First, the bad news. There are upwards of 800,000 strokes annually in the United States, an average of one every 45 seconds. Strokes are among the most common cause of adult disability in the United States and can have a devastating effect on patients’ quality of life.  

The good news is that most strokes are preventable, treatable and beatable, says Natalia Rost, MD, MPH, Chief of the Stroke Division at Massachusetts General Hospital, Professor of Neurology at Harvard Medical School, and Samana Cay MGH Research Scholar 2019-2024.

Approximately 75% of all strokes have a clear underlying cause, and the most common risk factors for stroke—high blood pressure, diabetes, high cholesterol, smoking and excessive alcohol use—are well-known and highly treatable.

It may not be possible to prevent all strokes, but there are steps you can take to significantly reduce your individual risk.

“Despite our best efforts, strokes will happen,” says Rost. “And the single best thing one can do is educate yourself and your loved ones about stroke. Know your risk of stroke and take every measure to prevent it.”

Ischemic vs. Hemorrhagic Stroke

A stroke occurs when blood flow is interrupted to the brain, depriving brain cells of much-needed oxygen and nutrients. There are two major types of strokes—ischemic and hemorrhagic.

Ischemic strokes occur when a blood vessel becomes blocked by a piece of a blood clot. Hemorrhagic strokes occur when a blood vessel in the brain ruptures or bursts.  

The typical treatment for an ischemic stroke is a powerful clot buster, which is most effective when given within the first 4.5 hours of stroke onset. Clots can also be removed through surgery up to 24 hours after the onset of symptoms.

For hemorrhagic strokes, treatment options include medication to stop the bleeding, promote clotting and reduce the swelling, as well as surgical interventions to seal off the ruptured vessel.

Why It’s Important to Act F.A.S.T.

In both types of stroke, time is of the essence. The longer blood flow is interrupted in the brain, the worse the outcomes are likely to be.

Health advocates use the acronym F.A.S.T. to help patients quickly spot the signs of stroke.

F= Face Dropping: Does one side of the face droop, or is it numb? If the person smiles, is the smile uneven?

A= Arm Weakness: Is one arm weak or numb? If the person raises both arms, does one drift downward?

S= Speech: Is speech slurred? Garbled? Or words don’t’ come out?

T= If the answer to one or more of the first three questions is yes, it’s Time to call 911!

Additional Risk Factors

For individuals over the age of 55, stroke risk increases proportionately with each decade of life. However, strokes can also occur in younger individuals, particularly those with the same risk factors—high blood pressure, diabetes, smoking, high cholesterol, excessive alcohol use—as older adults.

Additional risk factors for younger individuals include drug use, infections (including COVID-19) and consuming energy drinks and over-the-counter supplements with high amounts of stimulants.

A family history of stroke can also increase risk, both through genetics as well as shared behaviors, lifestyles and environmental factors. 

According to the Centers for Disease Control, individuals of Black, Hispanic, American Indian, and Native Alaskan descent may be more likely to have a stroke than non-Hispanic Whites or Asians.

Sex Differences in Stroke

While stroke is more common in men than in women, stroke outcomes are often worse in women.

Part of this may be due to age—since women tend to live longer than men, they often experience strokes at a later age when recovery is more difficult and in part, impeded by the lack of social support system.

Stroke outcomes in women may also be impacted by delayed diagnosis. Women frequently experience stroke in a different way than men. Symptoms are often milder and tend to be accompanied by a headache or feelings of unwellness.

Studies have shown that women who experience a stroke tend to underestimate and underreport their symptoms. Women are also often primary caretakers of the family and may be reluctant to prioritize own care while caring for others, which can lead to delays in diagnosis.

Medical professionals can also underestimate symptoms in women, leading to delayed or misdiagnosis and, ultimately, less favorable outcomes.

“My message to women is to know stroke symptoms and be proactive in seeking the emergency care you deserve,” Rost says. “Take care of yourself to be able to take care of others. And act FAST.”

Seven Strategies to Reduce Your Risk

American Heart Association has developed a formula called Life’s Simple 7 to help individuals reduce their risk of stroke. These seven strategies include:

• Manage blood pressure
• Control cholesterol
• Reduce blood sugar
• Get active
• Eat better
• Lose weight
• Stop smoking

“Remember, stroke is preventable, treatable, beatable,” says Rost. “You are not a victim. And together, we can beat stroke.”

About the Mass General Research Institute
Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care.
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