives are found to be more common in people who don’t have stroke risk factors.

For people not at risk of stroke, taking preventive steps may be more effective than a carotid ultrasound at reducing the risk of a stroke.

What can you do to lower your risk of stroke?

You may not be able to completely prevent a stroke, but managing coexisting health conditions and making certain lifestyle changes may minimize your risk. These lifestyle changes include:

  • keeping your blood pressure within a moderate range
  • getting your cholesterol levels checked at least every 5 years
  • lowering LDL cholesterol if it’s too high
  • managing diabetes and blood sugar
  • taking any medications as needed for health conditions
  • quitting smoking, if you smoke
  • maintaining a moderate weight
  • eating a heart-healthy diet
  • exercising most days of the week
  • getting regular checkups for risk factors of stroke, such as a heart condition
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It’s important to get immediate medical attention if you have sudden onset of the following symptoms:

  • weakness or numbness on one side of your body in your arms, legs, or face
  • confusion
  • trouble speaking
  • loss of balance or trouble walking
  • changes in vision
  • severe headache

A stroke diagnosis can be confirmed with the following tests:

  • CT scan: A brain CT scan can show bleeding in the brain or cell damage due to a stroke.
  • MRI scan: An MRI scan of your brain can identify changes and damage to brain tissue. This test may be done in addition to, or instead of, a CT scan.
  • Cerebral angiography: During a cerebral angiogram, a doctor injects a contrast medium into your blood. The contrast medium creates a clear X-ray of the blood vessels in your brain, which can help the doctor identify any blockages or bleeds.

In addition to these imaging tests, a doctor may also order blood tests or an electrocardiogram (EKG).

Blood tests measure your blood count, platelet count, and glucose levels, and can show if these counts and levels are stable. Coagulation markers will also be measured to see how well your blood is clotting.

Because a stroke can be caused by atrial fibrillation (AFib), an EKG can help a doctor identify heart rhythm problems that may have led to a stroke.

Language matters

You’ll notice that the language used below to share stats and other data points is pretty binary, especially with the use of “men” and “women.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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Certain factors may increase your risk of a stroke. Some risk factors can be controlled, while others can’t.

Stroke risk factors that you can control include:

  • High blood pressure: High blood pressure is a leading cause of stroke and the most significant controllable risk factor.
  • Diabetes: Having type 1 or type 2 diabetes puts you at a greater risk of stroke.
  • Heart disease: Several types of heart disease can increase your risk of stroke. Effectively managing heart disease may help reduce your risk.
  • Smoking: Smoking damages your cardiovascular system, which increases stroke risk.
  • Diet: Eating foods that are high in saturated fats and cholesterol can increase the risk of plaque buildup in your blood vessels.
  • Obesity: Having obesity can put you at a higher risk of elevated blood pressure, diabetes, heart disease, and stroke.
  • Physical inactivity: Lack of exercise can lead to health issues that may increase your overall stroke risk.

Stroke risk factors you can’t control include:

  • Health history: Any prior stroke or TIA puts you at a greater risk of another stroke.
  • Family history: Sometimes there may be a genetic component to stroke risk.
  • Age: Stroke can occur at any age, but your risk increases with age.
  • Race: Black people are 50% more likely to have a stroke compared with white people of the same age. This distinction may be due to comorbidities (coexisting health conditions) and existing inequities in healthcare.
  • Gender: According to the American Stroke Association, women are at higher risk of stroke than men.

While there are no screening guidelines for stroke, an ASCVD risk score can help assess your 10-year risk of stroke and heart disease by looking at various factors.

Additionally, a carotid ultrasound may help find the buildup of plaque in the carotid arteries, which can increase the risk of stroke. This test may not be useful for people who don’t have stroke signs.

For most people, taking preventive steps may be more effective than a carotid ultrasound at reducing the risk of a stroke.