Controllable Risk Factors

Is stroke prevention possible?

While stroke prevention may not be entirely possible, you can control or treat certain risk factors with the help of your doctor. You can change most of the conditions below through diet and exercise. Others may need medication.

Your best ally toward stroke prevention is knowledge. Talk to your doctor to find out if you have any of these health risks. Then, work together with your doctor to develop a plan that's right for you. You may want to use our Personal Risk Assessment Form as a starting point for talking with your doctor.

High blood pressure
High blood pressure is the most important risk factor for stroke. It's often called the "silent killer" because it usually has no symptoms. It affects 40 percent of African-American men and women over age 20.

Have your blood pressure checked at least once every two years — and more often if you have a family history of high blood pressure, stroke or heart attack. Then remember your numbers. Compare your results with the chart below.

Blood Pressure(mm hg)



Less than 120


140 or higher


Less than 80


90 or higher

If your readings are in the prehypertension or high-range areas, work with your doctor to lower your blood pressure. You may also need to take medicine. Be sure to take it as instructed. If you have side effects, talk to your doctor before you stop taking it.

Smoking cigarettes puts you at much greater risk for having a stroke. Constant exposure to other people's tobacco smoke also increases your risk — even if you don't smoke. If you're a woman who uses birth control pills and smokes, your risk is even higher.

The bottom line is this: If you don't smoke, don't start. If you do smoke, quit! When you stop smoking — no matter how long or how much you've smoked — your risk of stroke drops.

Diabetes is a fasting plasma glucose (blood sugar level) of 126 mg/dL or more on at least two occasions. It can be controlled, but it still increases your risk for stroke. About 2.7 million African Americans, or over 11 percent, have diabetes.
People with diabetes often also have high blood pressure and high blood cholesterol, and are overweight. This increases their risk for stroke even more. If you have diabetes, work with your doctor to manage it.

Carotid or other artery disease
The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits may become blocked by a blood clot.

Peripheral artery disease is the term for narrowed blood vessels that carry blood to leg and arm muscles. If you have peripheral artery disease, you have a higher risk of carotid artery disease, which makes stroke prevention more difficult.

Atrial fibrillation
In atrial fibrillation the heart's upper chambers quiver instead of beating effectively. This lets the blood pool and clot, raising the risk for stroke. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.

Transient ischemic attacks (TIAs or “mini strokes”)
TIAs produce stroke-like symptoms, but no lasting damage. They are strong predictors of stroke. Don't ignore a TIA — call 9-1-1 to get medical attention right away. Learn the stroke warning signs. They also apply to TIAs.

Certain blood disorders
A high red blood cell count makes blood clots more likely, increasing the risk of stroke. Doctors may treat this problem by removing blood cells or prescribing “blood thinners.”

Sickle cell anemia is a genetic disorder that mainly affects African-American children. “Sickled” red blood cells are less able to carry oxygen to the body's tissues and organs. They also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

High blood cholesterol
A high level of total cholesterol in the blood is a major risk factor for heart disease, which raises your risk of stroke. Among non-Hispanic blacks age 20 and older, more than one-third of men and nearly half of women have total blood cholesterol levels over 200 mg/dL — a level at which the risk for heart attack and stroke increases.

High levels of LDL ("bad") cholesterol and triglycerides (blood fats) can increase the risk of stroke in people with prior coronary heart disease, ischemic stroke or TIA.

A high level of HDL ("good") cholesterol lowers your risk of heart disease and stroke. A low level of HDL cholesterol raises the risk of heart disease and stroke.

Know your cholesterol numbers by getting screened. Compare your results to the chart below.

Cholesterol Level(mg/dL)

Desirable(low risk)
Borderline-High Risk
High Risk

Total cholesterol

Less than 200


240 or higher

LDL ("bad") cholesterol

Less than 130*


160 or higher

HDL ("good") cholesterol

40 or higher (the higher the better - an HDL of 60 mg/dL and above is considered protective against heart disease.)

Less than 40

Less than 40

*People who have had an ischemic stroke or heart attack (or are at high risk for having one) may be advised by their doctor to keep their LDL level below 100 or, if they're at very high risk, below 70.
If your readings are borderline or high-risk, work with your doctor to lower your risk for heart disease and stroke.

Physical inactivity and obesity
Get up and get moving. That's the message from the U.S. Surgeon General, who recommends 30 minutes or more of physical activity on most, and preferably all, days of the week. Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. Regular physical activity helps reduce your risk of heart attack, heart disease and stroke. So find an activity you love, grab a buddy, and stick to it. You'll like how good you feel!

Excessive alcohol
An average of more than one alcoholic drink a day for women or more than two drinks a day for men raises blood pressure and can lead to a stroke.

Illegal drug use
Intravenous drug abuse carries a high risk of stroke. Cocaine use has also been linked to strokes and heart attacks. Some have been fatal even in first-time users.

The Need for Quality Care
Finding a doctor you can trust can be challenging. That's why the National Committee for Quality Assurance (NCQA) and the American Heart Association/ American Stroke Association joined forces to create a new program that recognizes primary care physicians and others who care for patients with cardiovascular disease and stroke.