Eating Mediterranean or style diets, regularly engaging in physical activity and keeping your blood pressure under control can lower your risk of a first-time stroke, according to updated AHA/ASA guideline published in the American Heart Association’s (AHA) journal Stroke.

A huge opportunity

“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled — especially high blood pressure — account for 90 percent of strokes,” said James Meschia, M.D., lead author of the study and professor and chairman of neurology at the Mayo Clinic in Jacksonville, Florida.

The updated guidelines recommend these tips to lower risk:

• Eat a Mediterranean or DASH-style diet, supplemented with nuts.
• Monitor high blood pressure at home with a cuff device.
• Keep pre-hypertension from becoming high blood pressure by making lifestyle changes such as getting more physical activity, eating a healthy diet and managing your weight.
• Reduce the amount of sodium in your diet; sodium is found mostly in salt.
• Visit your healthcare provider annually for blood pressure evaluation.
• If your medication to lower blood pressure doesn’t work or has bad side effects, talk to your healthcare provider about finding a combination of drugs that work for you.
• Don’t smoke. Smoking and taking oral birth control pills can significantly increase your stroke risk. If you’re a woman who experiences migraines with aura, smoking raises your risk of stroke even more than in the general population.

Mediterranean-style or DASH-style diets are similar in their emphasis on fruits, vegetables, whole grains, legumes, nuts, seeds, poultry and fish. Both are limited in red meat and foods containing saturated fats, which are mostly found in animal-based products such as meat, butter, cheese and full-fat dairy.

Mediterranean-style diets are generally low in dairy products and DASH-style diets emphasize low-fat dairy products.

Avoiding secondhand smoke also lowers stroke and heart attack risks, according to the guidelines.

The writing committee reviewed existing guidelines, randomized clinical trials and some observational studies.

Years of impairment

“Talking about stroke prevention is worthwhile,” Meschia said. “In many instances, stroke isn’t fatal, but it leads to years of physical, emotional and mental impairment that could be avoided.”

Co-authors are Cheryl Bushnell, M.D., M.H.S.; Bernadette Boden-Albala, M.P.H., Dr.P.H.; Lynne Braun, Ph.D., C.N.P.; Dawn Bravata, M.D.; Seemant Chaturvedi, M.D.; Mark Creager, M.D.; Robert Eckel, M.D.; Mitchell Elkind, M.D., M.S.; Myriam Fornage, Ph.D.; Larry Goldstein, M.D.; Steven Greenberg, M.D., Ph.D.; Susanna Horvath, M.D.; Costantino Iadecola, M.D.; Edward Jauch, M.D., M.S.; Wesley Moore, M.D.; and John Wilson, M.D. Author disclosures are on the manuscript.