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Stroke

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Also indexed as: Cerebrovascular Accident, Transient Ischemic Attacks

Illustration

Several types of strokes can strike the brain with little warning—but you can cut your risk for future strokes. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Modify your diet
  • Reduce stroke risk by eating lots of fruits, vegetables, whole grains, and fish
  • Steer clear of smoke
  • Kick the habit and avoid secondhand smoke to lower your risk
  • Trim down
  • Shed those extra pounds and maintain a healthy weight to lower your risk
  • Work in a workout
  • Being a couch potato increases your stroke risk, so be sure to get regular exercise
  • Take a test
  • Visit your doctor for a series of tests to determine if you have problems with high blood pressure or high blood levels of cholesterol, triglycerides, or glucose; all may increase your risk of stroke

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full stroke article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About stroke

Stroke is a condition caused by a lack of blood supply to the brain or by hemorrhage (bleeding) within the brain.

Stroke is the third leading cause of death in the United States, but most strokes are not fatal. Depending on the area of the brain that is damaged, a stroke can cause coma, reversible or irreversible paralysis, speech problems, visual disturbances, and dementia. Factors that increase the risk of certain types of stroke include hypertension, diabetes, elevated levels of high cholesterol or homocysteine, and atherosclerosis (hardening of the arteries) of the blood vessels that supply the brain.

Product ratings for stroke

Science Ratings Nutritional Supplements Herbs
2Stars

Potassium

Vinpocetine

  
1Star

Folic acid (for high homocysteine only)

Magnesium

Tocotrienols

Vitamin B12 (for high homocysteine only)

Vitamin B6 (for high homocysteine only)

Vitamin E

  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms of stroke include weakness, numbness, or inability to move an arm or leg; sudden and intense headache; severe dizziness or loss of coordination and balance; difficulty with speaking or understanding; and blurred or decreased vision in one or both eyes. People with stroke may also have seizures, vomiting, drooling, and difficulty swallowing. Some people experience temporary warning episodes of neurologic symptoms called transient ischemic attacks (TIAs) before suffering a complete stroke. People experiencing symptoms suggestive of having suffered a stroke or a TIA require immediate (emergency room) medical attention.

Medical options

Over the counter aspirin (Bayer Low Adult Strength, Ecotrin Adult Low Strength) may help prevent future strokes in men.

Prescription medications, such as the anticoagulant warfarin (Coumadin) and the antiplatelet drugs clopidogrel (Plavix) and ticlopidine (Ticlid) are routinely given to people who have had strokes.

Individuals who experience a stroke caused by blockage of blood vessels (ischemic stroke) receive clot-dissolving (thrombolytic) medications, such as recombinant tissue plasminogen activator (Alteplase®) and the anticoagulant heparin. Individuals who have a stroke due to bleeding in the brain (hemorrhagic stroke) usually receive a surgical procedure that stops bleeding and repairs blood vessels. After the acute treatment of stroke, doctors often recommend rehabilitation, including physical, speech, and occupational therapy.

Dietary changes that may be helpful

Researchers have found an association between diets low in potassium and increased risk of stroke.1 2 3 People who take potassium supplements have been reported to have a low risk of suffering a stroke.4 However, the association of increasing dietary potassium intake and decreasing stroke mortality only occurred in black men and hypertensive men in one study.5 Others have found an association between increased risk of stroke and the combination of low dietary potassium plus high salt intake.6 Increasing dietary potassium has lowered blood pressure in humans, which by itself should reduce the risk of stroke.7 However, some of the protective effect of potassium appears to extend beyond its ability to lower blood pressure.8 Maintaining a high potassium intake is best achieved by eating fruits and vegetables.

Diets high in fruit and/or vegetables are associated with a reduced risk of stroke, according to most studies.9 10 In a large preliminary study, cruciferous and green leafy vegetables, as well as citrus fruit and juice, conferred the highest degree of protection.11 Because it is not clear which components of fruits and vegetables are most responsible for the protective effect against stroke, people wishing to reduce their risk of stroke should rely primarily on eating more fruits and vegetables themselves, rather than taking supplements.

A large study also found that women who eat higher amounts of whole grains are at lower risk of ischemic stroke.12 Those women who ate more than one whole-grain food on an average day (twice the amount of fiber eaten by the average American) had approximately a 35% lower risk of suffering an ischemic stroke compared with women who ate virtually no whole-grain products on an average day. This study fits with previous research showing that women who consume more whole grains are also at reduced risk for heart disease caused by atherosclerosis.

