Practical ways to lower your chances of having a stroke.
Stroke prevention is about understanding your risk factors and knowing what you can do to lower your chances of having a stroke. This page covers common stroke risk factors, healthy habits, medical conditions to manage, and practical steps you can take to protect your brain and heart.
Many strokes can be prevented, but not every stroke is preventable. Stroke prevention is not about blame. It is about knowing that risk can often be lowered through routine medical care, treatment of health conditions, and healthy daily habits that support heart and brain health.
The American Stroke Association states that up to 80% of strokes may be prevented by managing risk factors and adopting healthy lifestyle habits. Large international research also supports the importance of prevention. The INTERSTROKE study found that 10 potentially modifiable risk factors were associated with about 90% of the population-attributable risk for stroke worldwide. These numbers do not mean every individual stroke could have been avoided, but they do show that prevention can make a major difference.
Primary prevention means lowering the chance of a first stroke before one happens.
Secondary prevention means lowering the chance of another stroke after someone has already had a stroke or transient ischemic attack, also called a TIA.
Prevention usually works best when medical care and daily habits work together. Routine health checks are important because some of the biggest stroke risks can be silent. A person may have high blood pressure, high cholesterol, diabetes, atrial fibrillation, or sleep apnea without realizing how much those conditions may be affecting their stroke risk.
The 2024 American Heart Association/American Stroke Association primary prevention guideline emphasizes screening for stroke risk factors, supporting healthy lifestyle behaviors, and treating medical risks when needed. It also highlights the importance of considering barriers such as access to care, cost, transportation, food access, and other social factors that can affect prevention.
Prevention does not have to mean changing everything at once. For many people, the best starting point is to stay connected with routine healthcare, understand which risks matter most, and choose one or two realistic changes that can be sustained over time.
Stroke risk is not the same for everyone. Some risks are related to age, family history, or past medical events. Some are related to medical conditions that need treatment and monitoring. Others are shaped by daily habits, life stage, access to healthcare, stress, cost, transportation, food access, and the environment around us.
Knowing your risk does not mean blaming yourself. It means understanding what may increase risk, what can be checked, and where prevention efforts may help the most.
This section is a big-picture map. Later sections explain what to do about specific medical conditions, health behaviors, sleep, stress, and life-stage risks.
| Risk category | What this means | Examples |
|---|---|---|
| Risks you cannot change | These are part of your personal or family history. You cannot remove them, but knowing about them can help guide screening and prevention. | Age, family history of stroke, some inherited conditions, and prior stroke or TIA. |
| Medical conditions to treat and track | These are health conditions that may increase stroke risk and often need regular medical follow-up, monitoring, or medication. | High blood pressure, atrial fibrillation, diabetes, high cholesterol, heart disease, carotid artery disease, and sleep apnea. |
| Health behaviors and daily habits | These are habits that can affect blood pressure, cholesterol, blood sugar, weight, heart rhythm, sleep, and blood vessel health. | Eating patterns, physical activity, smoking or nicotine use, alcohol use, substance use, sleep habits, and sedentary time. |
| Life-stage and hormone-related risks | Stroke risk can change during different phases of life. Some risks are more relevant during pregnancy, postpartum, menopause, or when using certain hormone-related medications. | Pregnancy, postpartum period, preeclampsia, gestational diabetes, birth control, hormone therapy, menopause, migraine with aura, and gender-affirming hormone therapy. |
| Social, access, and environmental factors | Health is affected by more than individual choices. Prevention can be harder when people face barriers to care, healthy food, medication, safe activity, or support. | Healthcare access, medication cost, transportation, food insecurity, housing stability, safe places to exercise, work demands, chronic stress, racism, language access, and social support. |
Some risk factors fit into more than one category. For example, sleep apnea is a medical condition, but sleep habits and access to testing or treatment also matter. Weight can be influenced by medical conditions, medications, sleep, food access, stress, activity, and genetics. Smoking may be a personal habit, but quitting is also affected by stress, mental health, addiction, cost, and support.
The goal is not to identify every possible risk at once. The goal is to start with the risks that are most important, most measurable, and most realistic to address.
A stroke risk calculator can be a helpful starting point for understanding your personal risk. It cannot predict the future, diagnose a condition, or replace medical advice, but it can help you identify topics to discuss with your healthcare provider.
The Cleveland Clinic Stroke Risk Calculator is one tool that can help people think through possible stroke risk factors.
You do not need to know all of these before asking for help. A healthcare visit is a good place to find out which numbers matter most for you.
