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Strokes: Prevention

A stroke is an injury to the brain. It happens when the brain's blood source is stopped. Blood carries oxygen that all cells in the body need to live. The brain has one of the highest demands for oxygen. Cells in the brain die if they are without oxygen for more than a few minutes. This can cause lasting harm to the brain.

The risk of stroke can be lowered by keeping the heart and blood vessels healthy. This can be done through diet and exercise. It is also important to avoid smoking, limit alcohol, and manage other health problems.

Natural Therapies

Likely Effective

These supplements are likely to lower the risk of stroke:

α-Linolenic acid is a type of omega-3 fatty acids found in plants.^A1
Folic acid (folate) is a B vitamin that the body uses to make DNA and other genetic material. It also helps cells to divide.^H1-H4
Lutein is an antioxidant that is thought to prevent or slow cell damage.^K1

These dietary items may lower the risk of stroke:

Dietary fiber is the portion of a plant that cannot be fully broken down by digestion.^E1
Fish intake (especially lean fish)^F1
Flavanoids are substances found in plants and plant-based foods that are shown to have antioxidant effects.^{G1, G2}
Green tea (1 to 3 cups per day)^{I1, I2}
Lycopene is a red pigment found in tomatoes that is also an antioxidant.^L1

May Be Effective

These supplements may lower the risk of stroke:

Antioxidants are substances thought to prevent or slow cell damage.^C1-C5
B vitamins help the body make energy.^B1
Polyunsaturated fatty acids can help lower bad cholesterol in the blood which can lower the risk of heart disease and stroke.^O1
Vitamin E acts as an antioxidant to help protect cells from damage.^Q1-Q4

Tai Chi and qigong use gentle, dance-like moves. They may lower the risk factors for stroke.^P1

Unlikely to Be Effective

These supplements are unlikely to lower the risk of stroke:

Multivitamin and Mineral Supplements ^M1
Omega-3 fatty acids are special fats that help prevent and manage heart disease.^N1-N4

Acupuncture is the insertion of fine needles at body sites to elicit a response, such as pain relief. It is unlikely to improve lifestyle risk factors for stroke.^B1

Not Enough Data to Assess

Homocysteine-lowering interventions ^J1

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or pills you are taking. Some may get in the way of your treatment or other health problems you may have.

References►

A. α-Linolenic acid

A1. Pan A, Chen M, et al. α-Linolenic acid and risk of cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Dec;96(6):1262-1273.

B. Acupuncture

B1. Sibbritt D, Peng W, Lauche R, Ferguson C, Frawley J, Adams J. Efficacy of acupuncture for lifestyle risk factors for stroke: A systematic review. PLoS One. 2018;13(10):e0206288.

C. Antioxidants

C1. Cook NR, Albert CM, Gaziano JM, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Internal Med. 2007;167(15):1610-1618.

C2. Chen GC, Lu DB, et al. Vitamin C intake, circulating vitamin C and risk of stroke: a meta-analysis of prospective studies. J Am Heart Assoc. 2013 Nov 27;2(6):e000329.

C3. Ye Y, Li J, Yuan Z. Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PLoS One. 2013;8(2):e56803.

C4. Choe H, Hwang JY, Yun JA, et al. Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis. Nutr Res Pract. 2016;10(5):516-523.

C5. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol. 2018;71(22):2570-2584.

D. B Vitamins

D1. Zhang C, Chi FL, et al. Effect of B-vitamin supplementation on stroke: a meta-analysis of randomized controlled trials. PLoS One. 2013 Nov 25;8(11):e81577.

D2. Dong H, Pi F, et al. Efficacy of Supplementation with B Vitamins for Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials. PLoS One. 2015 Sep 10;10(9):e0137533.

D3. Spence JD, Yi Q, et al. B vitamins in stroke prevention: time to reconsider. Lancet Neurol. 2017 Sep;16(9):750-760.

E. Dietary Fiber

E1. Chen GC, Lv DB, Pang Z, Dong JY, Liu QF. Dietary fiber intake and stroke risk: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013 Jan;67(1):96-100.