The influence of dietary fat on the risk of stroke is not as clear as it is for heart disease risk. Some recent reports suggest an association between increased fat intake, including saturated fat (primarily found in meat and dairy), and a decreased stroke risk.13 14 These unexpected findings may be due to unique dietary conditions in the country studied (Japan) or to flaws in study design.15 16 17 Other evidence suggests the opposite relationship—that people consuming more saturated fat are at higher risk of stroke.18

Evidence regarding the role of unsaturated fats (primarily found in vegetable oils, cooked and processed foods made with vegetable oils, nuts, and seeds) is equally unclear,19 20 21 suggesting that unsaturated fats may have varying effects on different types of stroke or that some unsaturated fats differ from others in their influence on stroke risk.

Evidence is accumulating in favor of fish consumption, a rich source of omega-3 fatty acids, as a way to help prevent stroke. Eating fish has been linked to reduced stroke risk in most,22 23 24 but not all,25 26 studies.

High salt intake is associated with both stroke27 and hypertension, a major risk factor for stroke.28 Salt intake may increase stroke risk independent of its effect on blood pressure.29 Among overweight people, an increase in salt consumption of about 1/2 teaspoon (2.3 grams) per day was associated with a 32% increase in stroke incidence and an 89% increase in stroke mortality.30 Reducing salt intake is recommended as a way to reduce the risk of stroke.31

Having one or two drinks per day has lowered stroke risk in most studies,32 33 though some researchers report no protection34 and others find that even light drinking leads to an increased risk of stroke.35 Regular heavy drinking or binge drinking, however, has consistently raised the risk of suffering a stroke by increasing blood pressure and causing heart muscle abnormalities and other effects.36 37 38

Lifestyle changes that may be helpful

Smoking is associated with a significantly increased risk of stroke.39 40 41 Even secondhand smoke puts nonsmokers at increased risk.42

Exercise reduces the risk of stroke according to most,43 44 45 46 though not all,47 studies. The benefits of exercise are probably due to its effects on body weight, blood pressure, and glucose tolerance.

Obesity has been associated with an increased risk of stroke in most studies.48 49 Excess abdominal fat appears to be more directly linked to increased risk of stroke, compared with fat accumulation in the thighs and buttocks.50 51 52 While losing weight and keeping it off is difficult for most people, normalizing weight with a healthful diet and exercise program is one of the best ways to reduce the risk of many diseases, including stroke.

Vitamins that may be helpful

Vinpocetine given by intravenous injection has been reported to improve some biochemical measures of brain function in stroke patients.53 54 A controlled trial found intravenous vinpocetine given within 72 hours of a stroke reduced some of the losses in brain function that typically follow a stroke.55 However, the reliability of human stroke research using vinpocetine has been questioned,56 57 and more double-blind trials are needed. No studies using oral vinpocetine for treating acute strokes have been published.

Elevated blood levels of homocysteine, a toxic amino acid byproduct, have been linked to risk of stroke in most studies.58 59 60 What is not clear, however, is whether high homocysteine levels cause strokes or are simply a marker for some other causative factor. Supplementation with folic acid, vitamin B6, and vitamin B12 generally lowers homocysteine levels in humans.61 62 63 Whether lowering homocysteine will result in a decrease in the risk of suffering a stroke, however, remains unknown.

Narrowing of the neck arteries (carotid stenosis) caused by atherosclerosis is a risk factor for stroke. Preliminary diet studies have found that people who eat foods high in antioxidants such as vitamin C and vitamin E have less carotid stenosis.64 65

In a double-blind trial, people with atherosclerosis in the carotid arteries were given a palm oil extract containing 160–240 mg of tocotrienols (a vitamin E-like supplement) and approximately 100–150 IU vitamin E per day. After 18 months, they had significantly less atherosclerosis or less progression of atherosclerosis compared to a group receiving placebo.66 Vitamin E plus aspirin, has been more effective in reducing the risk of strokes and other related events than has aspirin, alone.67 However, most preliminary trials have shown no protective effects from antioxidant supplementation.68 69 70 71 72 73 A large Finnish trial concluded that supplementation with either vitamin E or beta-carotene conferred no protection against stroke in male smokers,74 although a later review of the study found that those smokers who have either hypertension (high blood pressure) or diabetes do appear to have a reduced risk of stroke when taking vitamin E.75

People with high risk for stroke, such as those who have had TIAs or who have a heart condition known as atrial fibrillation,76 are often given aspirin or anticoagulant medication to reduce blood clotting tendencies. Some natural inhibitors of blood clotting such as garlic,77 78 79 fish oil,80 and vitamin E,81 82 may have protective effects, but even large amounts of fish oil are known to be less potent than aspirin.83 Whether any of these substances is an adequate substitute to control risk of stroke in high-risk people is unknown, and anyone taking anticoagulant medication should advise their prescribing doctor before beginning use of these natural substances.

