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Microsoft word - secondary stroke prevention and smoking patient-family informationjan2011.docx

Information for Patients and Families
Authors: Sabrina Godbout; Jessica Goldberger; Genevieve Dupont; Sabrina Mansour;
What is secondary stroke prevention?

After a first stroke, the likelihood of experiencing a second stroke increases.
There are certain changes an individual can make to his/her lifestyle, to reduce
the possibility of a second stroke.
How common are second strokes?

The latest statistics show that people who have had a stroke have a 20% higher
chance of having another stroke within 2 years, compared to the general
What is the impact of a second stroke?

Recurrent strokes are more likely to be fatal than first strokes. Each stroke is
different and its effects vary from person to person. The functional consequences
depend on where the brain was injured and the extent of damage that has
occurred. The second stroke will not necessarily occur in the same area of the
brain as the first stroke.
Secondary  Stroke  Prevention  &  Smoking  Cessation   1  

What are the risk factors for a second stroke?

Secondary stroke risk factors are the same as those for primary stroke. There are
preventable as well as uncontrollable risk factors.
You have an important role in controlling and reducing preventable risk factors:
 high blood pressure (hypertension)
 high blood cholesterol and lipids
 heart disease
 type II diabetes
 being overweight
 high alcohol consumption
 physical inactivity
 smoking
 stress.
Uncontrollable risk factors are:
 age (over 60)
 gender
 family history of stroke
 ethnicity
 previous stroke and transient ischemic attack (TIA).

How can I prevent having another stroke?

It is suggested that 80% of secondary strokes can be prevented by a combination
of different lifestyle changes and medical intervention (Hackman, 2007). These
lifestyle changes include increasing activity level with exercise, smoking
cessation, diet modification, and stress reduction. It is important to understand
that 20% of strokes cannot be prevented with lifestyle modification due to
uncontrollable risk factors. This pamphlet address smoking cessation.
Secondary  Stroke  Prevention  &  Smoking  Cessation  

What is the impact of smoking on my health?
Smoking is associated with an increased overall morbidity and mortality. It has
many negative effects on your health and increases your risk of having a stroke.
It has been shown that smoking contributes to the build-up of plaque in your
arteries, increases the risk of blood clots, reduces the oxygen in your blood, and
increases your blood pressure. This makes your heart work harder, which
increases your chances of developing a first stroke as well as a second one.
There is strong and convincing evidence that smoking is an independent risk
factor for stoke regardless of age, sex, and ethnic group. For more information on
smoking and your health visit the Heart & Stroke Foundation's website.

Why should I stop smoking?

Smoking cessation is one of the most important lifestyle changes to prevent a
future stroke. It reduces recurrence of another stroke by 50%. It also enhances
your sense of taste and smell, and can improve your overall quality of life.
Furthermore, being free from addiction provides a good example for generations
to come!

I have been smoking for most of my life; will
quitting now really have an impact?

Regardless of how long you have smoked, quitting will have a positive impact on
your health. Observational studies have shown that your risk of stroke decreases
substantially just 5 years after quitting. Quitting smoking is also associated with a
reduction of stroke-related hospitalizations, showing its importance in preventing
a second stroke.
Secondary  Stroke  Prevention  &  Smoking  Cessation   3  

How can I find resources to help me quit?
You can discuss your intention to quit smoking with your family doctor, who will
be able to provide you with some tips and direct you to useful resources. You are
not alone in this process. Your state of mind is very important; just thinking about
quitting will put you on the road of success.
When attempting to stop smoking try to adopt healthy behaviors such as
maintaining a well balanced diet, exercise regime, and stress management skills.
You should also access social supports (family, friends, support groups), and ask
others not to smoke around you.
Medication can also help you succeed (such as bupropion, nicotine replacement
therapy, "patches", etc).
 NOTE: It is important to check with your physician
before taking any of these.
Some tips to help you quit
 Think about quitting.
 List the reasons why you want to quit.
 Think about why you smoke.
 Choose a "quit smoking" date.
 Prepare a "quit smoking" plan.
 Accept setbacks and learn from them.
 Be positive.
For more information on how to quit see the Public Health Agency of Canada

What is the impact of second hand smoke?

In the presence of second hand smoke, non-smokers as well as smokers inhale
thousands of harmful chemicals contributing to the development of different
diseases. This smoke causes physical reactions related to heart and stroke
disease after only 8 to 20 minutes of exposure. Second hand smoke should be

Secondary  Stroke  Prevention  &  Smoking  Cessation  

What do I believe caused the stroke?

By now you most likely have been told about the risk factors of stroke and have
discussed with your doctor those that most pertain to you. However, you are the
one who experienced the stroke, so you might have your own ideas regarding
what caused it; whether it was linked to a recent stressful event (such as the
death of a family member) or a past event. Your opinions are important and you
should openly discuss your concerns with a healthcare professional and your

How can I get control of the causes?

Once you have identified and discussed the causes, address each of them
individually and find ways to gain control so that you can be active in preventing
recurrence. The strategies will be different for each cause. The goal is for you to
make a plan and take control of your health.

Can medication help in reducing my chances of
having another stroke?

Information can be found on medications for secondary stroke prevention at:
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. Secondary  Stroke  Prevention  &  Smoking  Cessation   5  

 Cappuccio, F.P. (1997). Dietary changes and their effect on blood pressure:
what lesson should we learn? Journal of human hypertension, 11, 765-766.  Critchley, J.A. & Capewel , S. (2003). Mortality risk reduction associated with mmoking cessation in patients with coronary heart disease: a systematic review. JAMA, 290, 86-97.  Hackam D.G., & Spence J.D. (2007). Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke, 38, 1881-1885.  Heart and Stroke Foundation of Canada, retrieved on 2007 from  Singh, R.B., Dubnov, G., Niaz, M.A., Ghosh, S., Singh, R., Rastogi, S.S., Manor, O., Pel a, D., & Berry, E.M. (2002). Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high-risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. The Lancet, 360, 1455-1461.  Smith, S.C., Allen, J., Blair S. N., Bonow, R.O., Brass, L.M., Fonarow, G.C., Grundy, S.M., Hiratzka, L., Jones, D., Krumholz, H.M., Mosca, L., Pasternak, R.C., Pearson, T., Pfeffer, M.A., & Taubert, K.A. (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 Update. Endorsed by the National Heart, Lung, and Blood Institute. J Am Col Cardiol., 47, 2130 -2139.  The Internet Stroke Center - US, retrieved on October 30, 2007 from  The Stroke Association - UK, retrieved in 2007 from  Townend, E., Tinson, D., Kwan, J., & Sharpe, M. (2006). Fear of recurrence and beliefs about preventing recurrence in persons who have suffered a stroke. Journal of Psychosomatic Research, 61, 747-755.  Zhang, H., Thijis, L. & Staessen, J.A. (2006). Blood pressure for primary and secondary prevention of stroke. Hypertension, 48,187-195. Secondary  Stroke  Prevention  &  Smoking  Cessation  


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