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Other risk factors for stroke. Interestingly, there's, there are, there are the modifiable risk factors and things sort of non modifiable risk factors and there's a nice way to sort of differentiate what things that you have control over and things you don't have control over. So a couple more modifiable risk factors that you have control over. Smoking the number one preventable cause of death in the entire world. Smoking. And from my perspective, one less cigarette a day is a victory. Ideally we get everyone to stop smoking completely. Physical inactivity. I talked about it before. It's important in controlling blood pressure. It helps control cholesterol, it will help with blood sugar and diabetes. But it also helps the brain in other ways promoting good blood flow, amongst other things. And again, what I recommend is 30 minutes, at least four to five times a week of moderate intensity exercise. This is what the American Heart and Stroke Association recommends as well. Then the next modifiable risk factor is obesity. It goes hand in hand with everything else we just talked about. But obesity is an epidemic in the United States. More than 60% of adults are classified as obese. And so whether this is, you know, a combination of not being active enough, diet, and whatever it takes, we need to sort of pay attention to that as a risk factor and address it in any way that we can.
Other risk factors for stroke. Interestingly, there's, there are, there are the modifiable risk factors and things sort of non modifiable risk factors and there's a nice way to sort of differentiate what things that you have control over and things you don't have control over. So a couple more modifiable risk factors that you have control over. Smoking the number one preventable cause of death in the entire world. Smoking. And from my perspective, one less cigarette a day is a victory. Ideally we get everyone to stop smoking completely. Physical inactivity. I talked about it before. It's important in controlling blood pressure. It helps control cholesterol, it will help with blood sugar and diabetes. But it also helps the brain in other ways promoting good blood flow, amongst other things. And again, what I recommend is 30 minutes, at least four to five times a week of moderate intensity exercise. This is what the American Heart and Stroke Association recommends as well. Then the next modifiable risk factor is obesity. It goes hand in hand with everything else we just talked about. But obesity is an epidemic in the United States. More than 60% of adults are classified as obese. And so whether this is, you know, a combination of not being active enough, diet, and whatever it takes, we need to sort of pay attention to that as a risk factor and address it in any way that we can.
The non modifiable risk factors are sort of worth, at least recognizing and my sort of view on the non-modifiable risk factors are okay, fine, these are things you have no control over, but it's worth it to recognize because it's that much more important to really strangle the modifiable risk factors as best you can. Address them with as much aggression as you can. And so, non modifiable risk factors. So sex. So men have overall, on an age adjusted basis have more strokes than women, but over a lifetime women have more strokes than men. And with women the strokes are actually more lethal or more dangerous when they occur. Age. Stroke is a disease that is much more common as we get older. So recognizing that is an important thing and again, maintaining these risk factors as we age is very important. Next is genetics. If there's a strong family history of heart disease and stroke, that's very important to pay attention to. And last is race. And so we know that ethnically wise African Americans have a higher rate of stroke than Caucasians and Mexican-Americans are probably somewhere in between. So again, those are things worth paying attention to. We think that in African Americans, the higher rate of stroke has a lot to do with a higher incidence of high blood pressure. And treating that aggressively is very crucial in that specific population.
When we talk about stroke, one of the most important things that we need to focus in on are the risk factors and stroke prevention. And these are the things that we all sort of know, but maybe we forget or don't pay attention to. And one of the best sort of sayings that I always hear because I think people keep in mind what's good for your heart. And we all know what's good for prevention of heart attacks. And one of the things you can always sort of remind yourself is that what's good for the heart is good for the brain. That being said, let's talk about what are the significant risk factors for stroke. The most important risk factor for stroke far and away is high blood pressure. And it's interesting of all the risk factors that we have, this is the one that's most clearly associated with stroke. And you know, then the question is, well, what's the ideal blood pressure? And no one knows that perfectly. Generally speaking, a neurologist and stroke neurologist once one people at about 120/80. So that's the systolic over diastolic 120/80 is the blood pressure that's the goal. It's interesting though, if we look at stroke studies, any blood pressure and we're now I'm talking about the top number, the systolic, any blood pressure over 115 bears some increased risk of stroke. So from my perspective, especially in someone who's had a stroke before the lower I can get that blood pressure, the better. Keep in mind that blood pressure is hard to control. Of the millions and millions of Americans that have high blood pressure, only 50% actually are well controlled. So this is one of those things that it's important to be talking with your neurologist, your cardiologist, your primary care provider, and recognize that it's not just medications. Medications play a crucial role in controlling blood pressure, but we need to be doing other things as well, such as watching your diet and particularly the sodium in your diet. And if you look at any package, you can see how much sodium is in any food. And you should be holding yourself, If you having problems with high blood pressure, you should be holding yourself to less than 1.5 grams or 1,500 milligrams of sodium per day. And I'll tell you, it's hard to do. It sneaks up on you. And this is a really crucial thing for blood pressure control.
Next: high cholesterol. So high cholesterol is associated with stroke and generally speaking, we follow the national guidelines for stroke prevention or in primary prevention. This means if you've never had a stroke before, never had a heart attack before, there are national guidelines on what your cholesterol should be. And it's sort of, it's based on how many other risk factors you have. If you've had a stroke in the past or a TIA, then the goal automatically becomes a lower and more aggressive. I would point out that generally speaking, statins and there are many statins out on the market. These are really, really good drugs. They seem to have multiple beneficial effects with respect to stroke prevention. First of all, they lower the cholesterol. And when we're looking at the cholesterol, we're looking at a specific part of the cholesterol. This is one the total cholesterol and then the LDL, which is the bad cholesterol. And we want that to be as low as possible. Preferably blow 100 and in some cases even lower than that. And statins are very effective at controlling that better often than diet and exercise, although diet and exercise for cholesterol control are also very important. The statins have an extra benefit though, and it's probably the fact that they work as anti-inflammatories along the vessel wall. So you can imagine things like high blood pressure, diabetes and high cholesterol. They cause injury to the vessel wall. And when that injury happens, you get inflammation in the vessel wall and that's what causes plaques to occur and narrowing of the arteries. And so we think that statins help prevent some of that inflammation from occurring and prevent that plaque from forming in the first place, which we know is a cause for stroke and actually heart disease as well.
The next big risk factor that we need to pay attention to is diabetes. A diabetes increases the risk of stroke anywhere from three to six times. Nobody knows for sure. Diabetes has multiple effects in the brain. It actually is a risk factor for Alzheimer's disease as well. The most important sort of piece of information on diabetes and stroke prevention. It's diabetic control. Watching the diet, watching the number of carbohydrates in the diet and keeping that blood sugar low. Often your primary care provider or your endocrinologist will be looking at your, what's called an A1c, and they want that A1c nice and low, preferably six or below.
Number two is regular exercise. And the American Heart and Stroke Association recommends 30 minutes a day, four to five times a week of moderate intensity exercise. It doesn't have to be Gene Simmons sweat pouring down headband on. This is just any type of moderate walking where he just maintained that exercise for 30 minutes straight. And from my perspective, the most important part of an exercise routine is that it's something you're going to stick with. If it's something that's great exercise but hate it, you're never going to do it. It's not worth it. But, so you've got to find the things that you like. If it's dancing, great. You know, if it's you know, running with the dogs, great. Whatever it is, find that for you.
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