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For Stroke, call 9-1-1

Call 9-1-1 immediately if you experience or witness stroke symptoms.

Published on December 15, 2020

4 things you should know about strokes

Stroke Tips

Even though age is a significant factor in our susceptibility to stroke, one-third of all strokes occur in people younger than 65. Strokes can be fatal or seriously debilitating, affecting movement, speech, vision, cognitive function and emotional health. Fortunately, there are plenty of things you can do to lower your risks.

“Stroke is a vascular disease of the brain, like heart attack is a vascular disease of the heart, and it’s the same risk factors for both,” said neurologist Michael Markowski, MD of Neurologists of Cape Cod in Hyannis. “The main risk factors are diseases that can cause atherosclerosis in blood vessels like high blood pressure, high cholesterol, diabetes and smoking.”

For patients who have had a stroke, Dr. Markowski gives them straight-forward information to help them reduce their risk of having a second event.

  • Patients who smoke have a 50 percent risk of having another stroke.
  • Patients who have diabetes have a 44 percent risk of a secondary event.
  • Patients with high blood pressure have a 30 to 40 percent risk of a stroke.
  • High cholesterol increases patients’ risk by 20 to 30 percent.
  • Patients who have atrial fibrillation can reduce their risk of a second stroke by 68 percent with the medication Coumadin and by 15 percent with aspirin.

Addressing these risk factors can also prevent having a first stroke, he said.


Quitting smoking is an important way to reduce your risk of stroke because smoking raises blood pressure, accelerates clot formation and increases the amount of plaque in arteries. Dr. Markowski recommends talking to your primary care physician about smoking cessation aids like medication or nicotine replacement therapies such as gum, lozenges or patches. There is also plenty of support online to help people successfully quit.

The National Cancer Institute (NCI) has many resources to help people achieve that goal. Their website offers all sorts of free information and resources including a “Create My Quit Plan,” smart phone apps and text message programs. You can also call the NCI Smoking Quitline at 1-877-448-7448 for individual counseling and referrals to other sources of help.

Hypertension, Diabetes and High Cholesterol

“Hypertension is the number one risk factor for stroke,” Dr. Markowski said. “Strokes related to a blockage are called an ischemic stroke. They account for 85 percent of all strokes, but 15 percent of strokes are hemorrhagic related to a blood vessel that ruptures. High blood pressure is the most common cause of a hemorrhagic stroke and it is the most commonly treated risk factor for ischemic stroke.”

To lower blood pressure, it’s important to restrict salt intake, eat a healthy diet and get plenty of physical exercise. Diet and exercise are also vital to preventing high cholesterol and diabetes, so those healthy lifestyle changes offer multiple benefits in terms of risk reduction.

Doctors always hope patients can control blood pressure, cholesterol and sugar levels with diet and exercise, Dr. Markowski said, but if that’s not possible there are very effective and well tolerated treatments for these health problems.

Atrial Fibrillation

“The main vascular risk factors are high blood pressure, high cholesterol, diabetes and smoking, and that goes for reducing the risk of heart attack or stroke, but atrial fibrillation is a unique risk factor for strokes,” Dr. Markowski said. “With atrial fibrillation there is an irregular heart rhythm where blood clots form in the heart. As those blood clots travel with the rest of the blood outside the heart, they can block a blood vessel in the brain and it’s a very common cause of ischemic stroke.”

AFib is more common with age just as stroke is more common with age. Over 10 percent of patients in their 80s have AFib, but it is also a common cause of stroke in younger people as well. Because of that risk, if a patient has had a stroke and diagnostic testing such as MRI, heart ultrasound and carotid artery ultrasound imaging does not reveal a definitive cause for the stroke, patients are put on a prolonged heart monitor for three or four weeks. In some cases, a heart monitor with a three-year battery life is implanted under the skin.

“We know from multiple studies that the longer we look for atrial fibrillation, the more likely we are to find it,” Dr. Markowski said. “So even if we didn’t find AFib during their two- or three-day hospital stay, if the stroke looks like it could have been related to atrial fibrillation, then we will monitor people for weeks or sometimes years.”

The reason that monitoring is so important is that the presence of AFib determines the appropriate medication. Aspirin and Plavix are helpful in stroke and heart attack prevention, but they do not reduce the risk of stroke from AFib. For AFib you need blood thinners like warfarin or one of the newer medications called direct oral anticoagulants (DOACs).

The DOACs have many advantages over warfarin. They have a lower risk of bleeding, are less affected by diet and there is no need for lab monitoring.

“If someone has atrial fibrillation and they are not treated, their annual stroke risk is six percent,” Dr. Markowski said. “If you are on warfarin or one of these other newer anticoagulants, we reduce the risk to approximately one percent.”

Identify a Stroke F-A-S-T

Receiving immediate medical treatment is essential with a stroke, since there are things that can be done to lessen the effects, if started early enough after the event.

“Time is brain,” Dr. Markowski said. “Two million brain cells die every minute after a stroke. The sooner people get seen in the emergency department, the more treatment options we have for them.”

Therefore, one of the most important things to know about a stroke is how to identify the signs quickly. Stroke symptoms are much more variable than heart attack symptoms because they depend on the area of the brain that is affected. Signs include a sudden onset of symptoms that affect one side of the body, such as weakness, numbness or clumsiness. Stroke can also affect vision, so difficulty seeing out of one or both eyes is another symptom. Another symptom is difficulty expressing words or slurred speech or a severe headache.

The National Stroke Foundation came up with the acronym F-A-S-T to help people more easily remember the symptoms:

  • F stands for face. Are you experiencing any facial weakness or drooping when you smile?
  • A stands for arms. If you lift both arms, does one arm drift back down?
  • S stands for speech. Is your speech slurred or does it sound different than usual?
  • T stands for time, because time is of the essence. If you have any of these symptoms or notice someone else having them, call 911 right away.

Learn more about Stroke Care at Cape Cod Healthcare.