F. Fish Intake

F1. Qin ZZ, Xu JY, et al. Effects of fatty and lean fish intake on stroke risk: a meta-analysis of prospective cohort studies. Lipids Health Dis. 2018 Nov 23;17(1):264.

G. Flavonoids

G1. Wang ZM, Zhao D, et al. Flavonol intake and stroke risk: a meta-analysis of cohort studies. Nutrition. 2014 May;30(5):518-523.

G2. Tang Z, Li M, et al. Dietary flavonoid intake and the risk of stroke: a dose-response meta-analysis of prospective cohort studies. BMJ Open. 2016 Jun 8;6(6):e008680.

H. Folic Acid (folate)

H1. Huo Y, Li J, Qin X, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015;313(13):1325-1335.

H2. Zeng R, Xu CH, Xu YN, Wang YL, Wang M. The effect of folate fortification on folic acid-based homocysteine-lowering intervention and stroke risk: a meta-analysis. Public Health Nutr. 2015;18(8):1514-1521.

H3. Tian T, Yang KQ, et al. Folic Acid Supplementation for Stroke Prevention in Patients With Cardiovascular Disease. Am J Med Sci. 2017 Oct;354(4):379-387.

H4. Wang Y, Jin Y, et al. The effect of folic acid in patients with cardiovascular disease: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Sep;98(37):e17095.

I. Green Tea

I1. Zhang C, Qin YY, et al. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. Eur J Epidemiol. 2015 Feb;30(2):103-113.

I2. Pang J, Zhang Z, et al. Green tea consumption and risk of cardiovascular and ischemic related diseases: A meta-analysis. Int J Cardiol. 2016 Jan 1;202:967-974.

J. Homocysteine-Lowering Interventions

J1. Martí-Carvajal AJ, Solà I, et al. Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev. 2017 Aug 17;8:CD006612.

K. Lutein

K1. Leermakers ET, Darweesh SK, et al. The effects of lutein on cardiometabolic health across the life course: a systematic review and meta-analysis. Am J Clin Nutr. 2016 Feb;103(2):481-494.

L. Lycopene

L1. Cheng HM, Koutsidis G, et al. Lycopene and tomato and risk of cardiovascular diseases: A systematic review and meta-analysis of epidemiological evidence. Crit Rev Food Sci Nutr. 2019;59(1):141-158.

M. Multivitamins and Minerals

M1. Kim J, Choi J, et al. Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2018 Jul;11(7):e004224.

N. Omega-3 Fatty Acids

N1. Rizos EC, Ntzani EE, et al. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012 Sep 12;308(10):1024-1033.

N2. Aung T, Halsey J, et al. Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals. JAMA Cardiol. 2018 Mar 1;3(3):225-234.

N3. Hooper L, Al-Khudairy L, et al. Omega-6 fats for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018 Nov 29;11:CD011094.

N4. Abdelhamid AS, Brown TJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018 Nov 30;11:CD003177.

O. Polyunsaturated Fatty Acids

O1. Abdelhamid AS, Martin N, et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018 Nov 27;11:CD012345.

P. Tai Chi and Qigong

P1. Lauche R, Peng W, et al. Efficacy of Tai Chi and qigong for the prevention of stroke and stroke risk factors: A systematic review with meta-analysis. Medicine (Baltimore). 2017 Nov;96(45):e8517.

Q. Vitamin E

Q1. Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):154-160.

Q2. de Gaetano G; Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet. 2001;357(9250):89-95.

Q3. Schürks M, Glynn RJ, Rist PM, Tzourio C, Kurth T. Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials. BMJ. 2010;341:c5702.

Q4. Cheng P, Wang L, et al. Vitamin E intake and risk of stroke: a meta-analysis. Br J Nutr. 2018 Nov;120(10):1181-1188.

Last reviewed February 2020 by EBSCO NAT Review Board Eric Hurwitz, DC Last Updated: 5/26/2020

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