Managing 10 Stroke Risk Factors Can Prevent 90% of Strokes

Stroke is a collective term for cerebral infarction, where brain blood vessels are blocked, and cerebral hemorrhage, where blood vessels burst; it can suddenly paralyze bodily functions or threaten life. However, a significant portion of the causes of stroke is within an area that can be sufficiently managed through lifestyle corrections. Professor Kim Do-yeon of Seoul National University Bundang Hospital explained in the video that if stroke risk factors are strictly managed, 90% of strokes can theoretically be prevented.

The Importance of Managing Blood Pressure, Cholesterol, and Blood Sugar Levels

The most representative manageable factor that causes stroke is hypertension. In the case of cerebral infarction, hypertension stresses the vascular endothelial cells, causing arteriosclerosis, and in the case of cerebral hemorrhage, it becomes a cause of directly bursting blood vessels. Caution is required because high blood pressure leads to a vicious cycle where vascular elasticity decreases. If blood pressure is not extremely high, lifestyle improvements such as at least 150 minutes of moderate-intensity aerobic exercise per week, weight loss, and a low-salt diet are primarily recommended; when it cannot be controlled by lifestyle alone, it must be strictly managed through medication. There is a misconception that once you take blood pressure medication, you must take it for life, but if blood pressure enters the normal range through strict lifestyle management, medication can be discontinued or reduced.

LDL cholesterol is also a key indicator. While the LDL cholesterol level itself is not an unconditional problem, if LDL levels are high while blood vessels are damaged due to hypertension or diabetes, arteriosclerosis is accelerated. In particular, for patients who have already experienced cerebral infarction or myocardial infarction, it means there is a problem with the blood vessels, so management is required to strongly lower LDL levels to below 70. Meanwhile, there are research results suggesting that omega-3 supplements may be somewhat helpful in reducing the risk of cardiovascular disease. As a result of investigating 77,917 people participating in 10 large-scale clinical trials, the group that took omega-3 from 226mg to 1,800mg per day effectively reduced the risk of coronary artery disease, stroke, and vascular revascularization. However, it is appropriate to approach this as a health food concept rather than a treatment, and separate intake is considered only in special cases where triglycerides are very high, exceeding 500.

Diabetes causes inflammation in the systemic blood vessels, creating vascular cracks and helping the infiltration of LDL cholesterol. In particular, because cerebral blood vessels are thin, they are vulnerable to damage caused by diabetes. Therefore, it is important to be vigilant by periodically measuring blood pressure, cholesterol, and blood sugar levels. According to a meta-analysis study that examined 25 actual studies, it was confirmed that just by measuring blood pressure regularly and well, systolic blood pressure decreased by 3.82 and diastolic blood pressure by 1.45. This means that simply paying attention and checking frequently can be helpful.

The Practical Effects of Smoking, Drinking, and Obesity Management

Among lifestyle habits, smoking is a fatal factor that increases the risk of cerebral infarction by about 93%. Cigarettes affect not only lung health but also have a massive impact on blood vessels, contributing significantly to cerebral infarction occurring especially in the younger generation. In the case of drinking, there were views in the past that small amounts of alcohol were helpful, but according to recent research using genetic information (Mendelian randomization), it was found that the risk of stroke increases even with small amounts of alcohol. This study, conducted on approximately 500,000 people, reduced confounding factors by classifying groups through genetic information while excluding acquired factors; accordingly, the recent trend in the medical community is to not recommend even a single glass of alcohol.

Obesity increases risk by accompanying hypertension and hyperlipidemia. In particular, severe obesity of BMI 30 or higher can be a problem. According to a study on the effects of GLP-1 receptor agonists (such as Wegovy), which are receiving attention as recent obesity treatments, an analysis of 11 randomized controlled trials involving about 85,000 participants showed that semaglutide, the component of Wegovy, was effective in reducing the risk of cerebral infarction by about 24% and the risk of myocardial infarction by about 28%.

Physical activity is also essential. It is recommended to exercise for more than 30 minutes per session, 5 times a week, to the point of being out of breath (heart rate of 100 or more based on a smartwatch). However, in the case of the elderly, excessive high-intensity exercise may instead decrease the protective effect, so it is important to practice steadily within reasonable limits. A point of caution is that if a person with genetically weak blood vessels receives chiropractic or neck massage that excessively rotates the neck, the vertebral artery may tear, causing cerebral infarction. Since the vertebral artery passes through the vertebrae, actions that excessively and instantaneously rotate the neck should be avoided, and when the neck is stiff, it should be managed only by rubbing the outer skin.

Stroke Warning Signs and Symptoms That Should Not Be Missed

When a stroke occurs, symptoms such as slurred speech or weakness in one arm or leg appear. Additionally, language disorders, visual impairments, and dizziness may accompany it. In particular, in the case of visual impairment, if the same side of the field of vision is always invisible regardless of which eye is covered, there is a high possibility that it is a problem with the brain rather than the eye. For example, if the right field of vision is not visible, and even when the right eye is covered, the right side is still not visible when looking with the left eye, it is a brain problem. Dizziness must also appear regardless of posture. Dizziness that occurs when sitting up is likely a problem with the autonomic nervous system, but dizziness caused by cerebral infarction appears whether lying down or sitting, and if slurred speech or leaning to one side occurs simultaneously, a stroke should be strongly suspected.

There are cases where symptoms appear and then disappear within 24 hours, which is called a 'transient ischemic attack (mini-stroke).' One should not feel relieved just because the symptoms disappeared. This is a strong warning signal that a major stroke may come soon, so one should visit a hospital immediately to undergo examination. The earlier the stroke treatment, the better, and intravenous thrombolytic injection that dissolves blocked blood vessels can be considered within 4.5 hours after the onset of symptoms. However, this drug carries a risk of causing cerebral hemorrhage in about 3–7% of cerebral infarction patients, so it is administered only when the symptoms are distinct, accepting that risk. For reference, phenomena such as earlobe creases only have a statistical correlation and have not been proven as a direct mechanism of stroke.