Blood pressure
Cholesterol results
Blood sugar or A1c
Heart rhythm history, including atrial fibrillation
Current medications
Smoking or nicotine use
Physical activity level
Sleep concerns or possible sleep apnea
Family history of stroke or heart disease
Personal history of TIA, stroke, heart disease, diabetes, high blood pressure, high cholesterol, or pregnancy-related high blood pressure
A useful question to ask your healthcare provider is: Which stroke risk numbers should I know, and how often should I check them?
Some stroke risks come from medical conditions that need regular monitoring, treatment, or follow-up. These conditions may not always cause obvious symptoms, but they can still affect the blood vessels, heart, and brain over time.
This section focuses on medical conditions. Later sections focus on daily habits such as healthy eating, movement, smoking, alcohol, sleep, and stress.
High blood pressure is one of the most important stroke risk factors because it can damage blood vessels over time. It can narrow or weaken blood vessels, make the heart work harder, and increase the chance of blocked or bleeding strokes. Many people do not feel symptoms when blood pressure is high, which is why routine checks matter.
Atrial fibrillation, often called AFib, is an irregular heart rhythm that can allow blood clots to form in the heart. A clot can travel to the brain and cause an ischemic stroke. Some people feel palpitations, fluttering, fatigue, or shortness of breath, while others have no obvious symptoms.
Diabetes and long-term high blood sugar can damage blood vessels and often occur alongside other stroke risks such as high blood pressure, high cholesterol, kidney disease, and heart disease. Knowing whether you have diabetes or prediabetes can help guide prevention.
Cholesterol is one part of overall cardiovascular risk. When cholesterol contributes to plaque buildup in the arteries, blood vessels can narrow or clots can form. Cholesterol management may include nutrition changes, physical activity, medication, or a combination of approaches.
Some heart conditions can increase the risk of clots traveling to the brain. Carotid artery disease can narrow the blood vessels that carry blood to the brain. These conditions may require monitoring, medication, imaging, procedures, or specialist care depending on the person.
A prior TIA or stroke is an important warning sign. Secondary prevention focuses on understanding the likely cause, treating the risks that contributed, and reducing the chance of another stroke. A TIA should be treated as urgent, even if symptoms go away.
These questions are grouped here so the same provider questions do not need to be repeated in every section.
What are my most important stroke-related medical risks?
What numbers or symptoms should I monitor at home?
How often should my blood pressure, cholesterol, blood sugar, or heart rhythm be checked?
Do I need medication, testing, imaging, or specialist follow-up?
If I have had a TIA or stroke, what was the most likely cause and what is the prevention plan?
What symptoms should make me call 911 instead of waiting for an appointment?
The goal of treating and tracking medical conditions is not to create fear. It is to find the risks that matter most, monitor them over time, and work with a healthcare team to reduce stroke risk in a realistic way.
Healthy eating can help protect the blood vessels, heart, and brain. It can also support blood pressure, cholesterol, blood sugar, weight, energy, and overall health. Eating for stroke prevention does not have to mean following a perfect diet or changing everything at once.
A Mediterranean-style eating pattern is often recommended for heart and brain health. This pattern usually includes vegetables, fruits, beans, lentils, whole grains, fish, poultry, nuts, seeds, and non-tropical oils such as olive oil. It also limits foods that are high in added sugars, sodium, saturated fats, and highly processed ingredients.
Add fruits and vegetables when you can. Frozen, canned, and fresh options can all be useful.
Choose whole grains more often, such as oatmeal, brown rice, whole grain bread, or whole grain pasta.
Use beans, lentils, fish, poultry, nuts, seeds, and other lean proteins as regular options.
Choose oils such as olive or canola oil instead of butter or shortening when possible.
Look for lower-sodium options, especially with canned, packaged, and restaurant foods.
Limit sugary drinks when possible. Water, sparkling water, or unsweetened drinks can be helpful swaps.
Limit processed meats and fried foods if they are frequent parts of your routine.
Build meals around what is realistic for your budget, culture, energy level, cooking ability, and household needs.
Try water or unsweetened tea instead of soda for one drink each day.
Choose low-sodium canned soup or rinse canned beans and vegetables.
Add fruit to breakfast or keep a simple fruit option visible at home.
Add one vegetable to a meal you already eat, such as spinach in eggs or vegetables with pasta.
Try baked, grilled, or air-fried options instead of fried foods when that is realistic.
Use herbs, spices, garlic, vinegar, or lemon to add flavor without relying only on salt.
Choose a small handful of nuts, yogurt, fruit, or whole grain crackers as snacks when available.
