Up to 80% of strokes are preventable. This article shares how you can take care of your health and maintain healthy lifestyle habits, lowering your overall risk of stroke and other conditions.
Causes and Risk Factors
Modifiable Risk Factors
These risk factors can be avoided or reduced through your actions and choices, lowering your risk of stroke.
High Blood Pressure (Hypertension) | |
| Blood pressure is the force with which blood presses on the walls of your arteries as it flows through your body. It is measured using a blood pressure cuff. Generally, a healthy blood pressure target is 130/80 mmHg and below. Consistent measurements above 140/90 mmHg may indicate hypertension; consult your primary physician as soon as possible to manage it and prevent further complications. High blood pressure is the most common risk factor for stroke; in 2022, 81% of stroke patients in Singapore had hypertension.1 Additionally, hypertension is linked to higher mortality (death) and worse health outcomes after stroke.2 How does hypertension increase the risk of stroke? Uncontrolled hypertension increases the risk of all types of strokes by three to four times.3 High blood pressure damages and weakens blood vessel walls over time, making them more prone to blockage and rupture. If this happens in one of the brain’s arteries, it causes a stroke. How do I manage hypertension?
Read more about hypertension here. |
High Blood Cholesterol (Hyperlipidaemia) | |
Cholesterol is a type of lipid that your body needs to create new cells and hormones. Too much of it can increase your risk for stroke and other heart conditions. There are two main types of cholesterol:
You can find out your levels of each type of cholesterol by asking your primary physician for a blood test, which may be part of your regular health checks. Generally, an LDL ≥ 4.9 mmol/L is considered high, but your target may be different if you have other medical issues. How does hyperlipidaemia increase the risk of stroke? Stroke is linked to high levels of LDL cholesterol. In 2022, 83.7% of stroke patients had hyperlipidaemia.1 When fatty plaque builds up on artery walls, the arteries get more narrow over time. This makes them more easily blocked by blood clots, increasing your risk of ischaemic stroke. Hyperlipidaemia also increases your risk of heart disease, which itself is a risk factor for stroke. How do I manage hyperlipidaemia?
Read more about hyperlipidaemia here. | |
High Blood Sugar (Diabetes) | |
Diabetes is a chronic condition where your body does not create or process insulin properly, causing glucose (sugar) to build up in your blood. There are two main types of diabetes:
Often, people with diabetes have other health conditions like obesity, heart disease, high blood pressure, and high blood cholesterol, further increasing the risk of stroke. Furthermore, high blood sugar after stroke is associated with lower survival and poorer health outcomes.4 Your blood sugar can be measured during your regular health screening through a blood test. HbA1c (an indicator of average blood sugar over the past few months) and blood glucose targets vary between individuals based on their health status and risk. You can refer to the different blood glucose and HbA1c cut-offs for healthy, pre-diabetic, and diabetic individuals here. How does diabetes increase the risk of stroke? Too much sugar in the blood damages the inner lining of the arteries. Over time, the vessels stiffen and narrow, and fatty plaques build up on the vessel walls (atherosclerosis). This makes the arteries more likely to be blocked, increasing your risk of stroke. How do I manage diabetes?
Read more about diabetes here. | |
Smoking | |
Smoking increases your risk of stroke. Exposure to second-hand smoke almost doubles stroke risk for non-smokers. Quitting reduces your risk for stroke and other conditions. After 2-12 weeks, your circulatory system will start to improve. After two years, your risk for stroke drops significantly. After five years, your stroke risk will be the same as that of non-smokers.5 How does smoking increase the risk of stroke? Smoking is a major contributor to heart disease, which is itself a significant risk factor for stroke. Tar, nicotine, and other chemicals inhaled when smoking can increase blood pressure, cause plaque buildup along blood vessel walls (atherosclerosis), and alter your cholesterol profile by reducing the levels of “good” cholesterol and raising the levels of “bad” cholesterol. Carbon monoxide in cigarette smoke reduces the blood’s ability to carry oxygen, forcing your heart to work harder to pump oxygen around your body. Over time, these effects cause the blood vessels to be more prone to clotting or rupturing, significantly increasing your risk of stroke and that of those exposed to secondhand smoke. How do I quit smoking?
