Up to 90% of Strokes Can Be Prevented

Irina Pronkinova — GP, pediatrician, neurologist

Keeping an eye on the vessels lets us intercept the disease long before any neurological deficit appears.

The main modifiable risk factors

• Arterial hypertension. High pressure damages the endothelium and provokes rupture or thrombosis of the brain’s arteries. Lowering systolic pressure by just 10 mmHg cuts stroke risk by almost a third. Vessel damage occurs even at a “usual”, unnoticed pressure above 130/80 mmHg.
• Atrial fibrillation and heart disease. Rhythm disorders create the conditions for clots to form in the heart’s chambers. A detached clot travels with the bloodstream straight into the arteries of the brain. Timely rhythm screening and treatment with direct oral anticoagulants reduce this threat to a minimum.
• Dyslipidaemia and atherosclerosis. Excess low-density lipoprotein (LDL) cholesterol forms unstable plaques in the carotid and cerebral arteries. Controlling the lipid profile and taking statins stabilise the plaques and prevent them from breaking up.
• Diabetes. Chronic high blood sugar stiffens the vessel wall and damages the microcirculation.
• Smoking and inactivity. Smoking doubles the likelihood of ischaemic stroke through vasospasm and thicker blood. Regular aerobic activity of at least 150 minutes a week and a Mediterranean diet reliably reduce vascular inflammation.

Shingles vaccination (Shingrix): protection against post-infectious stroke

Reactivation of the Varicella Zoster virus (shingles) causes systemic inflammation of the vessel wall and can lead to a transient viral vasculopathy of the cerebral arteries.

Large cohort studies confirm:

• In the first 1–3 months after shingles the risk of ischaemic stroke rises by 30–80%, especially when the rash is on the face along the branches of the trigeminal nerve.
• Immunisation with the recombinant adjuvanted vaccine Shingrix is associated with roughly a 15–20% lower risk of stroke in people over 50, by preventing virus-induced damage to the brain’s vessels.

The course is two doses 2–6 months apart. Vaccination is recommended for all adults aged 50 and over, and for patients from 18 with immunocompromising conditions. At GMS, Shingrix vaccination is AED 1,500.

A first-line screening programme

Effective prevention does not call for courses of nootropics or IV drips of unproven benefit. Protecting the brain rests on objective diagnostics:

• Blood pressure monitoring. Keeping a blood pressure diary at home.
• Basic laboratory profile. Lipid profile (with a focus on LDL and non-HDL cholesterol), HbA1c, creatinine with estimated glomerular filtration rate (eGFR).
• Instrumental checks. Electrocardiography (ECG) — AED 400; with an irregular pulse, Holter ECG monitoring, AED 1,100; duplex ultrasound of the brachiocephalic arteries — the neck vessels, AED 1,100 — to assess intima-media thickness and detect atherosclerotic plaques.
• Vaccination record check. Reviewing your vaccination status against shingles, influenza and pneumococcal infection, which also provoke systemic vascular thrombosis.

Your visit to GMS

Stroke can be prevented. Your personal cardiovascular risk and an individual plan to protect the brain can be worked out at a visit to a neurologist — consultation AED 750 — or a cardiologist — consultation AED 750. Both doctors consult in English and Russian.

Sources

• O'Donnell M.J. et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE). Lancet, 2016
• University of Oxford. New shingles vaccine linked to lower risk of coronary heart disease, stroke and heart failure, 2026

FAQ

Can a stroke be prevented?

According to the international INTERSTROKE study, about 90% of strokes are linked to modifiable factors: blood pressure, heart rhythm disorders, LDL cholesterol, diabetes, smoking and physical inactivity. A vascular catastrophe does not happen in a day, so controlling these factors protects you long before any symptoms appear.

What blood pressure is dangerous for the brain’s vessels?

Vessel damage occurs even at a “usual”, unnoticed pressure above 130/80 mmHg. Lowering systolic pressure by just 10 mmHg cuts stroke risk by almost a third.

What does the shingles vaccine have to do with it?

Reactivation of the Varicella Zoster virus inflames the vessel wall: in the first 1–3 months after shingles the risk of ischaemic stroke is 30–80% higher. The Shingrix vaccine lowers stroke risk by roughly 15–20% in people over 50. The course is two doses 2–6 months apart.

What does the screening include?

A blood pressure diary, lipid profile, HbA1c, creatinine with eGFR, an ECG, Holter monitoring if the pulse is irregular, duplex ultrasound of the brachiocephalic arteries and a check of your vaccination record. Courses of nootropics and IV drips of unproven benefit are not part of the programme.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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