Researchers have found an association between diets low in magnesium and increased risk of stroke, an effect explained partially, but not completely, by the ability of magnesium to reduce high blood pressure.84 Protection from stroke associated with drinking water high in magnesium has also been reported.85 Intravenous magnesium given immediately after a stroke has been proposed as a treatment for reducing stroke deaths,86 but results so far have been inconclusive.87

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

References:

1. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.

2. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.

3. Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med 1987;316:235–40.

4. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.

5. Fang J, Madhavan S, Alderman MH. Dietary Potassium Intake and Stroke Mortality. Stroke 2000;31:1532–7.

6. Yamori Y, Nara Y, Mizushima S, et al. Nutritional factors for stroke and major cardiovascular diseases: international epidemiological comparison of dietary prevention. Health Rep 1994;6:22–7.

7. Stamler J, Caggiula AW, Grandits GA. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr 1997;65:338S–65S.

8. Suter PM. The effects of potassium, magnesium, calcium, and fiber on risk of stroke. Nutr Rev 1999;57:84–8.

9. Rodriguez Artalejo F, Guallar-Castillon P, Banegas Banegas JR, et al. Consumption of fruit and wine and the decline in cerebrovascular disease mortality in Spain (1975–1993). Stroke 1998;29:1556–61.

10. Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997;26:1–13.

11. Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282:1233–9.

12. Liu S, Manson JE, Stampfer MJ, et al. Whole grain consumption and risk of ischemic stroke in women. A prospective study. JAMA 2000;284:1534–40.

13. Gillman MW, Cupples LA, Millen BE, et al. Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997;278:2145–50.

14. Seino F, Date C, Nakayama T, et al. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo) 1997;43:83–99.

15. Brunner R. Dietary fat and ischemic stroke. JAMA 1998;279:1171–2 [letter].

16. Ornish D. Dietary fat and ischemic stroke. JAMA 1998;279:1172 [letter].

17. Stein HD. Dietary fat and ischemic stroke. JAMA 1998;279:1172 [letter].

18. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.

19. Ricci S, Celani MG, Righetti E, et al. Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group. J Neurol 1997;244:360–4.

20. Gillman MW, Cupples LA, Millen BE, et al. Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997;278:2145–50.

21. Seino F, Date C, Nakayama T, et al. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo) 1997;43:83–99.

22. Zhang J, Sasaki S, Amano K, et al. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study. Prev Med 1999;28:520–9.

23. Keli SO, Feskens EJ, Kromhout D. Fish consumption and risk of stroke. The Zutphen Study. Stroke 1994;25:328–32.

24. Iso H, Rexrode KM, Stampfer MJ, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA 2001;285:304–12.

25. Orencia AJ, Daviglus ML, Dyer AR, et al. Fish consumption and stroke in men. 30-year findings of the Chicago Western Electric Study. Stroke 1996;27:204–9.

26. Morris MC, Manson JE, Rosner B, et al. Fish consumption and cardiovascular disease in the physicians’ health study: a prospective study. Am J Epidemiol 1995;142:166–75.

27. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.

28. Tobian L. Dietary sodium chloride and potassium have effects on the pathophysiology of hypertension in humans and animals. Am J Clin Nutr 1997;65:606S–11S [review].

29. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens 1992;6:23–5.

30. He J, Ogden LG, Vupputuri S, et al. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 1999;282:2027–34.

31. Antonios TF, MacGregor GA. Salt intake: potential deleterious effects excluding blood pressure. J Hum Hypertens 1995;9:511–5 [review].

32. Hillbom M. Alcohol consumption and stroke: benefits and risks. Alcohol Clin Exp Res 1998;22:352S–8S [review].

33. Caicoya M, Rodriguez T, Corrales C, et al. Alcohol and stroke: a community case-control study in Asturias, Spain. J Clin Epidemiol 1999;52:677–84.

