After a stroke, you may suddenly find yourself taking several tablets every day. But often we aren't clear about what each tablet does and why. Many of the medicines prescribed after a stroke have one very important job — reducing your risk of another stroke. Here are some of the common ones: 🩸 CLOPIDOGREL / ASPIRIN — stopping platelets sticking together If you’ve had an ischaemic stroke — a stroke caused by a blood clot blocking an artery — you will often be prescribed an antiplatelet medicine. The most common long-term medication is clopidogrel. Aspirin is another antiplatelet and is commonly used immediately after an ischaemic stroke or TIA. Some people take aspirin instead of clopidogrel, and in certain situations aspirin and clopidogrel may be used together for a short period. These medicines make platelets less likely to stick together and form another clot. ❤️ APIXABAN, RIVAROXABAN, DABIGATRAN or EDOXABAN — preventing clots from the heart These belong to a group called DOACs — Direct Oral Anticoagulants. They are particularly important if your stroke was associated with atrial fibrillation (AF). AF causes the heart to beat irregularly. Blood can pool inside the heart, allowing a clot to form. That clot can then travel to the brain and cause a stroke. DOACs reduce the ability of the blood to form these dangerous clots. They include: • Apixaban • Rivaroxaban • Dabigatran • Edoxaban Some people need warfarin instead — for example, in certain types of heart-valve disease or with a mechanical heart valve. Importantly, anticoagulants and antiplatelets are not the same thing, and most people do not need both long-term unless there is another reason. 🫀 ATORVASTATIN and other statins — reducing cholesterol and stabilising arteries Statins are not simply “cholesterol tablets”. After an ischaemic stroke or TIA, a high-intensity statin such as atorvastatin is commonly prescribed to reduce the risk of another event. Lowering LDL cholesterol reduces the chance of cholesterol-rich plaques (artery deposits) growing or causing further problems in your arteries.

I attended a Lifestyle Medicine Conference last week and came away with four important messages that I believe are highly relevant for our stroke prevention community. For those who may not be familiar with Lifestyle Medicine, it is an evidence-based approach that supports people to improve their health through sustainable changes in nutrition, physical activity, sleep, stress management, social connection, and the avoidance of harmful substances. It works alongside, not instead of, conventional medicine. 1. Small Changes Can Make a Meaningful Difference One of the clearest messages from the conference was that you do not need to transform your life overnight to improve your health. Research consistently shows that realistic changes to how we eat, move, sleep, manage stress, and avoid harmful substances can improve blood pressure, cholesterol, and blood glucose control. These changes can also improve how we feel day to day, helping us with energy levels, mood, and overall wellbeing. 2. Our Reason for Changing Matters Knowing that we need to lower our blood pressure or lose weight is not always enough to sustain long-term change. We are far more likely to maintain healthy habits when they are connected to something personally meaningful: remaining independent, spending quality time with family, watching our children or grandchildren grow up, travelling, gardening, or continuing to enjoy the activities we love. The number may be the clinical goal, but our "why" is often what helps us take the next step and keep going when motivation fades. 3. Sleep Is Powerful and Often Underestimated Sleep is not simply a period of rest. It influences what we eat, how active we feel, how we manage stress, how we connect with others, and even our relationship with smoking and alcohol. Poor sleep can make healthy choices feel harder and unhealthy choices feel more tempting. Rather than thinking of sleep as separate from the other pillars of health, it may be more helpful to see it as the foundation that supports them all.

This isn’t strictly a stroke-prevention post. It’s a dementia-prevention post. But Stroke‑Proof is ultimately about protecting the brain—and looking after your hearing and eyesight may be a more important part of that than most people realise. The 2024 Lancet Commission estimated that addressing 14 modifiable risk factors could potentially prevent or delay around 45% of dementia cases. Two of those factors involve our senses: 👂 Hearing loss in midlife was estimated to account for around 7% of dementia cases at population level. 👁️ Untreated vision loss in later life was estimated to account for around 2%. Why might our senses affect the health of our brain? Think about how much stimulation reaches your brain through your eyes and ears. Every conversation you follow, face you recognise, book you read and environment you navigate activates complex networks of brain cells. When hearing or vision deteriorates, several things may happen: • The brain receives less sensory stimulation. • It has to work harder to interpret incomplete information. • People may withdraw from conversations and social activities. • Reading, exercise, travel and other cognitively stimulating activities can become more difficult. • Reduced input may contribute to changes in the brain regions that process sensory information. It may therefore be partly a case of maintaining the connections that keep our brain circuits active—continuing to stimulate the wiring rather than gradually allowing those pathways to become less active. In the ACHIEVE randomised trial, treating hearing loss did not significantly slow cognitive decline across the entire study population. However, among participants already at higher risk of cognitive decline, a hearing intervention slowed cognitive decline by 48% over three years. For vision, one study of more than 3,000 older adults with cataracts found that cataract surgery was associated with a 29% lower risk of subsequently developing dementia. That cannot prove that the surgery caused the reduction, but it strengthens the case for taking treatable vision loss seriously.

Good morning. Today I'm attaching the third instalment of Prof Chatterjee's series on blood sugar management. II actually thought I had posted this the week before last, so to catch us up I'm going to post part 3 today and part 4 on Wednesday. I will then add the whole 8 part series into the classroom section of Stroke-Proof for you to review at your leisure.

Did you know you can have a healthy weight but still carry too much fat around your waist? Abdominal fat (visceral fat) is stored deep inside your abdomen, surrounding organs such as the liver, pancreas and intestines. Unlike fat just beneath the skin, visceral fat is metabolically active and is linked to inflammation, type 2 diabetes (as discussed in the previous post), high blood pressure, abnormal cholesterol levels, and an increased risk of stroke. You can have a healthy BMI and still carry excess abdominal fat, so checking your waist measurement alongside your weight and BMI can provide valuable information about your health. As a general guide, try to keep your waist measurement below half your height. For example, if you’re 180 cm tall, your waist should ideally be less than 90 cm. What Should You Eat? Certain foods can help reduce visceral fat by improving insulin sensitivity, reducing inflammation, and increasing fibre and satiety. Here are some evidence-based foods that can help reduce abdominal fat, plus ideas for adding them to your diet. 🐟 Oily Fish Salmon, sardines, and mackerel are rich in omega-3 fatty acids (EPA and DHA), which help reduce inflammation, improve insulin sensitivity, and support liver health. Pan-Seared Salmon Lunch Bowl - Season the salmon with olive oil, lemon juice, black pepper and dill. - Pan-sear until thoroughly cooked. - Fry the leeks, peppers and mushrooms in a separate pan with a little olive oil, black pepper and your favourite herbs until softened. - Serve with brown rice, quinoa or barley. 🫒-Virgin Olive Oil Extra-virgin olive oil (EVOO) as part of the Mediterranean diet combined with vegetables, fruit, nuts, and legumes can help reduce abdominal fat. EVOO offers monounsaturated fats and polyphenols that reduce inflammation and improve insulin sensitivity. Mediterranean Quinoa Bowl - Cooked quinoa - Chopped tomatoes - Cucumber - Red pepper - Feta cheese - Olives (optional) Simple Vinaigrette