WHY MIDLIFE IS THE DANGER ZONE FOR HAVING A STROKE (AND HOW TO AVOID ONE)
What medical diagnosis do you fear most? For many people it is cancer. Ask a neurologist, however, and the answer is quite different.
“People fear dying from cancer. They fear living after stroke,” says Dr Arvind Chandratheva, consultant stroke physician and neurologist at University College London Hospital.
For decades, having a stroke was seen as a disease of old age – with the risk doubling in every decade after the age of 55 – yet, increasingly, patients arriving in hospitals with slurred speech and facial droop are in their 40s and 50s. They may then have to live with the after-effects for decades.
The rise in obesity and consumption of ultra-processed foods, coupled with sedentary lifestyles and worse sleep are to blame, says Dr Chandratheva, along with the taboo subject of recreational drug use. “Particularly, cocaine is now emerging as an under-recognised risk factor.”
The encouraging news is that around 90 per cent of strokes are considered to be preventable and “midlife is when the foundations are laid,” says Dr Chandratheva.
Here’s how you can reduce your risk, according to the experts.
Test for atrial fibrillation
One of the hardest parts of stroke prevention is that many of the risks are silent. Atrial fibrillation (frequently abbreviated to AF or A-Fib) is the most common heart rhythm disorder in the world, affecting one in five people, and yet it can have no symptoms.
“People with AF are five times more likely to have a stroke, with AF causing one in four strokes,” says Dr Nikhil Ahluwalia, a cardiologist and clinical researcher at the Barts Heart Centre.
“These AF-related strokes occur at a younger age and cause greater disability. It is important to detect, because AF-related strokes are preventable.
“AF symptoms can include palpitations, breathlessness, fatigue or dizziness, but many people have no symptoms at all, with their stroke hospitalisation being the first time it is picked up.”
Even in the absence of symptoms, AF leads to blood stagnating in the heart and forming blood clots. These can break away and travel up to the brain and block major arteries causing the stroke.
“I’m increasingly seeing patients who first discovered AF through their smartwatch or sports wristband,” says Dr Ahluwalia. “If a device alerts you that it has detected AF, you should save the readings for your doctor to review. They can then arrange further tests such as an ECG or, if the recordings are convincing enough, may even start you on anti-stroke medications right then.”
You can also check for AF by feeling your pulse at your wrist manually. Once diagnosed, the priority is reducing your stroke risk using medications, but other treatments may include rhythm-control medications, catheter ablation or pacemakers.
It’s never too late to stop smoking – but don’t assume alternatives are risk-free
Smoking may have fallen out of fashion, yet it remains one of the clearest modifiable stroke risks.
“Cigarettes contain hundreds of chemicals that damage blood vessels, increase inflammation, stiffen arteries and increase clot formation,” says Dr Chandratheva. “It is never too late to quit.”
Vaping, he warns, should be treated as a smoking cessation tool, “less harmful than smoking - but not harmless.”
Nicotine pouches can also carry risk. “Nicotine itself can raise blood pressure and heart rate and affect blood vessels and inflammation.”
Don’t keep the salt shaker on the table – and eat Mediterranean
Eating too much salt is one of the biggest drivers of high blood pressure, itself one of the strongest stroke risk factors.
“One reason we warn about processed foods is their very high salt content,” says Dr Chandratheva.
Ready meals, takeaways, processed snacks and packaged sauces are common culprits. It’s clearly better to cook from scratch but certainly don’t add extra salt – removing the salt shaker entirely from the table can help.
“A Mediterranean diet has been shown to reduce cardiovascular disease risk by up to 30 per cent. This benefit has been consistent across a number of very large studies over the last decade,” says Dr Ahluwalia. “Prioritise vegetables, fruit, whole grains, pulses, nuts and seeds, and choose oily fish more often than meat and olive oil instead of butter.”
Know your numbers
Annual cholesterol checks, from the age of 40, matter because as we age we process cholesterol differently; some are simply more prone to having raised cholesterol than others. In the UK, NHS guidelines recommend aiming for a total cholesterol level below 5mmol/L.
