Age: Are you over age 55?
Yes
No

The chances of someone having a stroke go up with age. Two-thirds of all strokes happen to people who are over age 65. Stroke risk doubles with each decade past age 55.

Gender: Are you male?
Yes
No

Males have a slightly higher stroke risk than females. However, because women in the United States live longer than men, most stroke survivors over age 65 are women.

Family History: Does your family have a history of stroke?
Yes
No

Although actual risk varies, people with a family history of stroke are at risk for stroke themselves.

Personal History of Diabetes: Do you have diabetes?
Yes
No

People with diabetes have a high stroke risk. This may be due to circulation problems that diabetes can cause. You can manage this risk factor for stroke by following your doctor's recommendations to control your diabetes.

Race: Are you of African American or Hispanic decent?
African American
Hispanic

African Americans and some Hispanics have two to three times the stroke risk of most other racial groups. This may be due to diet, a greater incidence and severity of high blood pressure and diabetes.

Having one or more uncontrollable risk factors does not necessarily mean you will have a stroke. It does mean that you should pay special attention to the lifestyle factors and treatable medical disorders that you are able to control to lessen your overall risk.

Controllable Stroke Risk Factors

Smoking: Do you smoke?
Yes
No

Smoking doubles your risk for stroke. It speeds up hardening of the arteries, increases the chance for blood clots to form and raises your blood pressure. The good news is that if you quit smoking today, your stroke risk from this factor may decrease significantly.

Alcohol: Do you consume more than two alcoholic beverages a day?
Yes
No

Studies show that drinking alcohol in moderation - up to two drinks per day may reduce your risk for stroke by almost half. However, drinking more than two drinks per day may increase your risk for stroke by as much as three times. Since alcohol is a drug that can interact with medication you are taking, we recommend that you discuss alcohol consumption with your doctor. Drinking alcohol can lead to other health and lifestyle problems, so if you don't drink, don't start.

Weight: Are you overweight?
Yes
No

Excess weight puts a strain on the entire circulatory system. It also makes people more likely to have other stroke risk factors such as high cholesterol, high blood pressure and diabetes. Your doctor can recommend a weight reduction program that includes changes in diet and exercise.

High Blood Pressure: Is your blood pressure consistently more than 135/85?
Yes
No

Having high blood pressure or hypertension, makes you four to six times more likely to have a stroke. It is the single most controllable stroke risk factor. Hypertension affects approximately 50 million American adults or about one-third of the population. Your doctor may recommend to treat your condition with a combination of the following: a low salt diet, adding moderate amounts of potassium to your diet, losing weight, stopping smoking, exercise and medication.

Atrial Fibrillation: Do you have an irregular heartbeat?
Yes
No

Atrial fibrillation, also known as AF, is a particular type of irregular heartbeat that affects more than 1 million Americans. AF can increase your stroke risk four to six times. It can be treated by cardioversion, a procedure in which an electrical stimuli is used to restore your heart's normal rhythm. When this does not work treatment concentrates on preventing the formation of blood clots. This is done through medication.

Heart Disease and High Cholesterol: Do you have heart disease?
Yes
No

Is your cholesterol level more than 200? Heart disease is an important risk factor for stroke. Plaque that builds up in the arteries can break away and migrate to the brain. This plaque can get caught in the narrow blood vessels of the brain causing a blockage that results in stroke.

High cholesterol is an indirect risk factor for stroke because it can put you at greater risk for heart disease. A cholesterol level of more than 200 is considered high. If you don't know what your cholesterol level is, find out. If you do have high cholesterol, work with your doctor to develop a plan to lower it. Simple lifestyle changes in diet and exercise may lower your cholesterol. Though many people can control their cholesterol levels through diet and exercise, some cannot and need medication prescribed by their physician.

Previous TIA or Stroke: Have you already had a TIA or stroke?
TIA
Stroke

Call 911 if you see or experience any of the following symptoms: Sudden numbness or weakness of face, arm or leg, especially on one side of the body; Sudden confusion, trouble speaking or understanding; Sudden trouble seeing in one or both eyes; Sudden trouble walking, dizziness, loss of balance or coordination; Sudden severe headache with no known cause. Stroke is a medical emergency. Treatment can be more effective if given quickly.

Regular doctor visits can help diagnose these problems and help present a stroke before it happens. These stroke risk factors can be managed by lifestyle changes and/or medical care.

Detection and management of stroke risk factors are the best waysS to lower your personal risk for stroke. If you answered yes to any of the questions on this form, you may be at increased risk for stroke. If any of the controllable risk factors listed apply to you, National Stroke Association recommends a visit to your doctor to discuss your individual risk and develop a treatment plan.