The chance of a stroke increases with age and the majority of strokes happen to people over 65, but a quarter occur in younger patients. Stroke occasionally happens in childhood.

There are, however, a number of major factors, which increase the risk:

• high blood pressure;
• smoking;
• physical inactivity, poor diet and obesity;
• diabetes;
• excessive alcohol intake;
• past history of transient ischaemic attack (TIA or ‘mini-stroke’);
• past history of an irregular heart beat or cardiovascular disease such as a heart attack.

High blood cholesterol is a greater risk factor for heart disease than for stroke but as there is a medical link between heart disease and stroke it should be considered. Diabetes and raised blood pressure add to the risk of stroke. People from South Asia have a tendency to some forms of diabetes and raised blood pressure is more common in Afro-Caribbean people.

Contrary to popular belief, stroke is not hereditary, but the fact that it recurs in families is being investigated. Stress is also often regarded as the cause for stroke, but there is no scientific evidence to link the two.

High blood pressure
If everyone understood the link between high blood pressure and stroke, had regular blood pressure checks as a preventive measure, and followed medical advice and treatment, then as a nation we could reduce death from stroke by 40%. Although doctors, practice nurses and company occupational health departments are all carrying out regular blood pressure checks, people do not understand that high blood pressure is a greater risk factor for stroke than for heart disease.

If you are found to have high blood pressure, even if you feel well, it must be reduced and controlled. For some people changes in lifestyle are quite sufficient. We could all benefit from the following common sense approach to life:

• Try to keep your weight steady.
• If you know that you are obese (really overweight), seek advice and help with your diet.
• Exercise is very important and few of us take enough of it.
• Control the amount of alcohol you drink -14 units for women and 21 units per week for men – that is two small drinks a day for women and three small drinks for men.
• Learn to live without extra salt added to your food.
• If your blood pressure is (or remains) high it can usually be controlled by taking medication prescribed by a doctor. It may be necessary to take drugs for long periods or indeed for the rest of your life. There are a number of drugs on the market. If a drug does not agree with you, discuss it with your doctor and ask to change.
• Follow a sensible diet (low fat, plenty of fruit and vegetables).

Smoking
Smoking is responsible for many diseases and stroke is no exception. Giving up smoking is worthwhile, whatever your age. Smoking is becoming less fashionable among older people but unfortunately it is increasing among the young. Smoking is more common in the north of the UK where the incidence of stroke has been found to be higher. Research is being undertaken to discover why this north-south divide exists.

Here are some tips to help you succeed in finally giving up:

• Understand your own habits. Smoking is strongly linked to certain times and situations;
• Think about changing your habits. Then make an action plan;
• Set a date to stop; stop completely on that day don’t gradually give up;
• Review past experience: what helped and what hindered;
• Plan ahead: identify likely problems, make a plan to deal with them;
• Tell your family and your friends that you are giving up. Ask them for their support;
• Plan what you are going to do about alcohol;
• Try Nicotine replacement therapy; use whichever product suits best.

Nicotine Replacement Therapy
This comes in many forms. Gum, tablets, patches, inhalers, (like a cigarette). Using these will double your chances of stopping. Nicotine replacement therapy, (“NRT”), will help reduce the craving of withdrawal. It also reduces the tension and irritability that some people have when they stop smoking. NRT is not addictive and also does not cause cancer. You can use NRT for as long as you like,even up to a year, if that is what it will take for your to give up cigarettes.
NRT is not perfect. You will still have the urge to smoke, but fortunately, can turn to an alternative, such as gum, inhaler etc.

Lack of exercise
There is now strong evidence, which shows that lack of exercise doubles the risk of a stroke. Physical inactivity has for a long time been linked to high blood pressure. So whichever way you look at it, exercise is good for you.

Most people incorrectly believe that they exercise enough but few achieve the minimum: 20 minutes three times a week. Although swimming is of benefit, brisk walking – which is weight bearing – is much better. To be effective the exercise should be sufficiently vigorous to make you become out of breath or perspire heavily. (If you check your pulse, it should be 20 beats per minute faster than normal.) If you have not done any exercise for a while you will need to start gently and build up your stamina over a period of time.

Diabetes
If there is diabetes in your family it is important that your doctor is aware of it and that your blood sugar levels are checked from time to time. People with diabetes, or a tendency to a high blood sugar have twice the risk of stroke.

Heart disease or TIA (mini-stroke)
People who have had a heart attack or small stroke or transient ischaemic attack, , where symptoms last for less than 24 hours are generally at greater risk of having a stroke. They need to be aware not only of the risk factors but of the necessity to take action:

• to have regular blood pressure checks;
• to make changes in their lifestyles;
• investigation, such as carotid ultrasound, when an ultrasound examination is carried out over the carotid artery in your neck. The procedure is just like ultrasounding for a baby or for heart valves but in this case over the arteries at the top of your neck.

A small regular daily dose (say 75 – 300mg) of aspirin has been shown in many studies to reduce the chances of a stroke, in those with risk factors, by about 15%. It is important to take medical advice before embarking on this treatment, particularly if you have an active peptic ulcer or suffer allergies or bleeding. People with an irregular heartbeat may be given warfarin, which reduces the blood’s tendency to clot. Other drugs, (such as dipyridamole or clopidogrel), may be used with or instead of aspirin.

Risk factors multiply up
Risk factors do not simply add up.  They multiply up.Data from the British Regional Heart Study, shows that a smoker, (twice the risk), with high blood pressure, (three times the risk), who is inactive, (one and a third times the risk), and has had a previous heart attack, (twice the risk), is at extremely high risk of stroke: 2 x 3 x 1.3 x 2 = 16 times more at risk than a person of the same age without these risk factors.

Stroke in younger people – the causes
In the main, risk factors are the same for older and younger people though the reason for the stroke can be different. Stroke in younger people may be due to certain rare medical conditions or to defects in blood vessels, which have been present from birth. Reducing the chances of a second stroke can depend on detecting and treating the condition, which caused the stroke in the first place.

Contraceptives
There is a false belief that a stroke can be caused by sexual intercourse. However, oral contraceptives may slightly increase the risk of a stroke. The newer low-dose preparations are safer than the older ones. They should not be taken by women who have high blood pressure or who smoke, particularly when they reach their late 30′s or early 40′s. Hormone replacement therapy, by contrast, does not increase the chance of having a stroke.

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4. Blood Clot — Deep vein throm­bosis
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6. Cir­cu­la­tion dis­orders: Aneurysm 

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