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How to help decrease your patients’ stroke risk

According to the Centers for Disease Control and Prevention (CDC), every 40 seconds in the United States, someone has a stroke, and every 4 minutes, someone dies of a stroke. [1] Research continues to elucidate additional insight into stroke risk and prevention. In this article, I’ll share a brief review of cerebrovascular accidents (CVA), more commonly known as strokes, I’ll share risk factors for stroke, and I’ll share how we as providers can help our patients decrease their risk for stroke.

A brief review of cerebrovascular accidents (CVA), more commonly known as strokes

Before I begin discussing risk factors for cerebrovascular accidents or strokes, I want to briefly review what a stroke is and the different types of strokes.

A stroke occurs when the brain’s blood supply is interrupted. As it is the second leading cause of death in developed countries, as well as the most common cause of long-term disability in adults, [2] stroke is a medical emergency; it requires immediate medical attention.

This interruption of the brain’s blood supply can come about either because of a clot that obstructs the brain’s blood flow (ischemic stroke) or because of blood flow interruption due to rupture of one or more vessels in the brain (hemorrhagic stroke). In addition to these two main types of strokes—ischemic and hemorrhagic strokes—it is possible to have a mild form of a stroke (or a “mini-stroke”). This type of stroke is called a transient ischemic attack or TIA. TIAs usually precede ischemic strokes.

What are some of the most common and less known risk factors for stroke?

The most common risk factors for stroke include:

  • Chronic diseases like hypertension and diabetes

  • Cardiovascular disorders including those that make clotting or other blockages more likely, such as atrial fibrillation, carotid artery disease, and diseases of the heart valves

  • Smoking

  • Viral infections or autoimmunity or other chronic inflammatory conditions, such as lupus and rheumatoid arthritis

  • High LDL cholesterol levels

  • Anxiety, depression, and high stress levels [3]

Age (older age), sex (men at younger ages, women during pregnancy and the post-partum period), race and ethnicity (African American, Alaska Native, American Indian, and Hispanic adults in the United States), and family history (e.g. if a parent had a stroke, especially if at a younger age) can each contribute to increased stroke risk as well.

Furthermore, research suggests that the following factors may also lead to increased risk for stroke:

  • Oral contraceptive pills increase risk for ischemic stroke, although the increased risk is comparatively small if there are no additional risk factors [4]

  • Preliminary research suggests that proton pump inhibitors may increase stroke risk [5]

  • Working long hours, especially if the person has worked those hours for 10 years or more, has also been associated with increased stroke risk [6]

How can patients decrease their stroke risk?

While there are some risk factors such as sex and age that our patients cannot control, there are many stroke risk factors that are within our patients’ control. Let’s review a few ways our patients can effectively decrease their risk for stroke.

Research has long demonstrated that limiting intake of inflammatory foods, such as red and processed meats, refined grains, and sugary beverages, is associated with a significant decrease in stroke risk. [7] By limiting their intake of these types of foods, our patients can significantly cut their stroke risk.

Additionally, research demonstrates that getting at least 7 hours of sleep on a nightly basis is associated with a significantly lower risk of stroke. [8] This, of course, is due to the fact that interrupted sleep or inadequate amounts of sleep leads to a pro-inflammatory state within the body that then increases risk for stroke and cardiovascular disease in general.

Low dietary potassium has also been associated with increased stroke risk. In one study, individuals who consumed less than 2.4 grams of dietary potassium per day were 1.5 times more likely to have a stroke than those who consumed more than 4 grams of potassium per day. [9]

Research also suggests that breastfeeding may help protect mothers against stroke, especially if they breastfed for 6 months or more. [10] This decreased risk of stroke in mothers who choose to breastfeed was strongest for those who breastfed for longer than six months and for Black women.

Finally, intravenous phosphatidylcholine may be beneficial in reducing elevated LDL cholesterol, a risk factor for stroke and other cardiovascular concerns.


In conclusion, there are multiple known risk factors for stroke but through diet and lifestyle recommendations, medication adjustments, and intravenous therapies like phosphatidylcholine, we can effectively help our patients address their risk factors for stroke.


[1] Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020.

[2] Ali Mousavi, S., Khorvash, F., & Hoseini, T. (2010). The efficacy of citroline in the treatment of ischemic stroke and primary hypertensive intracerebral hemorrhage; a review article. ARYA atherosclerosis, 6(3), 122–125.

[3] Jood, K., Redfors, P., Rosengren, A., Blomstrand, C., & Jern, C. (2009). Self-perceived psychological stress and ischemic stroke: A case-control study. BMC medicine. 7 (53). 10.1186/1741-7015-7-53.

[4] Loyola University Health System. (2009, October 27). Increased Stroke Risk From Birth Control Pills, Review Finds. ScienceDaily. Retrieved December 10, 2020 from

[5] American Heart Association. (2016, November 15). Popular heartburn medication may increase ischemic stroke risk. ScienceDaily. Retrieved December 12, 2020 from

[6] Fadel, M., Sembajwe, G., Gagliardi, D., Pico, F., Li, J., Ozguler, A., Siegrist, J., Evanoff, B. A., Baer, M., Tsutsumi, A., Iavicoli, S., Leclerc, A., Roquelaure, Y., & Descatha, A. (2019). Association Between Reported Long Working Hours and History of Stroke in the CONSTANCES Cohort. Stroke, 50(7), 1879–1882.

[7] Li, J., Lee, D.H., Hu, J., Tabung, F.K., Li, Y., Bhupathiraju, S.N., Rimm, E.B., Rexrode, K.M., Manson, J.E., Willett, W.C., Giovannucci, E.L., & Hu, F.B. (2020). Dietary Inflammatory Potential and Risk of Cardiovascular Disease Among Men and Women in the U.S.. Journal of the American College of Cardiology, 76(19), 2181 DOI: 10.1016/j.jacc.2020.09.535

[8] University of Warwick. (2011, February 8). Sleep deprivation: Late nights can lead to higher risk of strokes and heart attacks, study finds. ScienceDaily. Retrieved December 12, 2020 from

[9] American Academy Of Neurology. (2002, August 13). Will A Banana A Day Keep A Stroke Away? Low Potassium Intake May Increase Stroke Risk. ScienceDaily. Retrieved December 11, 2020 from

[10] Jacobson, L. T., Hade, E. M., Collins, T. C., Margolis, K. L., Waring, M. E., Van Horn, L. V., Silver, B., Sattari, M., Bird, C. E., Kimminau, K., Wambach, K., & Stefanick, M. L. (2018). Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. Journal of the American Heart Association, 7(17), e008739.


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