DEAR DOCTOR K:

I'm a woman in my 60s. A good friend recently had a serious stroke. Is there anything she could have done to prevent it?

DEAR READER:

Some strokes come out of the blue; they can't be predicted or prevented. Perhaps your friend suffered from such a stroke.

However, most strokes occur in people who have "risk factors" for stroke, such as an unhealthy lifestyle or a medical condition that is not being adequately treated. Most strokes happen in people who could have done more to protect themselves against one, but didn't.

To me, that's hard to understand. A stroke can be devastating. It can take away your ability to move, talk and understand the world around you. It can leave you utterly dependent on other people to help you with all the daily activities of living.

What happens in a stroke? The blood supply to a part of the brain suddenly is lost. Unless that blood supply is restored, a part of the brain dies. Without a regular supply of oxygen- and nutrient-rich blood, brain cells cannot remain alive.

The most common cause of a stroke is a sudden blockage in an artery. It's called an ischemic (iss-KEE-mic) stroke. A buildup of fat in the wall of a brain artery (a plaque of atherosclerosis) can cause a blockage. A clot traveling through blood can get wedged in the artery.

Less often, a stroke occurs when an artery in the brain bursts, causing a hemorrhage. This, too, severely damages a part of the brain.

There are many things people can -- and should -- do to reduce their stroke risk:

-- Lower blood pressure. Maintain a blood pressure of less than 120/80 mm Hg. Reduce salt in your diet and eat more fruits and vegetables. Those dietary changes will help lower blood pressure. If needed, take blood pressure medicines.
-- Lose weight. If you're overweight, losing as little as 10 pounds can have a real impact on your stroke risk.
-- Exercise more. Exercise at a moderate intensity for at least 30 minutes, five days a week. This will reduce your risk of getting a stroke (and many other illnesses), even if you don't lose weight from regular exercise.
-- Drink in moderation. Moderate alcohol intake lowers the risk of stroke. Women can have one drink per day; men can have up to two.
-- Take medicines your doctor has recommended for heart and blood vessel conditions. For example, a daily baby aspirin or a blood thinner for atrial fibrillation, or sugar-lowering medicines if you have diabetes.
-- Quit smoking. Smoking accelerates clot formation. Use aids such as nicotine pills or patches, counseling or medicine to help you kick the habit.

I don't know if your friend could have prevented her stroke, but I do know that most people whose lives are forever altered by a stroke could have done more to prevent it.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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