Perhaps you already know that three big risk factors for a stroke are obesity, smoking and high blood pressure.

But have you ever wondered which of these three is the greatest risk factor?

Suppose there are three large groups of men and women:

• Obese, but nonsmokers with normal blood pressure.
• Smokers, but normal weight and normal blood pressure.
• Hypertensives, but normal weight and nonsmoking.

Which of these three groups, otherwise matched for age and general lifestyle, are at greatest risk for an ischemic (blood clot) stroke?

“If I have to rank the three: hypertension, smoking and then obesity,” says Atif Zafar, MD, director of the stroke program at University of New Mexico Hospital and assistant professor of Stroke/Neurology at the UNM School of Medicine.

Now if you’re obese but a nonsmoker with normal blood pressure, this doesn’t mean you’re off the hook just because obesity came in third place.

Third place is not the loser here. Third place still packs a ferocious punch. It’s just not as hard as #1 and #2.

Thus, even if you’ve never smoked and always have normal blood pressure readings, obesity still puts you at much more risk of a stroke than if you were of normal weight.

High Blood Pressure and Stroke

“Hypertension undoubtedly is the second biggest culprit after aging,” says Dr. Zafar.

Be we can’t stop the aging process. But we CAN control the so-called modifiable risk factors, such as obesity, smoking and hypertension.

However, here’s something to consider: Obesity and smoking can lead to hypertension.

So if you’re carrying a lot of excess weight or smoke but have normal blood pressure … a baseline high blood pressure can be waiting for you down the road.

“Many obese folks have high blood pressure as a result of their obesity which makes them more prone to a stroke or heart attack,” says Dr. Zafar.

“Similarly, diabetes is more common in obese patients which makes obesity the common denominator for hypertension and diabetes.

“Smoking is also a reversible cause of stroke. Many young patients who smoke present with stroke.”

America’s Crippler

Ischemic stroke is the U.S.’s #1 cause of physical disability. And it’s very common, affecting all age groups, even though elderly age is the biggest risk factor.

However, elderly people who don’t smoke, have a normal body weight and do not have hypertension have a significantly lower risk of ischemic stroke than do aged people who have any one of those three conditions, let alone all three.

Further reducing the risk of stroke is that of a low sodium diet (under 2,000 mg/day) and regular aerobic and weight-bearing exercise.

Dr. Zafar is author of the book, “Why Doctors Need to Be Leaders.” His interests include vascular and endovascular neurology, and the neurosciences.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  

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Top image: Freepik.com/jcomp