Why glucose stability may matter in type 2 diabetes. This week for our Stroke Prevention tip Professor Chatterjee has written fantastic post about glucose variability and why it matters for stroke risk. There are some excellent diagrams in the post that I couldn't post into the text window, so instead I've uploaded the whole post as a PDF that you can read by clicking the link below. Enjoy!

Yes, we're back at blood pressure. After dozens of Stroke-Proof tips I think we've reached the point where any new tips we can come up with would be so minor in their importance that we'd be diluting the key messages. So, back to the start and the most important of all.... There are lots of things we can do to reduce our risk of stroke. But one stands above almost everything else: Getting blood pressure under control. It is not glamorous. It will not generate the same excitement as a full-body scan, a biological-age test or a new supplement. But the size of the prize is enormous. The INTERSTROKE study compared 13,447 people who had experienced a first stroke with a similar number who had not, across 32 countries. Having hypertension—or a measured blood pressure of at least 140/90 mmHg—was associated with almost three times the odds of stroke. At a population level, high blood pressure accounted for an estimated 47.9% of stroke risk. Its contribution was even greater for bleeding within the brain. The Global Burden of Disease study reached a remarkably similar conclusion using a very different method. It estimated that high systolic blood pressure contributed to around 55.5% of all healthy years lost to stroke worldwide in 2019—more than any other risk factor. These figures do not mean that lowering blood pressure would instantly prevent exactly half of all strokes. Population-attributable estimates are not the same as the benefit of an individual treatment. But they tell us something hugely important: Blood pressure sits at the centre of the stroke-prevention opportunity. Does lowering it genuinely prevent stroke? Yes. And this is not based only on association. It has been tested in large randomised trials. An individual-participant meta-analysis (combination of trials) combining around 350,000 people from 48 trials found that every 5 mmHg reduction in systolic blood pressure reduced the relative risk of stroke by about 13%. The greater the blood-pressure reduction, the greater the average benefit.

Hello everyone, Nik and I, together with the Stroke Prevention Team in our local stroke service have been developing a three-session Secondary Stroke Prevention Programme for stroke survivors and their families. Before we launch the pilot, we'd like to make sure we're focusing on what matters most to stroke survivors and their families. Please have a look at the programme outline. We'd love to hear any suggestions or advice that could help make the programme as useful and practical as possible for stroke survivors and their families. Secondary Stroke Prevention Programme (Pilot) Aim: To improve stroke survivors' knowledge, confidence and self-management skills to reduce the risk of recurrent stroke through education, behaviour change and ongoing peer support. Target audience - stroke survivors - Family members encouraged to attend - Format - Three weekly group sessions - 90 minutes each - Interactive, discussion-based sessions combining education with practical self-management strategies Session 1 Understanding My Stroke Objectives Participants will: - Understand what happened during their stroke - Understand why their stroke occurred - Recognise their own stroke risk factors - Begin reflecting on their personal recovery journey Topics · Welcome and programme overview · Brief introduction to what is stroke, types, How stroke affects the brain and causes symptoms, Recovery after stroke, Why another stroke can happen · Understanding personal risk factors- introduction to stroke risk factors · Personal stroke story and group discussion Session 2 Protecting My Brain Objectives Participants will: - Understand the main medical treatments that prevent another stroke - Gain confidence in monitoring important risk factors - Feel confident taking prescribed medications Topics - Antiplatelets and anticoagulants - Medication adherence, managing side effects and knowing when to seek advice - Blood pressure: understanding targets and home monitoring - Cholesterol and statin therapy - Atrial fibrillation and stroke prevention

I'm interested to share today's Stroke-Proof tip because it's an area I hadn't really thought as a risk factor before, but I know realise that it very much is! When people think about preventing stroke they think about: 🏃 Exercise 🥗 Diet 🚭 Smoking 🩸 Blood pressure 💊 Cholesterol Very few people think about their gums. Periodontal (gum) disease is a chronic inflammatory condition caused by bacteria around the teeth. Those bacteria don't always stay in your mouth. They can enter the bloodstream, increase systemic inflammation, damage blood vessels and may contribute to atherosclerosis and blood clot formation. Several large studies have found that people with periodontitis have a significantly higher risk of stroke. The latest systematic review analysed 36 studies involving more than 7.6 million people and found that periodontal disease was associated with around a 72% higher odds of stroke, with an even stronger association for ischaemic stroke. (PubMed) Fortunately... A recent systematic review found that treating periodontal disease—particularly regular professional dental scaling—was associated with a lower risk of future ischaemic stroke. (PubMed) Now, this doesn't prove that brushing your teeth prevents stroke. People with good oral hygiene often have other healthy habits too, and most of the evidence is observational. But we already know that good oral health has many benefits, and there's increasing evidence that it forms part of overall cardiovascular health. So if you're trying to become Stroke-Proof, don't stop at the gym or the kitchen. ✅ Brush twice a day with fluoride toothpaste ✅ Clean between your teeth every day (floss or interdental brushes) ✅ See your dentist regularly ✅ Don't ignore bleeding gums—they're common, but they're not normal. However.... Be cautiuous with broad-spectrum antiseptic mouthwashes (particularly chlorhexidine, unless specifically prescribed by your dentist).

Most of us experience stress from time to time. A little stress can help us stay alert, focus, and deal with life's challenges. But when stress becomes ongoing, it can start to affect our health including our risk of stroke. Why can chronic stress increase stroke risk? When we feel stressed, our body switches into its "fight or flight" response. Stress hormones are released to help us deal with a challenge. For a short time, this response is helpful. But when stress continues for weeks or months, it can: 🩸 Raise blood pressure 🍬Raise blood sugar levels 🩸Make the blood more likely to clot 🔥Increase inflammation throughout the body Over time, these changes can damage blood vessels and increase the risk of stroke. Chronic stress can also make it harder to maintain healthy habits. People under stress are often more likely to exercise less, eat less healthy foods, sleep poorly, smoke or drink more alcohol. Looking at the Evidence An INTERSTROKE analysis found that ongoing psychosocial stress was linked to a higher risk of stroke. People experiencing persistent stress at home were almost twice as likely to have a stroke, while those experiencing stress at work were almost three times as likely. The risk was even higher for people experiencing stress both at home and at work (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799352). It's not only ongoing stress that matters. The same study found that major life events in the previous year such as serious family conflict, the death of a spouse, or marital separation were also linked to a higher risk of stroke. The risk increased even further when people experienced two or more major life events within the same year. It's important to remember that stress alone does not cause a stroke. Stroke usually happens because several risk factors come together. However, learning to manage stress is one important way we can help protect our health.