Plan one simple repeat meal for busy days so eating well does not depend on having extra time or energy.
Food choices are affected by time, money, fatigue, disability, transportation, caregiver responsibilities, culture, appetite, swallowing safety, and access to groceries. A helpful prevention plan should not assume that everyone can cook from scratch, afford specialty foods, or follow a rigid meal plan.
If someone has diabetes, kidney disease, heart disease, food insecurity, difficulty swallowing, weight changes, or complex medical needs, a registered dietitian or healthcare provider can help tailor recommendations. If swallowing problems are present after stroke or with another neurologic condition, a speech-language pathologist may also be important.
Regular movement supports heart and brain health. It can help with blood pressure, cholesterol, blood sugar, sleep, mood, energy, strength, balance, and weight management. Movement does not have to mean going to a gym or doing intense exercise.
For many adults, a common goal is at least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous activity, plus muscle-strengthening activity at least two days per week. These goals can be built up gradually and adjusted based on health, disability, pain, fatigue, balance, and medical guidance.
Take a short walk after a meal.
Do seated marches, sit-to-stands, or gentle arm movements during TV commercials.
Stand up and move for a few minutes every hour if you sit for long periods.
Park farther away or take an extra lap around the store if that is safe for you.
Use water exercise, chair exercise, adaptive fitness, or physical therapy guidance if walking is difficult.
Do movement with a friend, family member, support group, or class for motivation and safety.
Use short exercise snacks, such as 3 to 10 minutes of activity, several times throughout the day.
Add simple strengthening, such as wall push-ups, sit-to-stands, step-ups, or resistance band exercises.
Choose activities you are more likely to repeat: dancing, gardening, biking, swimming, walking, tai chi, or household tasks.
Long periods of sitting can make it harder to reach activity goals. One practical approach is to look for small places where movement can fit into normal routines. Examples include standing during a phone call, walking while talking with a friend, doing balance practice at the kitchen counter, or taking a short movement break between tasks.
A helpful question is: Where can I add a little more movement into my normal day?
Weight can affect stroke risk, but weight is not the whole story. Blood pressure, blood sugar, cholesterol, sleep, nutrition, activity, stress, medications, disability, genetics, and access to care all matter. For many people, the most useful approach is to focus on healthy behaviors that can be repeated: moving more, building strength, eating more nourishing foods, sleeping better, and getting support when needed.
It is wise to ask a healthcare provider before starting or increasing exercise if you have chest pain, fainting, unexplained shortness of breath, unstable blood pressure, a recent heart problem, a recent stroke or TIA, frequent falls, severe dizziness, or other safety concerns.
Smoking, heavy alcohol use, and some substances can increase stroke risk by affecting blood pressure, blood vessels, heart rhythm, oxygen levels, clotting, and overall cardiovascular health. This section is not about shame or judgment. It is about knowing where risk may increase and where support is available.
Smoking and secondhand smoke damage blood vessels and increase the risk of heart disease and stroke. Nicotine products can also affect blood pressure and heart rate. Quitting is often difficult because nicotine is addictive, but people do not have to do it alone.
Support may include quitline coaching, nicotine replacement therapy, prescription medication, counseling, text programs, apps, support from family or friends, and repeated attempts. A slip does not mean failure. Each attempt can teach someone what support they need next.
Alcohol affects people differently. Heavy drinking can raise blood pressure and may increase the risk of stroke and heart disease. Alcohol can also affect sleep, balance, medications, mood, judgment, and heart rhythm in some people.
Helpful steps may include tracking how much you drink, adding alcohol-free days, asking a provider what amount is safe for you, avoiding alcohol as a sleep aid, or seeking support if cutting back feels difficult.
Some substances, including stimulants such as cocaine and amphetamines, are linked with increased stroke risk. Substance use can also interact with medications, blood pressure, heart rhythm, sleep, and mental health.
It is important to be honest with healthcare providers about substance use so they can give safer medical advice. Support is available, and asking for help is a health step, not a character flaw.
The goal is not perfection. Reducing tobacco exposure, cutting back on alcohol when needed, and getting support for substance use can all be meaningful steps toward lowering stroke risk.
Sleep and stress affect the body in many ways. They can influence blood pressure, heart rhythm, blood sugar, weight, inflammation, mood, energy, and the ability to follow through with healthy habits. Improving sleep and stress does not mean life has to be calm or perfect. It means looking for small supports that help the nervous system, body, and daily routines function better.
Healthy sleep is included in the American Heart Association’s Life’s Essential 8, a group of key health behaviors and health factors that support cardiovascular health.
