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Reducing the risk of a subsequent stroke

Adopting a healthy lifestyle
For people who have suffered a stroke or a transient ischaemic attack (TIA), there is always the fear of another stroke. But even though the risk is greater than someone who has never had a stroke you can modify your lifestyle to reduce the risk of another stroke.

(See What You Can Do to the Reduce the Risk of Stroke)

How medication can help
If you have had a stroke you are most likely taking some form of medication prescribed by your doctor to reduce the risk of a subsequent stroke.

The drugs prescribed are mainly those that:

  • lower blood pressure
  • reduce the risk of blood clots
  • lower ‘bad' cholesterol levels

It is important to take your medicine as prescribed by your doctor. Some people stop their medication as soon as they feel well – not knowing that they are putting themselves at risk.

You should ask your doctor to explain what the drugs are and why you should take them.
Also ask you doctor if there are any side effects of the drugs and should you develop any
unpleasant symptoms such as giddiness or nausea you must let your doctor know.

Types of drugs

Blood pressure drugs
High blood pressure is the most common cause of stroke. There are several types of drugs to treat this condition. Some of the most common types of drugs are:

  1. Diuretics – rid the body of excess fluids and salt (sodium)
  2. Beta-blockers – reduce the heart rate and the heart's output of blood
  3. Sympathetic nerve inhibitors – sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels.
  4. Vasodilators – these can cause the muscle in the walls of the blood vessels to relax, allowing the vessel to widen.
  5. Angiotensin-converting enzyme (ACE) inhibitiors – these interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict.
  6. Angiotensin II receptor blockers – block the effects of angiotensin.
  7. Calcium antagonists – can reduce the heart rate and relax blood vessels.

Anti-platelet drugs and aspirin to prevent blood clots
If you had an ischaemic stroke (caused by blockage of a blood vessel by a blood clot) your doctor would likely prescribed a drug to make your blood less sticky and less likely to form clots. These drugs include asperin, ticlopidine and clopidogrel, are called anti-platelet drugs. They work by preventing blood cells known as platelets from sticking together to form a blood clot – which can limit or completely stop the flow of blood to part of the brain to cause a stroke.

Anti-platelet drugs are, however, not suitable for people whose strokes were caused by bleedling due to rupture of a blood vessel.

Drug for atrial fibrillation (irregular heartbeat)
Atrial fibrillation is an irregular heartbeat that can cause blood clots to form easily in the heart. The blood clot may break off and travel to an artery in the brain to cause a stroke. To prevent this from occurring doctor may prescribe an anticoagulation drug usually wafarin. This drug inhibits clotting proteins, ‘thins' the blood, making it less likely that a clot will form.

Cholesterol-lowering drugs
A high level of ‘bad' cholesterol in the blood increases the risk of stroke. If a change of diet ie cutting down on red meat and food with high fat content does not reduce the cholesterol level in the blood, your doctor will probably prescribe cholesterol-reducing drugs which are designed to lower the levels of fats (lipids) in the blood, which include cholesterol and triglycerides.

Drugs for Diabetes Mellitus
Diabetes contributes to the building up of plaques inside the walls of arteries which
eventually blocks the flow of blood. If not enough blood gets to the brain cells stroke will occur.
If you are a diabetic, it is important to have your blood sugar level check regularly so that your doctor can prescribe the appropriate drugs.

Regular Medical Check-Up
If you had had a stroke it is important to attend regular medical check-ups so that you have your blood pressure, cholesterol level and weight are monitored.

All the types of drugs mentioned above can only be obtained from a doctor's prescription. You should always ask your doctor for a full explanation of the benefits and possible side-effects of drugs prescribed to you.

  1. Become more physically active. Exercising helps to lower blood pressure (high blood pressure is the single biggest risk factor for stroke), controls weight, helps create a healthy balance of blood fats and improves your body's ability to handle insulin. Aim to do some kind of moderate physical activity for 30 minutes for at least five days of the week.
  2. Eat a healthy diet. Fresh fruit and vegetables are rich sources of antioxidant vitamins and minerals, which research has found, reduces the risk of stroke. A high consumption of salt has been linked to high blood pressure, while too much saturated fat can lead to atherosclerosis (furring of the arteries).
  3. Stay a healthy weight. Being overweight is a risk of a stroke.
  4. Don't smoke. Smoking increases your risk of stroke because it causes atherosclerosis (furring of the arteries) and makes the blood more likely to clot.
  5. Drink sensibly. Watching your alcohol intake can help you avoid stroke. Avoid heavy drinking, especially drinking large amounts of alcohol in one go, as this can cause blood pressure to soar. Don't drink every day. Try to have at least a couple of alcohol-free days a week.
  6. Get your blood pressure checked. All adults should have their blood pressure checked at least once every five years (more often is they have high blood pressure), are taking medication or have other underlying conditions.
  7. Seek advice from your doctor before taking contraceptive pill or going for HRT.


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