Risk Factors Under Your Control

Stroke is dangerous and deadly, but you can control and treat several of its risk factors.

Group of senior retirement friends exercising outdoors

High Blood Pressure

Nearly half of American adults have high blood pressure, or hypertension. High blood pressure is a leading cause of stroke and the most significant controllable risk factor. Optimal blood pressure is less than 120/80 mm Hg. Know your numbers and manage your blood pressure.


The nicotine and carbon monoxide in cigarette smoke damage your heart and blood vessels, making you more susceptible to a stroke. Nearly 12 out of every 100 adults in the U.S. currently smoke. Furthermore, according to a nationwide analysis of stroke survivors in the U.S., 58.8% of them had a history of smoking. 

Where You Live Matters

People who live in rural areas are more likely to smoke than those in urban areas. A study found that White adults living in rural areas had 62% higher smoking rates compared to White adults in urban areas. Hispanic and Black adults show similar increased smoking rates at 38% in rural communities. On the other hand, Asian adults are 32% more likely to smoke in urban areas.

LGBTQ+ May be at Higher Risk

In 2020, more lesbian, gay, or bisexual (LGB) adults smoked cigarettes compared to heterosexual/straight adults. LGB adults were also more likely to use any commercial tobacco products compared to heterosexual/straight adults. Transgender adults are more likely to use commercial tobacco products particularly e-cigarettes. According to the U.S. Office of Disease Prevention and Health Promotion, discrimination against LGBTQ people may lead to unique physical and mental health disparities and cardiovascular health.

Increased Risk for Women

Hormonal birth control containing estrogen can raise the levels of clotting factors in the body, The use of birth control pills combined with cigarette smoking can greatly increase the risk of stroke in women.

Although cigarette smoking has declined over the past few decades, more different types of tobacco products are now available, including e-cigarettes, smokeless tobacco, pipes and vaping. Quitting smoking can significantly reduce the risk of stroke, quit smoking now to lower your risk. Download the How to Quit Tobacco tips for success.


If you have Type 1 or 2 diabetes, it’s important to control your blood sugar. Diabetes mellitus is an independent risk factor for stroke. Many people with diabetes are overweight and have high blood pressure and high blood cholesterol, increasing their risk. While diabetes is treatable, the presence of the disease still increases your risk of stroke. Learn how to lower your risk of diabetes and prediabetes.


Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Those high in sodium (salt) can increase blood pressure. And those with high calories can lead to obesity. But a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke. The American Heart Association Diet and Lifestyle Recommendations outline a healthy diet.

Two well-studied eating plans meet American Heart Association recommendations. One is the Mediterranean-style diet:

  • emphasizes vegetables, fruits, whole grains, beans and legumes;
  • includes low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils and nuts; and
  • limits added sugars, sugary beverages, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats.

The other is Dash, or Dietary Approaches to Stop Hypertension. The Dash diet allows more dairy products and meat, while the Mediterranean diet includes regular use of olive oil.

A plant-based, vegetarian or vegan diet can also be a healthy way to eat.

Physical Inactivity

Physical inactivity can increase your risk of stroke, heart disease, overweight/obesity, high blood pressure, high blood cholesterol and diabetes. Follow these recommendations:

  • Get at least 150 minutes a week of moderate-intensity aerobic activity – brisk walking, water aerobics, gardening, tennis, biking, or
  • Get at least 75 minutes a week of vigorous-intensity aerobic activity – running, hiking uphill, swimming laps, jumping rope.
  • Add muscle-strengthening activity on at least 2 days per week – resistance bands or weights.
  • Don’t have 30 minutes? Break it up into two 15-minute segments.

Remember, it’s never too late, so get started today by sitting less and moving more. Learn about the latest AHA Physical Activity recommendations.


Excess body weight and obesity are linked to an increased risk of high blood pressure, diabetes, heart disease and stroke. Losing as little as 5 to 10 pounds can significantly affect your risk. Even if weight control has been a lifelong challenge, start taking small steps today to manage your weight and lower your risk.

