Stroke Prevention: 7 Medications That Are Working and How to Take Them Correctly

Who is at higher stroke risk

Multiple factors raise stroke risk. Several are addressable through medication and lifestyle. Others are not changeable but inform how aggressively prevention should be pursued.

• High blood pressure, the most important modifiable risk factor.
• Atrial fibrillation, which can cause clots in the heart that travel to the brain.
• Diabetes.
• High cholesterol, particularly elevated LDL.
• Smoking.
• Carotid artery disease.
• A prior stroke or transient ischemic attack (TIA).
• Family history.
• Age, with risk doubling each decade after 55.

The 7 medications that prevent stroke

1. Blood pressure medications

The single most effective category for stroke prevention. ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics all reduce stroke risk by lowering blood pressure. The class matters less than getting the pressure into the target range and keeping it there.

2. Statins

Lower LDL cholesterol and stabilize existing plaque, both of which reduce ischemic stroke risk. Atorvastatin and rosuvastatin are the most commonly prescribed for high risk patients.

3. Aspirin

Low dose aspirin (81 mg) is used for stroke prevention in patients who have already had a stroke or TIA, who have certain cardiovascular conditions, or who are at high risk and have a low bleeding risk. Aspirin for primary prevention (in patients who have not had a stroke or heart attack) is now used more selectively than in past decades because of bleeding risk.

4. Clopidogrel and other antiplatelets

Clopidogrel (Plavix), and combinations of clopidogrel plus aspirin in certain situations, are used after a stroke or TIA, after stenting, and in patients with peripheral artery disease.

5. Anticoagulants

For patients with atrial fibrillation, anticoagulants prevent the clots that cause about a third of all strokes. The direct oral anticoagulants (apixaban, rivaroxaban, dabigatran, edoxaban) have largely replaced warfarin in many patients because they require less monitoring and have somewhat lower bleeding risk.

6. Diabetes medications

Several diabetes medications, particularly GLP-1 receptor agonists and SGLT-2 inhibitors, reduce cardiovascular events including stroke beyond their blood sugar effect. Whether you are on the optimal diabetes regimen for cardiovascular protection is a worthwhile conversation with your prescriber.

7. PCSK9 inhibitors and other lipid lowering options

For patients who need more LDL reduction than statins can provide, PCSK9 inhibitors and ezetimibe are options shown to reduce stroke risk further.

How to take these medications correctly

The medication category that matters most is the one you take consistently. A statin taken twice a week is essentially not working. A blood pressure medication that you take when you remember is providing a small fraction of the protection it could.

• Take your medication at the same time every day. Pair it with an existing habit, like brushing teeth or making coffee.
• Refill before you run out. Set reminders. Use automatic refills. Use medication synchronization to align all refills to one day per month.
• Use a pill organizer if you take more than three medications.
• Do not stop a medication on your own because of side effects. Call your pharmacist or prescriber first.
• Tell every clinician you see every medication you take, including OTC products and supplements.

Recognizing a stroke

The standard warning signs are summarized in the acronym FAST. Face drooping. Arm weakness. Speech difficulty. Time to call 911. Other signs include sudden numbness, sudden vision changes, sudden severe headache without a known cause, and sudden trouble walking or balance.

If you suspect a stroke, do not drive yourself or the affected person to the emergency room. Call 911. Stroke treatment is time sensitive. The faster help arrives, the more brain tissue can be saved.

Where pharmacy fits

Most of stroke prevention is medication compliance over years. That is the slow, patient, repetitive work that pharmacies do every month. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You take a blood thinner and are considering an OTC pain reliever, supplement, or herbal product.
• You have missed multiple doses of a heart or BP medication.
• You have noticed bleeding or bruising on an anticoagulant.
• You have had a TIA or a stroke previously and want to confirm your prevention regimen is complete.
• You have stopped a heart medication on your own for any reason.
• You are unsure whether your blood pressure or cholesterol is at target.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.