Published: February 10, 2026
Larry B. Goldstein, M.D., professor and chair of the Department of Neurology at UK HealthCare, delivered a compelling presentation on stroke prevention that underscores the critical role of primary care providers in reducing stroke incidence.
Stroke is the fourth leading cause of death in the United States, with about 795,000 new and recurrent strokes occurring annually. The disease carries an enormous burden — both human and financial — with direct health care costs reaching $24 billion in 2021-2022 and indirect costs adding another $25 billion.
Kentucky faces particularly high stroke rates, ranking 14th nationally with a mortality rate of 42.9 per 100,000 population. Counties in Appalachia show even higher rates, exceeding 60 per 100,000 in many areas. These statistics highlight the urgent need for effective primary prevention strategies.
Approximately 80% of strokes are first-time events, making primary care providers the frontline defense.
“Roughly 90% of the population-attributable risk for stroke involves modifiable factors that clinicians can address with their patients,” Dr. Goldstein said.
Research demonstrates that following five healthy lifestyle factors — not smoking, maintaining a healthy diet, engaging in physical activity, avoiding obesity and restricting alcohol consumption — can reduce stroke risk by 81% in both women and men. The effect shows a clear dose-response relationship, with each additional healthy behavior conferring additional benefit.
Dr. Goldstein emphasized that even patients with high genetic risk for stroke can dramatically reduce their risk through lifestyle modifications. The Mediterranean diet with added nuts shows the strongest evidence for stroke prevention, supported by randomized controlled trial data showing approximately a 50% risk reduction compared with controls.
Physical activity recommendations are straightforward: Something is better than nothing. Studies show cardiovascular disease and stroke risk reduction improves with activity levels from one minute up to at least 150 minutes per week. A 30-minute walk during lunch breaks can meet basic recommendations.
Kentucky has one of the highest hypertension rates in the country at 55%. Dr. Goldstein stressed that high blood pressure is the single most important treatable risk factor for stroke aside from lifestyle modifications.
Proper blood pressure measurement matters. Readings should be taken with patients calm, seated with feet on the floor, arm at heart level, averaging three measurements — not rushed readings taken immediately upon arrival.
Lifestyle modifications significantly impact blood pressure: Weight reduction yields 5 to 20 milligrams of mercury (mmHg) reduction per 10 kilograms lost; sodium restriction to under 2,400 milligrams daily provides 2 to 8 mmHg reduction, and the DASH diet can lower blood pressure by 8 to 14 mmHg.
When medication is needed, the choice matters for stroke prevention. Beta-blockers show the least benefit for stroke risk reduction among antihypertensive classes and demonstrate the highest blood pressure variability between measurements. Lowering blood pressure by 10/5 mmHg results in a 33% reduction in stroke risk.
While Kentucky’s diabetes prevalence reaches 13%, tight glycemic control alone does not reduce stroke risk. However, several interventions do make a difference.
GLP-1 receptor agonists significantly reduce stroke risk in patients with diabetes. Tight blood pressure control in diabetic patients provides a 31% reduction in stroke risk compared with less-stringent control. Statins reduce stroke risk by approximately 22% in high-risk patients, including those with diabetes.
The relationship between high cholesterol and stroke is complex. Unlike coronary heart disease, which shows a clear relationship with high cholesterol levels, stroke risk remains relatively flat across cholesterol levels in the general population. This occurs because lower cholesterol associates with higher hemorrhagic stroke risk while higher cholesterol associates with higher ischemic stroke risk.
Statins remain the only lipid-lowering therapy proven to reduce stroke risk as monotherapy, providing approximately 22% risk reduction. Importantly, lowering cholesterol with statins does not increase hemorrhagic stroke risk — a common misconception. Randomized controlled trials show no increased hemorrhagic stroke risk even when cholesterol drops to 20 to 30 milligrams per deciliter.
Lifestyle counseling: Five healthy lifestyle factors (no smoking, healthy diet, physical activity, healthy weight, moderate alcohol) reduce stroke risk by 81%. This represents the most powerful intervention available — more effective than any single medication.
Blood pressure measurement: Take accurate readings with patients calm, seated, feet flat, arm at heart level, averaging three measurements. Kentucky’s 55% hypertension prevalence means most patients need this attention.
Antihypertensive selection: Avoid beta-blockers for stroke prevention — they show the least benefit and highest blood pressure variability among antihypertensive classes. A 10/5 mmHg reduction provides 33% stroke risk reduction.
Diabetes management: Focus on GLP-1 receptor agonists, tight blood pressure control (31% risk reduction), and statins rather than aggressive glycemic targets alone for stroke prevention.
Statin counseling: Address patient concerns about side effects by discussing risk-benefit ratio. Most reported side effects represent nocebo effect. Consider dose reduction or switching statin types. Statins do not increase hemorrhagic stroke risk.
Mediterranean diet: Recommend Mediterranean diet with nuts as the evidence-based dietary pattern, showing 50% stroke risk reduction in randomized trials.
Sodium restriction: Target under 2,400 milligrams daily (1 teaspoon of salt). Average U.S. consumption is 3,400 milligrams daily. Teach patients to read nutrition labels.
Sleep and smoking: Screen for sleep disorders (40% of Kentuckians have inadequate sleep) and address tobacco use (18% smoking rate, plus vaping and hookah). Environmental tobacco smoke carries the same stroke risk as primary smoking.