How to Reduce the Risk of a Second Stroke

Which neurological condition may cause difficulty in speaking, sudden weakness, numbness or problems with vision, all at once? The answer is simple: It’s a stroke. That’s why surviving a stroke feels like a monumental milestone, but you need to take care of certain things to reduce the risk of a second stroke. The probability of a second stroke can be reduced by identifying the cause of the first stroke and following your doctor’s prescribed treatment.

Another factor that answers how to prevent a second stroke is managing modifiable risk factors such as your blood pressure, cholesterol levels, physical activity, diet, diabetes and follow-up care. However, there is no specific strategy that guarantees complete prevention. Preventive care varies as per the stroke type, cause and your health conditions.

Why Is There a Risk of a Second Stroke?

The risk of a second stroke stems from the underlying vascular or heart-related conditions if left untreated. Another reason that increases the risk of a second stroke is damaged blood vessels, high blood pressure, an irregular heart rhythm or plaque buildup.

Some more specific triggers of a second stroke are:

• Carotid or other vascular disease
• Previous Transient Ischemic Attack (TIA)
• Plaque buildup in the carotid arteries
• Regular smoking
• Sedentary lifestyle
• Poor diet
• Diabetes
• Uncontrolled high blood pressure
• Elevated cholesterol levels
• Atrial fibrillation and other heart conditions

Most of these triggers may indicate early signs of brain strokes, such as sudden weakness or difficulty in speaking. If you experience any of these signs, consult your doctor without any further delay.

8 Ways to Reduce the Risk of a Second Stroke

Secondary stroke prevention involves addressing the cause and modifiable risk factors. The following 8 ways to reduce the risk of a second stroke focus on regular health monitoring and following your doctor’s recommendations.

1. Keep Your Blood Pressure Under Control

It is crucial to maintain blood pressure levels since high blood pressure puts extra strain on blood vessels and can lead to another stroke. You should check your blood pressure as recommended by your clinician and follow the treatment plan. You may also need to make some lifestyle changes to maintain normal blood pressure.

2. Take Stroke-Prevention Medicines Exactly as Prescribed

Depending on your condition, stroke prevention may include taking antiplatelet medicine, anticoagulant, blood pressure medicine, or cholesterol medicine. Each type of medicine has a particular action and addresses a certain risk factor of stroke. You should take all medicines you take as per your doctor’s guidance to reduce the risk of a second stroke.

3. Manage Cholesterol

Higher levels of low-density lipoprotein (LDL) cholesterol in the body lead to the accumulation of fatty deposits inside artery walls. As a result, it may cause a medical condition called atherosclerosis. This condition narrows or damages the arteries and increases the risk of developing vascular diseases. To avoid atherosclerosis, you must follow the recommended cholesterol control and test schedule.

4. Control Diabetes and Blood Sugar

Proper diabetes control protects the blood vessels from high glucose damage and plaque buildup. Stable blood glucose levels reduce the risk of frequent blood clot formation and reduce blood pressure. Because of that, stable blood glucose levels reduce the chances of a second stroke. Another important step in controlling diabetes is taking prescribed medicines as directed by your doctor. You may also need to make changes in your lifestyle for better prevention of stroke.

5. Stop Smoking

Smoking is a modifiable risk factor for stroke since it damages blood vessels and increases cardiovascular risks. If you smoke, consult your doctor to learn effective ways to quit this habit. Smoking cessation strategies are often built on evaluating your health needs, smoking history, current medicines and personal circumstances.

6. Follow a Heart- and Brain-Healthy Eating Pattern

Healthy eating can assist you in controlling blood pressure, cholesterol and blood sugar after the stroke. Your diet must consist of vegetables, fruits, whole grains and proteins. Also, you should not add excessive salt to your diet and avoid processed food.

7. Stay Physically Active as Medically Appropriate

Physical activities may assist in recovery from heart and stroke. However, the type and amount of physical activities will depend on your mobility, balance, disabilities, and overall health. Rehabilitation programs can also be considered. To know which exercises and physical activities are right for you, consult your doctor.

8. Attend Regular Follow-Up Appointments

Follow-ups can help you to monitor and prevent conditions that may cause another stroke. During a follow-up visit, doctors often check for your:

• Blood pressure
• Cholesterol levels
• Diabetes
• Heart rhythm
• Medicines
• Neurological recovery
• New symptoms

Why Finding the Cause of the First Stroke Matters

Preventing another stroke partly depends on finding out why the first stroke happened. Once the cause is identified, doctors can choose the right treatment and focus on the factors that may increase the risk of another stroke.

The assessment may include, depending on your health condition:

• Brain scans
• Blood testing
• ECG
• Heart Rhythm Monitoring (HRM)
• Echocardiography
• Imaging of blood vessels

Not all patients need these tests. Which ones you choose depends on the type of stroke, medical history, symptoms and initial findings. Treatment may also depend on whether the stroke was caused by a blood clot, bleeding, a heart rhythm disorder or something else. Thus, it makes the cause identification an important part of specific stroke treatment and planning for secondary stroke prevention.

