Why the Risk Is Higher and the Signs to Know

By Nelius W.K, AGACNP-BC, Nurse Practitioner and Founder of Suilen Health. Health education only; this does not replace advice from your own clinician.

A stroke can change a life in a few minutes. In our community it happens more often than it should, and it tends to happen earlier. That’s hard to hear, but there’s a useful side to it: most of what raises stroke risk is something you can check, treat or change.

What the numbers say

Every 40 seconds, someone in the United States has a stroke. That’s more than 795,000 people a year, according to the CDC. For non-Hispanic Black adults, the risk of a first stroke is nearly twice as high as it is for white adults, and Black adults have some of the highest stroke death rates in the country.

It also shows up younger. In a study published in the American Heart Association’s journal Hypertension, researchers followed more than 5,000 young adults for an average of 26 years. The Black participants had almost four times the stroke rate of the white participants. Stroke rates climbed fast around age 40.

Why is the risk higher?

No single thing explains it, but one factor sits at the center: blood pressure. The American Stroke Association says more than half of Black adults have high blood pressure, and it tends to start earlier and be harder to bring down. In that same Hypertension study, stage 2 high blood pressure (140/90 or higher) more than quadrupled stroke risk by age 30 and raised it 5.6 times by age 40.

Diabetes plays a part too, since it’s more common in Black adults, and the American Stroke Association notes that younger people with diabetes who have a stroke are more likely to be Black. Sickle cell disease is another known risk factor. Add extra weight, high cholesterol, smoking and low activity, and the risks stack up.

Here’s the part worth holding onto

The American Stroke Association says up to 80 percent of strokes may be preventable. Not all, but most. That makes a few ordinary habits worth a lot:

  • Know your blood pressure and keep it in the range your clinician sets. For most adults the goal is below 130/80.
  • If you have diabetes, keep your A1C where your clinician wants it.
  • Cut back on salt, mostly the hidden kind in canned soup, deli meat and seasoning blends.
  • Move more. Ten minutes after a meal counts.
  • If you smoke, quitting is one of the strongest things you can do.
  • Take your medicines. If one bothers you or costs too much, say so. There are almost always other options.

Learn the signs: BE-FAST

When a stroke starts, the first few minutes and hours matter. Treatments work best when they’re started quickly, so the goal is to recognize it and call right away. The American Stroke Association teaches BE-FAST:

  • Balance: sudden loss of balance or dizziness
  • Eyes: sudden trouble seeing in one or both eyes
  • Face: one side drooping when the person smiles
  • Arm: weakness or numbness in one arm
  • Speech: slurred or strange speech
  • Time: call 911 right away

If you see even one of these, don’t wait to see if it passes. Call 911. Don’t drive yourself or have someone drive you in if an ambulance can come. And if you can, note what time the symptoms started, because the care team will ask.

After a stroke

Surviving a stroke is only the first step, and a lot of people go home without a clear idea of what comes next. The American Stroke Association reports that Black stroke survivors are more likely to have a second stroke within a year, and are less likely to be treated for complications like depression and fatigue. If you or someone you love has had a stroke, keep every follow-up appointment, and ask directly about blood pressure, cholesterol, medicines and recovery support.

Questions to take to your next visit

  • What is my blood pressure goal?
  • Am I at risk for a stroke because of my diabetes, cholesterol or heart rhythm?
  • Is there anything in my family history I should tell you about?
  • What should I do, and who should I call, if I notice a warning sign?

Related reading: Hypertension and Diabetes

Want more support?

Our Stroke: Take Control Care Kit goes through the warning signs, how to lower your risk, and what recovery looks like, in plain language: Get the kit.

If you’d rather learn alongside other people, our monthly membership has live Saturday sessions at 10:00 AM, one topic at a time: Join Suilen Health.

Sources

  • Centers for Disease Control and Prevention. Stroke Facts (stroke frequency, annual numbers, and risk by race).
  • American Stroke Association. Let’s Talk About Black Americans and Stroke (prevalence, risk factors, prevention, and survivors).
  • American Heart Association. “Black young adults face higher stroke risk than their white peers” (news report on a study in the journal Hypertension, 2021).