Poor sleep, irregular sleep, and untreated sleep disorders can make it harder to manage blood pressure, blood sugar, weight, mood, and energy. Sleep problems can also make it harder to exercise, prepare healthy meals, take medications consistently, or attend appointments.
Helpful sleep habits may include keeping a consistent wake time, creating a calming bedtime routine, reducing screens close to bedtime, limiting caffeine later in the day, getting morning light when possible, and avoiding alcohol as a sleep aid. If sleep problems continue, medical support may be needed.
Sleep apnea is a condition where breathing repeatedly stops or becomes shallow during sleep. This can lower oxygen levels, disrupt sleep, increase strain on the heart, and contribute to high blood pressure and other health problems. Some people with sleep apnea feel very sleepy during the day, but others mainly notice snoring, morning headaches, poor concentration, or hard-to-control blood pressure.
Possible signs of sleep apnea include loud snoring, gasping or choking during sleep, pauses in breathing witnessed by someone else, morning headaches, dry mouth, daytime sleepiness, trouble concentrating, high blood pressure, or atrial fibrillation. Diagnosis may involve a sleep study. Treatment may include CPAP, other positive airway pressure devices, oral appliances, positional strategies, weight-related treatment when appropriate, or other medical options.
Stress can affect prevention both directly and indirectly. Ongoing stress may affect sleep, eating, movement, tobacco or alcohol use, medication routines, blood pressure, and the ability to make or keep appointments. Stress is also shaped by real-life factors such as caregiving, finances, work, housing, discrimination, grief, trauma, social isolation, and access to support.
Stress management does not mean pretending everything is fine. It means building enough support and recovery into life that the body is not constantly stuck in high alert.
Pause for one minute. Notice your feet on the floor. Relax your shoulders. Take a slow breath in, then exhale a little longer than you inhale. Name one thing you can see, one thing you can feel, and one next step you can take. Mindfulness does not remove stress, but it can help the nervous system slow down long enough to choose the next step.
Talk with a trusted person, counselor, support group, faith leader, or healthcare provider.
Use short movement breaks, stretching, walking, breathing, prayer, journaling, music, or time outside.
Ask for practical help with transportation, food, medication costs, paperwork, caregiving, or appointments.
Seek urgent help if stress, depression, anxiety, or substance use feels unsafe or unmanageable.
Stroke risk can change across life stages. Some risks are related to pregnancy, hormones, menopause, aging, migraine, medical history, or medications. These risks do not mean someone will have a stroke, but they are important to discuss with a healthcare provider.
This section is included because some life-stage and hormone-related risks can be missed if prevention only focuses on the most common risk factors.
Pregnancy and the weeks after delivery can affect blood pressure, blood clotting, heart workload, and stroke risk. High blood pressure during pregnancy is an especially important warning sign. Pregnancy-related conditions such as preeclampsia, eclampsia, and gestational diabetes can also matter for long-term heart and brain health.
It is important to seek urgent care for sudden severe headache, vision changes, weakness, numbness, confusion, chest pain, shortness of breath, seizures, fainting, or other concerning symptoms during pregnancy or after delivery. Postpartum follow-up matters, especially for people who had high blood pressure or other complications during pregnancy.
Some hormone-related medications may affect stroke risk for certain people, especially when combined with other risk factors such as smoking, high blood pressure, age, clotting history, or migraine with aura. This does not mean everyone should avoid hormonal contraception or hormone therapy. It means the choice should be individualized.
Migraine with aura is important to mention during medical visits, especially when discussing estrogen-containing birth control or hormone therapy. A new or sudden neurologic symptom should not be assumed to be migraine. Sudden face drooping, arm weakness, speech trouble, vision loss, severe dizziness, confusion, or a sudden severe headache should be treated as an emergency.
Stroke risk generally increases with age. Menopause can also be a time when blood pressure, cholesterol, weight, sleep, and blood sugar change. Routine health checks can help identify changes early.
Hormone therapy may be appropriate for some people for specific symptoms, but it should be discussed with a healthcare provider based on personal risks, benefits, and timing. Hormone therapy should not be used simply as a stroke-prevention strategy.
Stroke can happen in younger adults, even though risk increases with age. Younger adults should not ignore high blood pressure, diabetes, high cholesterol, smoking, migraine with aura, pregnancy-related complications, heart rhythm symptoms, substance use, or a family history of early stroke or heart disease.
A helpful prevention message for younger adults is: you are not too young to know your risks, and prevention can start before problems become more serious.