Understanding, and tracking, key personal health statistics is crucial: blood pressure, cholesterol, blood sugar levels and BMI. They’re the equivalent of your body’s dashboard.
Hypertension, or high blood pressure (BP), remains the biggest modifiable stroke risk – yet many people have no idea that theirs is elevated. “From the age of 40 you should monitor BP at least twice a year, more if it seems unstable,” says Dr Chandratheva.
“I want to see readings below 120 at the top and 80 at the bottom ideally. For people who’ve had a stroke, the target should be less than 130 over 80.
“Action needs to be taken if your BP is above 140 over 90 in the clinic, or consistently over 135 over 85 in the home setting, when you are more likely to be relaxed. If, six weeks later, BP remains high, see your GP to discuss medication.”
Use tech to check your blood pressure
Smartwatches, such as the Apple Watch, can now go beyond simply measuring an individual’s blood pressure at a single moment, like a traditional cuff. Instead they use data from the optical heart sensor to analyse how a user’s blood vessels respond to the beats of the heart. It will notify users if it detects consistent signs of hypertension.
“This is a new way of screening for high blood pressure and it is great to have more tools that can help us detect hypertension sooner,” says Dr Ahluwalia.
But it is still early days for this technology, he warns. “We need to understand the best way to manage a person who comes into the clinic with these findings, and whether we should treat it in the same way as we treat conventionally-detected high blood pressure,” Dr Ahluwalia adds.
Meanwhile, wrist-based blood pressure monitors, such as the Hilo, can provide overnight readings that may help identify patterns such as blood pressure that fails to dip during sleep – which is linked to cardiovascular risk.
“It is great to have the option of health technologies that empower people. However, they should be used in collaboration with a doctor – who will be able to interpret the results and knows how to manage them – otherwise the data can feel overwhelming and potentially drive anxiety if you get alerts that you cannot handle alone,” says Dr Ahluwalia.
Spread out alcohol across the week (and avoid recreational drugs in all forms)
Excessive consumption of alcohol carries increased stroke risks: it raises blood pressure, disrupts sleep and contributes to weight gain and diabetes risk. Binge drinking can also trigger atrial fibrillation.
“The idea that a daily glass of red wine protects the heart is out-dated,” says Dr Chandratheva. “I don’t tell patients they must abstain, but stick to no more than 14 units per week, spread across several days, with alcohol-free days built in. Avoid binge drinking.”
There is also another, more worrying trend emerging. In stroke clinics today patients are routinely asked about recreational drug use because of its recognised link with cerebrovascular disease.
Taking cocaine in midlife – even occasionally – is playing roulette with your health.
“Cocaine can trigger sudden spikes in blood pressure, cause narrowing and spasm of blood vessels, increase clotting risk and potentially lead to longer-term arterial damage,” says Dr Chandratheva.
The best exercise is the one you’ll keep doing
“There is no one ‘best exercise’ for warding off a stroke, the best one is the one that you most enjoy and will continue doing, be that swimming, running or Tai Chi. Consistency is more important than intensity,” says Dr Ahluwalia. “Current guidance recommends at least 150 minutes of moderate exercise each week. If you can vary between low intensity, high intensity strength training and flexibility work, that may help maintain your joints and ligaments too.”
Long-term moderate exercise matters more than short bursts of intensity alone, he says. This is sometimes known as “Zone 2” training. Essentially all it means is exercising at around 60-70 per cent of your maximum heart rate – “low enough that you can still hold a conversation,” he says.
“Combining a Zone 2 workout, such as hikes, brisk walking or gentle cycling, with a social component, like working out with a partner or exercise group, can help the activity to stick and feel enjoyable rather than a burden.”
Finally, sort out any sleep issues. This has become an overlooked cardiovascular risk factor, insist the experts, as modern life means many adults are scrolling later and sleeping less.
“Poor sleep is associated with blood pressure spikes and abnormalities in your hormone profile,” explains Dr Ahluwalia. “Sleeping for less than six hours per night, for several nights per week, is associated with higher blood pressure, higher stress hormone levels and even higher stroke risk.”
The good news, however, is that these effects can be reversed just by taking more steps to get that shut eye in.
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