What Role Does Atrial Fibrillation Play in Recurrent Stroke?

Atrial Fibrillation (AF) is an irregular heart rhythm condition, which means that the heartbeat will be irregular. The irregularity of the heartbeat leads to the pooling of blood in the heart and the formation of a thrombus (a blood clot that forms inside a blood vessel or the heart). The thrombus may travel to the brain and lead to an ischaemic stroke due to blocking of blood vessels.

After some strokes, patients may have their cardiac rhythm checked for signs of AF, which may have contributed to the occurrence of the stroke. Cardiac rhythm may be checked using an ECG or long-term monitoring. AF is an intermittent condition, and thus it may not be detected through a short examination.  In case AF is found, the treatment of AF will depend on various factors including your stroke history and cardiac health, among others.

Lifestyle Changes After a Stroke – Quick Checklist

After a stroke, daily habits and ongoing medical care both play a role in reducing future health risks. The table below highlights the main areas to focus on and what each one involves:

What Should You Avoid After a Stroke?

After experiencing a stroke, certain habits and care deficiencies should be addressed. The following are things that you should avoid for your recovery and prevention of another stroke:

• Stopping medications without the advice of your doctor
• Not keeping up with your follow-ups
• Avoid smoking
• Failing to control your high blood pressure
• Drinking too much alcohol
• Ignoring your diabetes or cholesterol issues
• Thinking that recovery equals no more risk of strokes
• Neglecting neurological symptoms

Know the Warning Signs of Another Stroke

A second stroke can cause sudden changes in movement, speech, vision or coordination. Some common warning signs include:

• Facial weakness or drooping
• Weakness or numbness in an arm or leg, particularly on one side
• Difficulty speaking or understanding speech
• Sudden changes in vision
• Sudden problems with balance or coordination
• Other sudden neurological symptoms

If any of these brain stroke symptoms appear suddenly, seek emergency medical evaluation immediately.

When Should You Follow Up With a Neurologist After a Stroke?

It is recommended that you visit a neurologist within the initial few weeks of having had a stroke, or as soon as your treating team recommends you to do so. The visit will allow you to get assessed for your neurological recovery process, the medications you have been prescribed, and also the risk factors for having another stroke. A timely visit to local practitioners such as a neurologist in Jaipur also helps you get started on preventive treatments.

Can a Second Stroke Be Completely Prevented?

There is no specific way to ensure that another stroke will not happen. However, you can reduce the risk of a second stroke by recalling the cause of the first stroke and discussing any recurrence of this condition with your doctor. A preventive approach may include taking prescribed medicines as directed by your doctor. A strong preventive approach also includes keeping your blood pressure in the ideal range, maintaining appropriate lifestyle habits and attending all follow-up consultations.

FAQs About Preventing a Second Stroke

1. How can I reduce my risk of a second stroke?

You can reduce the chances of a second stroke by managing your blood sugar levels, cholesterol levels, paying attention to any new or recurring symptoms and attending follow-up appointments on time.

2. What increases the risk of another stroke?

High blood pressure, irregular heart rhythm, and diabetes increase the risk of stroke. Some lifestyle factors such as smoking, a sedentary lifestyle, skipping post-stroke medicines or following a poor diet can also increase the risk of another stroke.

3. Can high blood pressure cause another stroke?

Yes, high blood pressure increases the risk of another stroke because it puts much force on the artery walls, which may damage blood vessels over time.

4. What foods should stroke survivors limit?

You should avoid foods that have high sodium content and processed foods. Both of them can increase blood pressure, which increases the risk of stroke.

5. Is exercise safe after a stroke?

Yes, controlled exercises as guided by your doctor are safe after a stroke.

6. Why are medicines important after a stroke?

Post-stroke medicines target the specific underlying causes of the stroke and reduce the chances of any such conditions.

7. Can stress increase stroke risk?

Yes, persistent and chronic stress can increase the risk of stroke.  This can occur because stress may raise the heart rate and blood pressure, creating additional strain on the cardiovascular system. The changes can cause the accumulation of plaque, which can cause dangerous blood clots to form or travel to the brain and cause a stroke.

8. What are the warning signs of another stroke?

The common warning signs of stroke are loss of balance, vision changes, facial drooping, speech difficulty or arm weakness.

9. How often should a stroke patient have follow-up appointments?

The exact timeline of follow-ups may vary for each patient. Doctors often recommend having a follow-up within 1 to 3 months after discharge from medical facilities, and another follow-up visit every 3 to 6 months during the first year post-stroke.

10. Can a second stroke be prevented completely?

There is no assurance of complete prevention of a second stroke. But you can prevent such conditions by taking some precautionary steps.

Dr. Sumit Kamble

specialization intending to various Neurological disorders including Epilepsy, Stroke, Headache and Spine problems.

Dr. Sumit Kamble is one of the best Neurologist in Jaipur. He has done his MBBS from Govt Medical College, Nagpur, MD in General Medicine from Govt Medical College, Baroda, and DM in Neurology from Govt Medical College, Kota. At present, He is working as a Consultant Neurologist in Jaipur, Rajasthan.

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