INDIANAPOLIS (WISH) — The American Heart Association and the American Stroke Association have updated primary guidelines to help people to prevent a first stroke.

Every 40 seconds, an American has a stroke, and, every three minutes, an American dies from a stroke. Over 600,000 Americans will have their first stroke this year, a preventable event if underlying risk factors are controlled or eliminated.

What causes a stroke?

Stroke is caused by lack of blood flow to a portion of the brain due to blood clot, ruptured blood vessel or hemorrhage, vasoconstriction of a blood vessel, or dissection of an artery.

Risk factors

• High blood pressure (goal <130/80).
• High cholesterol.
• Diabetes.
• Obesity.
• Obstructive sleep apnea (consider in people with hard-to-control blood pressure, difficulty sleeping, fatigue, snoring or a combination of those factors).
• Endometriosis.
• Pre-eclampsia.
• Premature menopause (44 and younger).
• Sickle cell disease.
• Lupus.
• Racism and discrimination.
• Lack of access to stable housing, nutritious food, walkable neighborhoods, education and health care.
• African Americans have a risk factor twice that of Caucasians. The risk of death from stroke is highest in Blacks and Pacific Islanders.
• Supplemental hormone use for gender-affirming care.
• Oral hormone replacement therapy in women older than 60, and 10 years after menopause onset.
• Smoking and vaping.
• Physical inactivity.

Health care professionals should be screening for these risk factors and recommending lifestyle changes and, in some instances, medications. Care teams can provide people with their risks and next steps.

Preventive measures

• Mediterranean diet or culturally relevant similar intake of whole fruits, veggies, lean protein, whole grains as tolerated, nuts and seeds and oil sparingly. Use extra virgin olive oil for low-heat cooking and avocado oil for high heat cooking.
• Salt reduction.
• 75 minutes of vigorous intensity activity, or 150 minutes of moderate activity weekly.
• Reducing sedentary behavior. Stand up every hour if seated for long periods of time.

Know the signs of a stroke

• Balance: loss of balance, dizziness or difficulty walking.
• Eyes: sudden loss of vision, double vision or blurry vision.
• Face: facial drooping, numbness or uneven smile.
• Arms: numbness in one arm, or one arm drifting downward when both raised.
• Speech: difficulty speaking or confusion.
• Time: Time is life with a stroke. If any of these symptoms are present, call 911 and mention when the first symptoms started.