September 19, 2019

How to Prevent a Second Stroke

Act fast: Your risk for recurrent stroke is highest just after your first stroke

Illustration of brain showing an ischemic stroke episode

Each year in the United States, close to 800,000 ischemic strokes occur. Around 25% of them are recurrent — meaning they are not the first stroke a person has. Lack of blood flow to the brain — from a blood clot or blocked vessel — causes ischemic strokes.


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“Your risk of a second stroke is highest within the first two days,” says neurologist Blake Buletko, MD. “But you remain most vulnerable for up to three months and even up to one year after the first stroke.”

Those most vulnerable for a second stroke are people over age 80, males, African Americans and people with strong family history or genetic predisposition to stroke.

Déjà vu? What caused your first stroke can cause a recurrent stroke

The causes of a second (third or fourth) stroke areoften the same as for primary strokes:

  • High blood pressure doubles (at a minimum) your risk of stroke when uncontrolled.
  • High cholesterol can lead to plaque buildup in the arteries, decreasing blood flow to the brain and other parts of the body.
  • Diabetes and associated high blood sugar damages blood vessels and increases the likelihood that blood clots will form.
  • Smoking thickens your blood and the possibility that plaque will build up in the arteries.
  • Obesity increases your odds of having a stroke and is linked to diabetes, heart disease and high blood pressure.
  • Cardiac abnormalities like atrial fibrillation can cause clots to form in the heart that then travel to the brain.

“If you’ve experienced an ischemic stroke, your neurologist will likely perform tests to rule out cardiac abnormalities or significant plaque buildup in arteries,” says Dr. Buletko. “In the event you are diagnosed with one of these conditions, your neurologist will likely use a leading-edge therapy to both treat and prevent another stroke.”

Your life depends on these recurrent stroke-prevention tips

In addition to medications and procedures, lifestyle adjustments lessen your chance of a recurrent stroke. You can help prevent a second stroke by:

  • Kicking up the cardio: Incorporate two and a half hours a week of aerobic exercise, such as walking or bicycling, into your daily routine.
  • Dining like Mediterranean people: Include fewer saturated fats and trans fats, plus more fiber and foods high in omega-3 fatty acids, such as fish and flaxseed.
  • Avoiding the salt shaker: Stick to one-half teaspoon per day by eating fewer processed foods.
  • Becoming a teetotaler: If total abstinence from alcohol is not in your repertoire, limit your consumption to five ounces or less per day (reach for red wine first because it has heart and brain-protecting properties).
  • Stubbing those butts: Start quitting today — find a smoking cessation program and use aids like nicotine patches. Risk decreases two to four years after stopping smoking and nearly eliminated by year five.
  • Finding some tranquility: Develop coping skills to manage your daily stresses. Consider mindfulness meditation or a yoga practice.
  • Permanently shedding the winter weight: Shoot for a body mass index (BMI) of 25 or less. You may need the support of a dietitian to determine the appropriate calorie intake (usually less than 2,000 calories per day).

Stay alert: Watch for these second-stroke symptoms

“As with risk factors, the warning signs for a recurrent stroke are the same as for a first stroke,” says Dr. Buletko. “I use the acronym BE FAST to help patients remember stroke symptoms.”

  • B is for balance: Losing your balance or coordination suddenly.
  • E is for eyes: Having your vision change suddenly, such as the loss of vision in one or both eyes or seeing double vision.
  • F is for face: Experiencing droopy facial features on one side of the face.
  • A is for arms: Having one arm or leg suddenly become weak.
  • S is for speech: Slurring your words or having difficulty speaking or understanding others.
  • T is for time: Don’t take a “wait and see” approach — call 911 or head to the emergency department.

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