Stroke is the fourth leading cause of death in Singapore, after cancer, ischaemic heart disease, and pneumonia. It is the fourth most common cause of hospitalizations. Stroke is the second most common cause of death worldwide. Risk factors for stroke include high blood pressure, smoking, diabetes mellitus, and elevated cholesterol. Additional risk factors include obesity, carotid stenosis, homocysteinemia (elevated homocysteine level), lack of fruits and vegetables consumption, and a sedentary life style. Non-modifiable risk factors include age over 55 years, male gender, black and Hispanic ethnicity, and a maternal or paternal family history of stroke. Ischemic strokes account for 85% to 90% of all strokes in Western societies, with the remainder coming from intracranial hemorrhages. Most hemorrhagic strokes are are caused by high blood pressure.

Screening for risk factors can be easily done during visits to a GP clinic. Potentially modifiable risk factors need to be recognized early. The following are parameters, which need to be screened:

1. Blood pressure. Diastolic blood pressure values consistently greater than 90 mm Hg and/or systolic blood pressure values consistently greater than 140 mm Hg indicate hypertension.
2. Smoking and nicotine addiction.
3. Occult diabetes and insulin resistance. Look for elevations of fasting glucose, glycolated hemoglobin and triglyceride.
4. Elevation of low density lipoprotein (LDL).
5. Non-fasting homocysteine level. Homocysteine values above the normal range of 5 to 12 µmol/L with comorbid disease indicates the need for vitamin B complex supplementation.
6. Obesity. Body mass index of greater than 27 and waist-hip ration of greater than 1.0 for men, and 0.8 for women.
7. Carotid artery stenosis. Endarterectomy is the treatment of choice for symptomatic high-grade stenosis. As for asymptomatic stenosis, there are still a lot of controversies. The current practice is to leave asymptomatic high-grade lesion (more than 70% occlusion) alone. However, a decision to intervene surgically appears acceptable in patients with few comorbid conditions and if endarterectomy is performed by a surgeon having a less than 3% morbidity and mortality rate.

Preventive measures.

1. Nutrition

1.1 Avoid trans fatty acid

Foods which need to be avoided include foods which contain trans fatty acid, in particular hydrogenated fats. Trans fatty acids are found in numerous foods - commercially packaged goods such as cookies and crackers, commercially fried food such as French Fries from some fast food chains, other packaged snacks such as microwaved popcorn as well as in vegetable shortening and some margarine. Indeed, any packaged goods that contains "partially-hydrogenated vegetable oils" or "shortening" most likely contain trans fats.