Diet
A healthy diet rich in fruits and vegetables and low in salt and saturated fats may significantly lower the risk for a first ischemic stroke. (The protective effects of diet on a second Stroke are less clear.)

Fruits and Vegetables. Diets rich in fruits (particularly citrus) and vegetables (particularly those that are green, leafy or cruciferous, such as broccoli and kale) are particularly protective against a first ischemic and possibly Hemorrhagic stroke.

Foods such as apples and tea, which are high in food chemicals called flavonoids, may also be very beneficial. Foods high in potassium (bananas, oranges, and potatoes) may be particularly protective in people with high blood pressure.

Whole Grains. A 2000 study reported a lower incidence in stroke in women who had a high intake of whole-grain foods.

Calcium, Potassium, and Magnesium. Calcium, magnesium, and potassium serve as electrolytes in the body and may play a role in stroke:

A major 1999 study reported that calcium intake is associated with a lower risk for Stroke in women, which supports an earlier study reporting a lower risk for stroke in men who drank more milk.

Some evidence suggests that diets rich in potassium may protect against stroke, mostly by reducing blood pressure but also possibly because of other mechanisms. Low potassium levels may also increase the risk for stroke in certain people. In a 2000 study, potassium-poor diets were associated with a higher risk for stroke only in men with hypertension.

Magnesium deficiencies may increase the risk for Atrial Fibrillation. No evidence yet exists, however, that taking magnesium supplements is protective.

Fats and Oils. Although saturated fats, found in animal products, are known risk factors for heart disease, the effects of fats and oils on Stroke are less clear. In fact, some fat may be important for stroke protection:

 
• One study indicated that middle-aged men without heart disease who had the highest intake of monounsaturated or saturated fat (not polyunsaturated oils) also had the lowest risk for stroke. Monounsaturated oils, obtained in olive and canola oils, however, may have protective benefits against both heart disease and stroke.  
• A fatty acid called alpha-linolenic acid found in canola oil, soybeans, and walnuts, may have particular benefits against stroke by helping to prevent the formation of blood clots. (High amounts of saturated fats, found in animal products, are not recommended since they increase the risk for heart disease.)  
• Omega-3 fatty acids, which are found in certain oily fish and may be obtained in supplements, may reduce risks for ischemic stroke, Omega-3 fatty acids are further categorized as docosahexaenoic (DHA) and eicosapentaenoic acids (EPA). These compounds have anti-inflammatory and anti-blood clotting effects and may be significantly beneficial to the heart. Consuming fish two or three times a week, in any case, helps the heart and may also reduce the risk of stroke.  
• Studies suggest that the low intake of animal protein and saturated fats increases the risk of Hemorrhagic stroke (which is, however, a much lower risk than ischemic stroke.

Vitamins. The effects of vitamins on stroke, Dementia, or both are being studied. Studies are conflicting, however. A 2000 study on people with type 2 Diabetes has suggested that high-dose supplements of vitamin E may protect the brain. On the other hand, a 2000 study reported no protective association from supplements but did report a slightly lower risk of death from stroke in people who had a high intake of foods rich in vitamin E. Yet another 2000 study offered some additional information. Men who took either vitamin E or C or who took them both for less than three or four years experienced no protection against Dementia associated with stroke. However, men who took both for the full eight years of the study reported an 88% reduced risk for Dementia from stroke or blocked blood vessels. (They had no effect on Alzheimer’s.) Supplement dosages were not reported. High doses of vitamin E may increase the risk for bleeding and therefore Hemorrhagic stroke. Studies have suggested that people who have higher blood levels of folic acid have a lower than average risk for stroke.

Caffeine Intake, Alcohol, and Smoking
Everyone should quit smoking and, if they drink alcohol at all, should do so in moderation. In healthy people with normal blood pressure, drinking a couple of cups of coffee a day is unlikely to do any harm. Caffeine drinkers, however, would do better to choose tea, which may have beneficial nutrients, and people with existing hypertension should avoid caffeine altogether (since caffeine may increase the risk for stroke in this group).

Exercise
The benefits of exercise on Stroke are less established than on heart disease, but recent studies are suggesting a positive association:

 
• According to one analysis of a group of 11,000 men, those who burned between 2,000 and 3,000 calories a week (about an hour of brisk walking five days a week) cut their risk of stroke in half. Groups who burned between 1,000 and 2,000 calories or more than 3,000 calories per week also gained some protection against stroke but to a lesser degree. In the same study, exercise that involved recreation was more protective than exercise routines consisting simply of walking or climbing.

A 2000 study of women also found substantial protection from brisk walking or striding (rather than casual walking).

Blood-Pressuring Lowering Agents in Patients with or without Hypertension
Drug therapy is always recommended for people with hypertension where there is evidence that it is affecting the organs. Reducing even mild to moderate high blood pressure using drug therapy (primarily diuretics, ACE inhibitors, and beta-blockers) has been shown to lower the risk of stroke by as much as 42%. ACE inhibitors may be particularly protective against stroke in many patients, including those with Diabetes.

Importantly, one 2001 study suggested that taking anti-hypertensive agents can reduce the risk for a stroke even in patients with a history of TIA or a first stroke even if they have normal blood pressure. In the study the patients took a diuretic plus an ACE inhibitor. Results were particularly impressive with patients who had a history of Hemorrhagic stroke.

Cholesterol Lowering Drugs

Statins. The cholesterol-managing HMG-CoA reductase inhibitors, commonly called statins, such as lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor), reduce the risk of a second stroke in people with High cholesterol levels and heart disease. These agents lower LDL (the so-called bad cholesterol) and raise HDL (the so-called good cholesterol) levels and help open up arteries. Having taken statins may help stroke sufferers recover more quickly, although more research is needed to confirm this. It is not clear if they are helpful for people with a prior stroke but no history of heart disease.

Fibrates. Fibrates are other agents used to improve cholesterol levels. They tend to increase HDL (the good cholesterol) and reduce levels of triglycerides (which are now believed to be important health risk factors). Fibrates include gemfibrozil (Lopid), fenofibrate (Tricor), and bezafibrate (under investigation). In one trial, men with heart disease and low HDL levels had a 31% lower risk of ischemic stroke after taking gemfibrozil than did men who took a placebo. (These drugs may not provide the same benefits in people with higher HDL.)

Hormone Replacement Therapy
The beneficial effects of estrogen on blood vessels that open blood flow to the heart should also serve the same purpose in the brain and protect against stroke. The effect of HRT on stroke has been controversial, however. There have been many contradictory studies, some showing a reduction in risk, some an increase, and many showing no effect.

Major studies on women and hormone replacement therapy have reported in 2001 little or no protection against stroke in postmenopausal women who took hormone replacement therapy.

 
• One of the studies known as the Women’s Estrogen for Stroke Trial (WEST) reported a slightly increased risk for heart attack and stroke in postmenopausal women taking HRT within the first two years of treatment.  
• In the Heart and Estrogen Replacement Study (HERS) there was no difference in stroke risk between those taking or not taking HRT.

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