The Silent Threats: Understanding Stroke Risk Factors

Hidden risks for stroke often go unnoticed, yet they can significantly impact your health over time. The good news? You have the power to lower your stroke risk by identifying these factors early and making proactive changes. From adopting healthier lifestyle habits to addressing underlying medical conditions, the steps you take today could make all the difference tomorrow. 

In this blog, we speak to Ashish Masih, M.D., a board-certified, fellowship-trained neurologist with INTEGRIS Health Medical Group Neurology, to learn more. 

“A stroke can strike without warning, altering life in an instant,” Masih says. “While some risk factors such as high blood pressure and smoking are widely recognized, others such as silent brain infarctions, sleep apnea or even chronic stress can be considered silent factors raising your chances of stroke."

Key stroke risk factors

At a glance: Stroke risk is influenced by a combination of medical, lifestyle factors and uncontrollable factors. High blood pressure is the most significant contributor as it weakens and damages blood vessels over time. Other major risk factors include smoking, which promotes clot formation and vessel damage, and diabetes, which can reduce blood flow and increase clotting risks.

Certain medical conditions increase the risk of stroke because they directly or indirectly affect the blood vessels, blood flow or the heart, which are critical to maintaining proper blood supply to the brain.

• High blood pressure is the leading cause of stroke due to damaged arteries.
• High cholesterol can cause fatty deposits to build up in arteries, leading to blockages.
• Heart disease (such as atrial fibrillation and coronary artery disease) can cause blood clots that lead to strokes.
• Diabetes causes high blood sugar that damages blood vessels, increasing stroke risk.
• Obesity is linked to high blood pressure, cholesterol and diabetes.
• Sickle cell disease causes abnormal red blood cells that can block blood flow to the brain.
• Obstructive sleep apnea causes repeated interruptions in breathing, leading to low oxygen levels and increased blood pressure that puts strain on the cardiovascular system.

Various lifestyle factors increase stroke risk because they negatively impact the health of your blood vessels, heart and overall circulation.

• Smoking damages blood vessels and increases clot formation.
• A diet high in saturated fats, trans fats and sodium can raise blood pressure and cholesterol – high sodium intake raises blood pressure, while unhealthy fats contribute to plaque buildup in arteries.
• Physical inactivity increases the risk of obesity and other medical conditions.
• Excessive alcohol consumption raises blood pressure and triglyceride levels.
• Chronic stress contributes to high blood pressure and heart disease.
• Sleep disorders and chronic sleep deprivation increase the risk of both ischemic and hemorrhagic strokes.

Uncontrollable factors can still come into play, even when a person doesn’t have any medical conditions or poor lifestyle habits.

• Stroke risk doubles every 10 years after age 55.
• There is a family history component, as some people have a genetic predisposition to conditions such as high blood pressure.
• Women are at higher risk, especially during pregnancy or when using birth control pills.
• Non-Hispanic Black people have nearly double the risk of a first stroke compared to White people.

Less obvious stroke risk factors

What to know: When we think about stroke risk, common factors like high blood pressure or smoking often come to mind. However, several lesser-known and silent risk factors can quietly increase the likelihood of a stroke. These hidden risks can often go unnoticed, making regular health monitoring essential.

Silent brain infarctions are small, undetected strokes that don’t cause noticeable symptoms but can be found on an MRI.

• Even without symptoms, silent brain infarctions can double the risk of a subsequent symptomatic stroke.

Silent heart attacks occur without noticeable symptoms, such as chest pain.

• A silent heart attack increases the risk of blood clots and stroke.

Microbleeds in the brain are tiny, often undetected hemorrhages in the brain.

• They signal fragile blood vessels and can pave the way for either ischemic (clot-based) or hemorrhagic (bleeding) strokes, especially in older adults.

Hormonal changes can occur due to birth control pills, hormone replacement therapy or pregnancy complications like preeclampsia.

• These changes can make blood more likely to clot or contribute to elevated blood pressure.

How to decrease stroke risk

Why it matters: Lowering your risk of stroke starts with building a foundation of healthy habits and staying proactive about your well-being. Small, consistent changes today can lead to a healthier future.

Adopt a healthy lifestyle by making healthy choices.

• Quit smoking and limit alcohol consumption to protect blood vessels.
• Eat a balanced diet that focuses on fruits, vegetables, whole grains, lean proteins and low-fat dairy.
• Aim for at least 150 minutes of moderate-intensity aerobic activity per week.

Regular check-ups are essential for catching silent risks early.

• This means getting blood pressure checks and having your blood drawn to measure cholesterol levels and blood sugar levels.
• Use prescribed medications for conditions such as high blood pressure or diabetes as directed.

Next steps: If you know you're at a higher risk or a stroke – or even if you're unsure – now is the time to reach out to your doctor. They can help you identify your personal risk factors, clarify silent risks you might not be aware of and discuss ways to reduce those risks.

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