Read more about the actions you can take to quit smoking and how to support loved ones on a similar journey in the linked articles. You can also reach out to the I Quit Programme and the National Addictions Management Service for additional support in quitting smoking. | |
Irregular Heartbeat (Atrial Fibrillation (AF)) | |
Atrial fibrillation (AF) is a heart rhythm disorder characterized by an irregular and often rapid heartbeat. The heart has four chambers; two upper (atria) and two lower (ventricles). In a healthy heart, the atria contract in a coordinated manner to push blood into the ventricles, which then pump it to the rest of the body. In AF, the atria quiver instead of contracting effectively, causing blood to pool in the upper chambers. For many people, AF has no symptoms and can only be identified during a health screening or with an electrocardiogram (ECG). If there are symptoms, you may experience:
How does AF increase the risk of stroke? AF increases the risk of stroke by 5 times and often occurs alongside hypertension and heart disease, which are also risk factors of stroke. Blood pooling in the atria increases the chance of a clot forming in the heart. The clot can travel to the brain’s arteries through the bloodstream, causing a stroke. Strokes caused by AF tend to be more fatal and result in worse long-term effects.5 How do I manage AF? On diagnosis, your doctor will advise you on how to manage the condition and reduce your risk of stroke. This could include the use of blood-thinning medication, medication to help your heart beat more effectively, or surgical procedures to restore your heart rhythm. Managing conditions like high blood pressure, obesity, diabetes, unhealthy lifestyle habits, and sleep apnoea can reduce your risk for AF and its complications including stroke. Read more about atrial fibrillation here. | |
Unhealthy Lifestyle Habits | |
Lifestyle choices such as poor dietary choices, physical inactivity, and high levels of stress indirectly contribute to your stroke risk by worsening conditions like high blood pressure, high cholesterol, atrial fibrillation, obesity, diabetes, and other conditions that increase your risk of stroke. How do I lead a healthier lifestyle? Changing lifestyle habits can be an overwhelming task. Stay a step ahead of stroke by remembering the acronym S.M.A.R.T. Smoke-free living: Smoking is a major modifiable risk factor for stroke. The smoking section above and the linked fact sheet contain more information and resources. Meals that are healthy: Good dietary choices like going for less salt, less sugar, and less oil can reduce your risk of stroke. It is important to have a nutrient-rich and balanced diet. You can find out more about how to eat healthily here. It is also important to limit your alcohol intake. Men should consume no more than two standard drinks per day, and women no more than one standard drink per day. To learn more about alcohol consumption and stroke, click here. Active lifestyle: It is recommended that adults get between 150-300 minutes of moderate-intensity activity weekly, with at least two days including muscle-strengthening activities. Read more about the benefits of exercise and ways to get more active here. Regular health screening: Routine health screenings can help detect silent conditions like high cholesterol and high blood pressure that increase your risk of stroke. The conditions you are recommended to be tested for change with age, and are explained in detail here. Take prescribed medication: If you have a pre-existing condition (e.g. high blood pressure, high cholesterol, diabetes, atrial fibrillation etc.), taking your prescribed medication consistently keeps your condition under control and reduces your risk of stroke. Always consult your healthcare provider before stopping or adjusting your medication dosage, even if you feel fine. | |
Unmodifiable Risk Factors
These risk factors are beyond your control. However, being aware of them helps you understand your overall stroke risk and why managing your modifiable risk factors is so important.
Age |
| Stroke can affect anyone at any age. However, the risk of having a stroke approximately doubles every 10 years after age 55.6 As we age, our blood vessels become stiffer and less able to dilate and constrict, increasing the chances of clots and blockages forming. The prevalence of other risk factors like high blood pressure and atrial fibrillation also increase with age.7,8 |
Sex |
Men have a slightly higher risk of stroke than women. In 2022, 58% of stroke patients were male.1 This may be due to the greater presence of risk factors such as high blood pressure and smoking in men, as well as some physical differences between male and female bodies. In women, the risk of stroke roughly doubles in the 10 years after menopause.9 After menopause, oestrogen levels drop. This increases risk for cardiovascular disease, changes blood lipid profiles, and causes blood vessels to stiffen, which all increase stroke risk. |
Hereditary Factors |
| A family history of stroke can raise your risk of stroke. This can be due to genetic disorders that directly cause stroke or include stroke as a complication, or genetic factors that increase your risk for conditions that are themselves risk factors for stroke, such as diabetes or familial hypercholesterolaemia. |
Previous Stroke, Transient Ischaemic Attack (TIA), or Heart Attack |
| Previous stroke, TIA, or heart attack puts you at a greater risk for stroke than someone who has not had these conditions. This is especially true if the condition underlying the previous stroke is not managed. To reduce your risk as much as possible, follow your doctor’s advice and take prescribed medication regularly. Read more about secondary stroke prevention in the section below. |
Prevention Introduction
After having a stroke or transient ischaemic attack (TIA), your risk of having another one is higher. About 1 in 5 people who have had a stroke will suffer another within the next 5 years.