34. Donahue RP, Abbott RD, Reed DM, Yano K. Alcohol and hemorrhagic stroke. JAMA 1986;255:2311–4.

35. Romelsjö A, Leifman A. Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49,618 young Swedish men. BMJ 1999;319:821–2.

36. Thrift AG, Donnan GA, McNeil JJ. Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage. Epidemiology 1999;10:307–12.

37. Caicoya M, Rodriguez T, Corrales C, et al. Alcohol and stroke: a community case-control study in Asturias, Spain. J Clin Epidemiol 1999;52:677–84.

38. Hillbom M. Alcohol consumption and stroke: benefits and risks. Alcohol Clin Exp Res 1998;22:352S–8S [review].

39. Shinton R. Lifelong exposures and the potential for stroke prevention: the contribution of cigarette smoking, exercise, and body fat. J Epidemiol Community Health 1997;51:138–43.

40. Jacobs DR Jr, Adachi H, Mulder I, et al. Cigarette smoking and mortality risk: twenty-five-year follow-up of the Seven Countries Study. Arch Intern Med 1999;159:733–40.

41. Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ 1989;298:789–94.

42. You RX, Thrift AG, McNeil JJ, et al. Ischemic stroke risk and passive exposure to spouses’ cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group. Am J Public Health 1999;89:572–5.

43. Lee IM, Hennekens CH, Berger K, et al. Exercise and risk of stroke in male physicians. Stroke 1999;30:1–6.

44. Sacco RL, Gan R, Boden-Albala B, et al. Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study. Stroke 1998;29:380–7.

45. Agnarsson U, Thorgeirsson G, Sigvaldason H, et al. Effects of leisure-time physical activity and ventilatory function on risk for stroke in men: the Reykjavik Study. Ann Intern Med 1999;130:987–90.

46. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med 1995;333:1392–400 [review].

47. Evenson KR, Rosamond WD, Cai J, et al. Physical activity and ischemic stroke risk : the atherosclerosis risk in communities study. Stroke 1999;30:1333–9.

48. Rexrode KM, Hennekens CH, Willett WC, et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997;277:1539–45.

49. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med 1995;333:1392–400 [review].

50. Megnien JL, Denarie N, Cocaul M, et al. Predictive value of waist-to-hip ratio on cardiovascular risk events. Int J Obes Relat Metab Disord 1999;23:90–7.

51. Walker SP, Rimm EB, Ascherio A, et al. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol 1996;144:1143–50.

52. Folsom AR, Prineas RJ, Kaye SA, et al. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke 1990;21:701–6.

53. Gulyas B, Bonoczk P, Vas A, et al. [The effect of a single-dose intravenous vinpocetine on brain metabolism in patients with ischemic stroke.] Orv Hetil 2001;142:443–9 [in Hungarian].

54. Szakall S, Boros I, Balkay L, et al. Cerebral effects of a single dose of intravenous vinpocetine in chronic stroke patients: a PET study. J Neuroimaging 1998;8:197–204.

55. Feigin VL, Doronin BM, Popova TF, et al. Vinpocetine treatment in acute ischaemic stroke: a pilot single-blind randomized clinical trial. Eur J Neurol 2001;8:81–5.

56. Bereczki D, Fekete I. A systematic review of vinpocetine therapy in acute ischaemic stroke. Eur J Clin Pharmacol 1999;55:349-52 [review].

57. Bereczki D, Fekete I. Vinpocetine for acute ischaemic stroke. Cochrane Database Sys Rev 2000;2:CD000480.

58. Lalouschek W, Aull S, Serles W, et al. Genetic and nongenetic factors influencing plasma homocysteine levels in patients with ischemic cerebrovascular disease and in healthy control subjects. J Lab Clin Med 1999;133:575–82.

59. Ridker PM, Manson JE, Buring JE, et al. Homocysteine and risk of cardiovascular disease among postmenopausal women. JAMA 1999;281:1817–21.

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63. Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197–204 [review].

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66. Tomeo AC, Geller M, Watkins TR, et al. Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis. Lipids 1995;30:1179–83.

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68. Blot WJ, Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 1993;85:1483–92.

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72. Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996;334:1145–9.

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84. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.

85. Yang CY. Calcium and magnesium in drinking water and risk of death from cerebrovascular disease. Stroke 1998;29:411–4.

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