Written by Dr Katie Stephens, GP

Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP). 

Stroke causes

There are multiple possible causes of strokes. Research has shown a link between the following causes and ischaemic strokes (caused by a blood clot)¹:

1. Diabetes Mellitus
2. Atrial Fibrillation (a type of irregular heartbeat that can cause turbulence in the bloodstream and increase the chance of a blood clot forming)
3. Previous heart attack
4. Previous stroke
5. Intermittent claudication (a disease characterised by calf pain that happens on walking, due to problems with the arteries in the legs)
6. Other causes of atherosclerosis (unhealthy narrowing of the arteries), such as high cholesterol levels and obesity²

Conversely, the following causes were found to be linked with haemorrhagic strokes (caused by a bleed in the brain rather than a clot; also, typically more severe):

7. Smoking
8. Excess alcohol consumption

Lastly, these causes had a strong connection to both types of stroke:

9. Advanced age
10. Female Sex
11. Hypertension (high blood pressure)

And of course, it is worth emphasising that last cause mentioned, as we know that hypertension is actually the biggest risk factor overall for cardiovascular disease, and contributes to half of all strokes³.

Are strokes hereditary?

Unfortunately, if someone in your family has had a stroke, the risk of you having one goes up. Certain people groups appear to be at increased risk also, in particular, people with South Asian, African and Caribbean ethnicities. This may be due to these groups of people having higher rates of diabetes and high blood pressure². Fortunately, regardless of what risks you’ve inherited, there are always steps you can take to bring this risk down.

Preventing Strokes

With high blood pressure being the number one risk factor for stroke, and with it being so common (up to half of adults in the UK may have hypertension, with 3 out of 4 people not knowing they do⁴) and so easy to check, I would advise that if you have not checked your blood pressure recently, you get this done as a priority. Use our blood pressure calculator⁵ to see if your reading puts you at risk.

After this, it can be useful to think about preventing strokes based on whether you have had one already (secondary prevention) or not (primary prevention).

Primary Prevention

This involves taking a pro-active approach by looking at what risk factors you have, and making changes to your lifestyle and/or medication to mitigate these risks as best as possible. To summarise the modifiable risk factors, these include:

• Smoking Visit the NHS Quit Smoking page⁶ for support in becoming smoke-free.
• Excess alcohol consumption There is local support⁷ available if you need it.
• Obesity Download the free NHS app here⁸.
• Raised cholesterol
• Medical conditions, such as Hypertension, Diabetes and Atrial Fibrillation

If you don’t know your cholesterol and average sugar levels, please speak to your GP or let us help you get them checked with our Healthy Heart Blood Test⁹.

An important point to make here is the benefit of physical activity: while it is obvious how being more active can modify some of the above risk factors (e.g. reducing obesity, improving cholesterol ratios, lowering blood pressure), there is also evidence that the impact of higher levels of physical activity in preventing stroke goes even beyond this¹⁰.

Secondary Prevention

If you’ve had a stroke already, the first step in preventing a second one is typically to assess for the above risk factors. This typically involves blood tests and other investigations such as a heart tracing to check for atrial fibrillation and a scan of the carotid arteries in the neck.

Alongside managing any conditions that are found, usually it is advisable to start some new medication. This typically includes a high-dose statin to optimise cholesterol levels, and a blood-thinning agent to reduce the risk of a second clot.

Stroke Recovery

This will look different for each person, depending on the severity of the stroke, and what part of their brain was involved. Generally, though, the recovery may involve support from Physiotherapists, Occupational Therapists (sometimes making modifications at home to help with mobility or other issues), GPs, Speech And Language Therapists and Cognitive Behavioural Therapists. Stroke.org.uk has some fantastic resources¹¹ which go into more detail on what to expect when recovering from a stroke, including some helpful tips¹² for those looking after a stroke survivor.

If you think that you, or someone with you, may be having a stroke, please ring 999 now.

For more information, you are welcome to have a look at the topics covered by my previous blog¹³ or view the NHS advice here¹⁴.

References

1. Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009; 40:2068–2072. https://www.ahajournals.org/doi/10.1161/strokeaha.108.540112
2. https://www.nhs.uk/conditions/stroke/causes/
3. https://www.gov.uk/government/publications/health-matters-combating-high-blood-pressure/health-matters-combating-high-blood-pressure
4. I Hammami, B Lacey, S Lewington. The burden of hypertension and associated risk for cardiovascular mortality in the UK biobank. European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy563.3028, https://doi.org/10.1093/eurheartj/ehy563.3028
5. https://www.kinetikwellbeing.com/blood-pressure-tool/
6. https://www.nhs.uk/better-health/quit-smoking/
7. https://www.nhs.uk/nhs-services/find-alcohol-addiction-support-services/
8. https://www.nhs.uk/better-health/lose-weight/
9. https://www.kinetikwellbeing.com/home-blood-test/healthy-heart-blood-test/
10. VJ Howard, MN McDonnell. Physical Activity in Primary Stroke Prevention. Stroke. 2015;46:1735–1739 https://doi.org/10.1161/STROKEAHA.115.006317
11. https://www.stroke.org.uk/life-after-stroke
12. https://www.stroke.org.uk/finding-support/caring-for-a-stroke-survivor
13. https://www.kinetikwellbeing.com/stroke-symptoms-diagnosis-treatment/
14. https://www.nhs.uk/conditions/stroke/