A combination of consistent lifestyle changes and medication is necessary to reduce the chances of a recurrent stroke. It is important to keep up with your medical appointments and medication regimen to manage the risk factors and conditions underlying your stroke.
Common medications and measures that your doctor may prescribe to manage your conditions are detailed below. Always follow your doctor's guidance and prescription, and do not start or stop medication without medical advice.
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Anti-Platelet Medication
E.g. Clopidogrel, Acetylsalicylic Acid, Dipyridamole
Platelets are cell fragments in your blood that form clots when there is an injury, preventing too much blood loss. If you are at high risk for stroke, your doctor may prescribe antiplatelets, which stop platelets from forming clots that can cause ischaemic stroke. Antiplatelets should be taken consistently according to your doctor’s instructions.
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Anti-Coagulant Medication
E.g. Warfarin, Direct Oral Anticoagulants (E.g. Rivaroxaban, Dabigatran, Apixaban)
Anticoagulants are a type of blood thinner that help prevent the formation of new blood clots and keeps existing clots from getting larger. They work by interfering with the function of certain blood clotting factors that are needed to form clots. Anticoagulants are usually prescribed to patients with atrial fibrillation (AF) and other cardiac or blood disorders. In AF, they help to prevent clots from forming when blood pools in the upper chambers of the heart.
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Cholesterol-Lowering Medication
Cholesterol-lowering medications, in addition to lifestyle changes such as a healthy diet, work to lower the levels of “bad” cholesterol in your blood by interfering with the body’s cholesterol production process. This prevents further buildup of fatty plaque in your arteries and thus lowers the risk of stroke. Managing blood cholesterol also helps to lower the risk of heart disease, which is another risk factor of stroke.
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Antihypertensive Medication (Blood Pressure-Lowering Medication)
High blood pressure (hypertension) is one of the most prevalent risk factors for stroke. Antihypertensive medications reduce blood pressure in different ways – some interfere with the processes that cause blood vessels to narrow, while others allow the heart and blood vessels to relax and open. Hypertension is a silent risk factor of stroke. Even if you feel fine, do not stop taking your prescribed medication without seeking your doctor’s advice as it keeps your condition under control.
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Lifestyle Changes
Medication alone is insufficient to maintain your health after a stroke. It is important to lead a healthier lifestyle to reduce your risk of stroke and other conditions that are associated with stroke. Learn more about S.M.A.R.T. and how to lead a healthier lifestyle in the section above.
References
1 National Registry of Diseases Office (2025). Singapore Stroke Registry Annual Report 2022. www.nrdo.gov.sg/publications/stroke
2 Wilmot, M., Leonardi-Bee, J, & Bath, P. M. W. (2004). High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension, 43(1), 18-24. doi: 10.1161/01.HYP.0000105052.65787.35
3 Yu, J., Zhou, R., & Cai, G. (2011). From Hypertension to Stroke: Mechanisms and Potential Prevention Strategies. CNS Neuroscience and Therapeutics, 17(5), 577-584. doi: 10.1111/j.1755-5949.2011.00264.x
4 Mosenzon, O., Cheng, A. Y. Y., Rabinstein, A. A., & Sacco, S. (2023). Diabetes and Stroke: What Are the Connections? Journal of Stroke, 25(1), 26-38. doi: 10.5853/jos.2022.02306
5 World Stroke Organization (2026). Stroke and Smoking | World Stroke Organization.https://www.world-stroke.org/world-stroke-day-campaign/prevent-stroke/stroke-and-smoking
6 Yousufuddin, M. & Young, N. (2019). Aging and ischemic stroke. Aging, 11(9), 2542-2544. doi: 10.18632/aging/101931
7 Singapore Heart Foundation (2023, July 31). Normal Blood Pressure: Guidelines for Elderly. https://www.myheart.org.sg/heart-news/blood-pressure-for-elderly/
8 Singapore Heart Foundation (2023, June 5). Living with a Palpitating Heart. https://www.myheart.org.sg/heart-news/living-with-a-palpitating-heart/
9 Lisabeth, L & Bushnell, C. (2013). Menopause and Stroke: An Epidemiologic Review. Lancet Neurology, 11(1), 82-91. doi: 10.1016/S1474-4422(11)70269-1
Contributed By
- An initiative by the Stroke Services Improvement Team in collaboration with all public healthcare institutions.