Having a stroke may be the thing I fear most, because of the possibility of permanent disability and becoming a burden to my family. So, I read a study published in the New England Journal of Medicine in December with concern as it showed a surprisingly high chance of having a stroke, with the risk throughout one’s lifetime increasing from 23 percent in 1990 to 25 percent in 2016.

A few important statistics: 800,000 people in this country will have a stroke every year, and 610,000 of those are first strokes. Only 12 percent of these strokes will be heralded by the warning sign called a transient ischemic attack, or TIA, which is the brief onset of stroke symptoms that quickly go away.

The incidence of stroke is highest in the southeast U.S., the so-called stroke belt of the country. There, higher poverty, decreased utilization of health care, and being African American lead to the highest chance of having a stroke.

Most stokes, 87 percent, are called ischemic (from sudden decreased blood supply to the brain), and 13 percent are hemorrhagic (from bleeding into the brain).

Here are some ways to reduce the risk of stroke — and if you have one, to decrease the chance of permanent disability — based on the most recent research:

  1. If you think you might be having a stroke, seek medical attention quickly. In a 2018 study funded by the National Institutes of Health and published in the NEJM, intervention by removing a blood clot from the brain (which can often be the cause of a stroke) by a procedure called a thrombectomy within 6 to 16 hours after experiencing symptoms prevented disability in almost half of the cases.
  2. Routine use of oxygen did not help when someone had an acute stroke, and in fact, can actually hurt.
  3. Migraine headaches are a risk factor for heart attack and stroke, so people who suffer from migraines should be especially attentive to lowering risk.
  4. Ischemic strokes often have a cardiac source. Of these strokes, 20 percent are from atrial fibrillation, an irregular heartbeat from the top chamber of the heart. New studies suggest that many people who experience atrial fibrillation do not know they are having it. Sometimes, extended monitoring of the heart needs to be done after a stroke to make sure this is not the case. Only powerful blood thinners such as warfarin, and newer (more expensive) medications such as Eliquis, Pradaxa and Xarelto are effective if this is the case. Aspirin alone is not.
  5. About 35 percent of ischemic strokes come from atheroma, fatty plaque that can develop in arteries such as the aorta. This is treated very differently, with cholesterol lowering medications and drugs that affect the platelets in blood, such as aspirin or newer medications like Plavix or Brilinta.
  6. Ischemic stroke is becoming more common in younger people (those under 50). Increased incidence of diabetes (either type 1 or type 2) is thought to be the major reason, but smoking and atrial fibrillation also are key.
  7. When younger people have a stroke, genetics may play a role, but being screened for undetected cancer is important because a malignancy can make blood more likely to clot.
  8. The most common causes of hemorrhagic stroke are elevated blood pressure and smoking. One study suggested that supplementing with Vitamin E increased this risk, and another showed a dramatic and devastating increase in this kind of stroke with methamphetamine use -- 40 percent of meth users with stroke had some permanent disability, and 33 percent died.
  9. The risk of having a stoke in one’s life is increasing, and the risk of having an ischemic stoke is going up faster than hemorrhagic stroke. The likely reasons being sedentary lifestyles, increased rates of obesity and diabetes, inadequately controlled hypertension, and so many people still smoking cigarettes. The message: Dealing with these issues will lower your risk.
  10. A stroke can still happen even if you are doing everything right. Signs include sudden numbness or weakness of the face, arms or legs; new confusion or trouble speaking or understanding others; sudden vision changes; acute dizziness or trouble walking; and sudden severe headaches. Although these symptoms could be from other causes, they need to be checked out right away. If these symptoms occur, seek immediate medical attention as time is of the essence.

David Becker, M.D., is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.