A recent study highlights that smoking, high blood pressure, and atrial fibrillation—an irregular heartbeat condition—are among the most significant factors contributing to the severity of disability or the risk of death following a stroke.
While other risk factors also play a role in increasing stroke risk, they appear to have a lesser impact on the likelihood of severe disability or fatality.
The study underscores the role of additional risk factors such as diabetes, high cholesterol, alcohol consumption, physical inactivity, poor dietary habits, stress, and excessive abdominal fat.
While these elements contribute to the likelihood of experiencing a stroke, their impact on the severity of its outcomes is not as pronounced as the leading factors.
“Our findings emphasize the importance of controlling high blood pressure — which is the most important modifiable risk factor for stroke globally — along with managing atrial fibrillation and avoiding smoking,” says lead study author Catriona Reddin, MBBS, PhD, of the University of Galway in Ireland.
Examining Key Contributors to Severe Stroke Outcomes
The research encompassed approximately 27,000 adults, with an average age of 62. Among the participants, nearly half had previously suffered a stroke. Out of those stroke survivors, about 4,850 individuals experienced severe strokes, rendering them incapable of performing basic tasks such as walking, dressing, or feeding themselves, and in some cases, leading to death.
The findings, published in the journal Neurology, revealed that individuals with high blood pressure faced a risk over three times higher of experiencing a severe stroke compared to those without hypertension.
Atrial fibrillation, a disorder that causes an irregular and often rapid heartbeat, was associated with a risk increase of more than fourfold. Additionally, smoking was linked to nearly twice the risk of severe stroke outcomes.
Joshua Z. Willey, MD, a neurology professor at Columbia University Irving Medical Center in New York City, who was not involved in the study, provided insights into why high blood pressure has such a significant impact on stroke severity.
He explains, “In the case of hypertension, this is a leading contributor to hemorrhagic strokes, which tend to be more severe and have higher mortality.”
Hemorrhagic strokes, which occur due to the rupture of a blood vessel in the brain, tend to have worse outcomes compared to ischemic strokes, which result from a blood clot or fat deposit blocking blood flow to the brain.
Preventing Stroke Through Lifestyle Adjustments
One limitation of the study is its focus solely on modifiable risk factors—those that individuals can alter to reduce their risk of experiencing a severe stroke. The research did not explore other contributing causes such as chronic obstructive pulmonary disease (COPD) or certain types of cancer, which could also impact stroke severity.
Despite this limitation, the study reinforces the importance of addressing modifiable risk factors as a strategy not only to prevent strokes but also to mitigate the extent of their impact.
Trudy Gaillard, PhD, RN, an associate professor and health disparities researcher at Florida International University in Miami, who was not part of the study, emphasizes this point, stating,
“The most important thing a person can do to lower their risk of stroke is to manage and control their chronic health conditions. Working closely with their primary care providers in controlling these modifiable risk factors is important,” she says.
Strategies for Reducing Stroke Risk
Effective stroke prevention strategies include taking prescribed medications to manage high blood pressure, using blood thinners for atrial fibrillation, and quitting smoking.
Dr. Willey notes that engaging in moderate physical activity, such as a 30-minute brisk walk daily, and following a heart-healthy diet can also significantly reduce stroke risk.
Dietary patterns such as the Mediterranean Diet and the Dietary Approaches to Stop Hypertension (DASH) diet, both of which prioritize lean proteins, whole grains, and fresh fruits and vegetables, are recommended for better cardiovascular health.
By focusing on these preventative measures, individuals can substantially decrease their risk of severe stroke and its devastating consequences. As this study highlights, small, proactive changes in lifestyle and medical management can have a profound impact on long-term health outcomes.