Updated April 29, 2026

According to the American Heart Association, of the 795,000 Americans who will have a first stroke this year, 23% will suffer a second stroke. That may sound alarming, but there are ways to work with your doctor to create a tailored care plan that helps lower your risk of a second stroke. Victor Urrutia, M.D., director of The Johns Hopkins Hospital Comprehensive Stroke Center and the Sheikh Khalifa Stroke Institute, offers tips on avoiding a second stroke.

How does the approach differ in preventing the first vs. second stroke?

Before you have a stroke, the goal is to reduce risk factors that may cause a stroke, such as high blood pressure, diabetes, unhealthy weight, smoking, lack of exercise, and heavy drinking. A family history of stroke means you need to pay extra attention to these risk factors.

After you have a stroke, the focus shifts to finding the cause and targeting the contributing factors more aggressively, while still reducing the basic risk factors. This could mean adding medications or increasing doses, as well as rethinking what healthy numbers look like for you as far as blood pressure, cholesterol, sodium intake and other key health indicators.

Your care plan may include strategies to:

• Reduce the risk of blood clots with blood-thinning medications. The medications may vary depending on the possible sources of blood clots.
• Control blood pressure: aiming to maintain it below 130/80 mm Hg.
• Lower cholesterol: aiming to lower LDL (low-density lipoprotein) cholesterol below 70 mg/dL or 50 mg/dL in some cases.
• Control blood sugar: If you have diabetes or insulin resistance, aim for A1c below 7%.

Tips to Prevent a Second Stoke

While every person’s plan is unique and guided by their care team, there are several well‑established habits and strategies that often play a major role in preventing a second stroke.

1. Stop Smoking

The list of illnesses caused or worsened by smoking tobacco is a long one. In fact, smoking almost doubles your risk for an ischemic stroke. Cutting out tobacco eases dangerous stress on the blood vessels in your brain—as well as in your heart and elsewhere.

2. Take Your Medicine

If your doctor prescribed medicine to help you control your cholesterol, blood pressure, diabetes or other underlying conditions, don’t skip doses. Even if you start feeling better, it is important to:

• Take every pill you are prescribed on the set schedule
• Not stop medications until approved by your doctor

Not taking your medicine is an important risk factor for repeat stroke. According to one study in patients with coronary artery disease, those who took 75% or less of their medications as prescribed had a four times higher risk of stroke than patients who took their medications as directed.

Prescription medications cannot cure chronic problems, but they can lower the risk of bad consequences such as stroke, secondary stroke and heart attack.

3. Improve Your Diet

Research shows that diet can affect stroke risk, including reducing the risk of second stroke. The most recommended diet for secondary stroke prevention and overall heart and vascular health is the Mediterranean diet. It focuses on:

• Vegetables, fruits, legumes, nuts
• Whole grains
• Olive oil as the main fat
• Fish and poultry
• Very little red meat, processed foods and sweets

Diet plays a major role in many risk factors associated with strokes, including blood pressure, blood sugar and cholesterol. Your doctor may suggest specific dietary changes to address these, such as lowering sodium intake or cutting out saturated fats. DASH diet is an option for those who need to manage high blood pressure. It is not only low in sodium, but very high in nutrition.

4. Get Moving

Regular exercise is one of the most powerful tools for preventing a second stroke because it strengthens the entire cardiovascular system in ways that medication alone cannot match. Moving your body helps:

• Improve blood flow
• Lower blood pressure
• Support healthier cholesterol levels
• Make it easier for your heart to pump efficiently

These are all key factors in reducing second stroke risk. Even simple, consistent movement like walking, light cycling or gentle strength training can make a meaningful difference. Aim for at least 150 minutes a week of moderate exercise, this amounts to 30 minutes, five days a week.

5. Manage Stress and Prioritize Sleep

After a stroke, the brain and cardiovascular system are in a vulnerable state. Chronic stress and poor sleep amplify this vulnerability by affecting blood pressure, inflammation and overall health.

At the same time, having a stroke is a stressor in itself. It can lead to loss of function or independence, anxiety, depression, as well as financial and relationship strain. Many people who had stroke also experience sleep problems such as insomnia and circadian rhythm disruption. Sometimes, these issues stem from undiagnosed obstructive sleep apnea.

While it may seem impossible to regain calm and emotional balance after a stroke, give mindfulness a try to help lower stress and improve sleep. And talk to your doctor about mood and sleep, especially if you only get 6 hours or less of uninterrupted sleep.

When to Consider Surgery

Most people do not need surgery to prevent another stroke. However, if stroke was caused by a blocked or extremely narrow blood vessel, this cause can be addressed with surgery in some cases.

Surgeries such as endarterectomy and stenting can be done on the carotid arteries to reduce risk of recurrent stroke.

Although strokes happen in the brain, sometimes the source of the problem is elsewhere in the body. For example, in people with atrial fibrillation, blood clots can form in the heart and travel to the brain. There are various procedures to fix structural problems in the heart and help reduce the risk of blood clots forming.

Overall, surgery on the heart and blood vessels has many risks. It is recommended only to select people for whom the benefit of reducing future stroke risk outweighs the surgery risks.

Medically reviewed by Victor Urrutia, M.D.