High Cholesterol

Cholesterol is the fat-like substance in your blood. High cholesterol increases the risk of blocked arteries and if an artery leading to the brain becomes blocked, it can result in a stroke. Studies suggest ideal cholesterol levels at about 150 mg/dL. Take control of your cholesterol.

Atrial Fibrillation (AFib)

Atrial fibrillation is a heart rhythm disorder that can result in a blood clot traveling to the brain and causing a stroke. If you have AFib, know your stroke risk and get treatment to lower your chances of having a stroke.

Sleep Apnea

Sleep apnea is part of sleep-disordered breathing disorders. This chronic condition results in partial or complete cessation of breathing many times throughout the night, resulting in daytime sleepiness or fatigue. This condition can impact people of all ages, including children, but the risk factors include being male, overweight and over the age of 40. More than half of the people who have a stroke also have sleep apnea. Here are some common signs and symptoms:

  • Snoring (usually observed or reported by sleep partner)
  • Disrupted sleep or waking up frequently during the night, gasping for air
  • Daytime fatigue and feeling tired
  • Morning headache
  • Problems with concentration and memory

This condition can cause low oxygen levels during sleep as well as elevated blood pressure, both of which can increase the risk of a stroke. Sleep apnea may contribute to or be the cause of first-time or recurrent stroke.

Sickle Cell Disease (Sickle Cell Anemia)

Sickle cell disease (SCD) is a genetic disorder that mainly affects Black and Hispanic children. It causes “sickled” red blood cells, which are less able to carry oxygen to the body’s tissues and organs. These cells stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

To reduce their risk of stroke, people with sickle cell disease can work with their health care professionals to prevent and carefully manage flare-ups.

The stroke rates in children with SCD are significantly higher than in the general population of children. Therefore, the American Society of Hematology recommends that children between 2 and 16 with SCD be screened annually with transcranial doppler ultrasound (TCD). TCD is a simple, painless test that can determine whether children with SCD are at high risk for stroke.

Learn more about uncommon causes of stroke.

Carotid Artery Disease

Carotid artery disease, also called carotid artery stenosis, occurs when fatty deposits (plaques) clog the blood vessels that deliver blood to your brain and head. This condition develops slowly and results in a narrowing of the arteries, increasing your risk for stroke. There are often no symptoms, and the first sign may be a TIA or a stroke. Regular checkups are important, and your health care professional can listen to the arteries in your neck with a stethoscope for abnormal sounds. Other tests are also available for early diagnosis.

Peripheral Artery Disease (PAD)

Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. The fatty buildup of plaque in artery walls causes PAD. People with PAD have a higher risk of carotid artery disease, which raises their risk of stroke.

Other Heart Disease

People with coronary heart disease or heart failure are at higher risk of stroke than those with healthy hearts. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some congenital heart defects can also raise the risk of stroke. Work with your health care professional to manage these related conditions.


Stroke Risk Assessment

If you are interested in checking your personal risk for stroke, our Stroke Risk Assessment can help. Remember some stroke risks are changeable while others are not. If you scored high for risk factors or are unsure of your risk score, always talk with your health care professional about your questions and how you can reduce your risk.

Heart Disease and Stroke

The link between heart disease and stroke is significant. Several types of heart disease are risk factors for stroke. Likewise, stroke is a risk factor for coronary heart disease. People with coronary heart disease, angina, or a heart attack due to atherosclerosis (hardening of the arteries) have more than twice the risk of stroke.

Resources on stroke risk factors:

Risk Factors for Stroke
Carotid Endarterectomy (PDF)
High Blood Pressure and Stroke Infographic

Resources to help manage your stroke risk:

Lifestyle Changes to Prevent Stroke (PDF)
FAQs about AFib (PDF)
AFib Symptom Tracker (PDF)
Anticoagulants and Antiplatelet Agents (PDF)