Older adults may have more than one stroke risk factor at the same time. Prevention often means keeping routine follow-up, reviewing medications, checking blood pressure, asking about heart rhythm concerns, addressing sleep apnea when suspected, and making sure the plan is realistic.
The goal is not to overwhelm someone with every possible risk. The goal is to identify the most important risks and make a plan that fits the person’s health, independence, support system, and goals.
People using gender-affirming hormone therapy should have supportive, knowledgeable healthcare. Stroke prevention should be individualized and respectful, with attention to blood pressure, smoking or nicotine use, migraine with aura, personal or family clotting history, cholesterol, diabetes, and other cardiovascular risk factors.
Does my pregnancy history affect my long-term heart and brain health?
Does migraine with aura affect my birth control or hormone options?
Should my blood pressure, cholesterol, diabetes risk, or heart rhythm be checked more closely at this stage of life?
Are there prevention steps that are especially important for my age, medical history, or hormone-related care?
Stroke prevention works best when it becomes a realistic plan, not a long list of things to fix all at once. The goal is to understand your biggest risks, choose practical next steps, and work with your healthcare team over time.
You do not need to do everything perfectly. Start with one or two steps that are realistic for your health, schedule, support system, and daily life.
A useful plan usually includes three parts: know your risks, choose your next action, and decide how you will follow up. The action could be medical, behavioral, or practical. For example, one person may need to schedule a primary care visit, another may need help quitting smoking, and another may need a sleep study or a plan for more movement.
If you have not had routine care recently: Schedule a primary care visit.
If you do not know your blood pressure: Ask to have it checked or ask whether home monitoring is appropriate.
If eating habits feel overwhelming: Start by adding one fruit or vegetable each day, choosing lower-sodium options, or replacing one sugary drink.
If movement feels difficult: Start with short walks, chair exercises, water exercise, or movement breaks during the day.
If quitting smoking feels hard: Ask about quitline support, coaching, nicotine replacement, medications, or counseling.
If sleep is poor: Ask whether sleep apnea screening or a sleep study is appropriate.
If stress or life barriers are getting in the way: Ask for help with transportation, cost, support, mental health, food access, or follow-up planning.
A prevention plan is more likely to work when it fits real life. If something gets in the way, bring it up. Common barriers include cost, transportation, caregiving responsibilities, fatigue, disability, stress, food access, confusing instructions, medication side effects, or not having enough support.
A realistic plan might include help from a primary care provider, pharmacist, dietitian, physical therapist, counselor, quitline, community program, support group, family member, or friend.
Prevention is not one appointment or one decision. It is a process of checking in, adjusting the plan, and building habits and supports that protect your brain and body over time.
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by Jake Sheaffer
“I once threw a canister of my supplement powder at the wall and dented it. That’s something I can’t imagine ever doing before my stroke, but it’s just another part of my recovery to work on.”
______________________________
On an early October weekend in 2019, Alesha Goodman and her longtime boyfriend Drew hiked over 50 miles of rugged desert landscape in the Ochoco National Forest in Central Oregon. They were on a nine-day hunting trip they’d been planning for months. While Drew streaked up the steep slopes of sagebrush and loose rock, Alesha tarried behind breathing heavily, fighting the searing pain radiating from the base of her skull. An active thirty-four-year-old who frequented local gyms, walked her dog daily, and hiked on weekends, Alesha never suspected the severe neck pain and nausea she’d had for the past week and a half were signs of an impending stroke. And not just one stroke, but two. Two potentially fatal strokes that would occur within an hour of each other the day after she returned from the Ochocos.
An only child, Alesha was close to her parents and her grandmother who lived on her parents’ property later in life. As a kid, she delivered newspapers in her Bend, OR neighborhood, and in her spare time, she wrote children’s books for fun and read voraciously, prompting close friends to refer to her as a “living encyclopedia of odd information.”
On the Monday morning after she got home, Alesha sat in traffic at a parkway off -ramp, still in discomfort from the neck pain and the nausea. She had new symptoms, too, dizziness and feeling faint. Regardless of the pain, she readied herself for work, but she had an uneasy feeling about her job.
Over the weekend, Alesha had received multiple text messages from her employer, a jewelry company in Central Oregon, about an issue with her company email and password, but with no cell reception, she couldn’t respond to her manager’s concerns. After searching through Alesha’s desk for her email password and not finding it, but instead finding an important legal document she’d already dealt with but had not yet disclosed to her boss, the company hired a specialist to get around the digital safeguards. That day, Alesha was let go from her position.
Purchase the Book to Learn More About Alesha’s Journey!