The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: stroke and transient ischaemic attack

Map of Medicine: cardiovascular disease risk management

Map of Medicine: smoking cessation

There are nine risk factors for cerebrovascular disease.

They are:

• high blood pressure (hypertension)
• smoking 
• poor diet 
• high blood cholesterol
• lack of exercise
• being overweight or obese
• diabetes 
• excessive alcohol consumption
• stress 

Many of the risk factors for cerebrovascular disease are linked, which means that if you have one it is likely you will also have others.

For example, people who drink excessive amounts of alcohol often have poor diets and are more likely to smoke. Also, someone who is overweight or obese is more likely to have high blood pressure, diabetes and high cholesterol.

Addressing one risk factor, such as giving up smoking, will bring important health benefits. However, to significantly reduce the risk posed by cerebrovascular disease you need to look at your lifestyle as a whole. In particular, you need to consider:

• your weight
• your diet
• how active you are and the amount of regular exercise you do
• whether you need to stop smoking
• how much alcohol you drink
• your stress levels 

As well as reducing your risk of developing cerebrovascular disease, making changes to your lifestyle will also lower your risk of having other serious health conditions, such as coronary heart disease, heart attack and cancer.

High blood pressure

High blood pressure is one of the most significant risk factors for cerebrovascular disease. This is because the increase in blood pressure damages the walls of the brain’s blood vessels, increasing the risk of a blood clot forming or an artery rupturing (splitting). Both of these can trigger a stroke.

If you have high blood pressure, you are four times more likely to have a stroke than someone with healthy blood pressure.

Not taking enough regular exercise increases your chances of developing high blood pressure and high cholesterol (see below for advice about how much exercise you should be doing each week).

You can also prevent high blood pressure by eating healthily, maintaining a healthy weight, not smoking and drinking alcohol in moderation.

Read more about preventing high blood pressure.

Smoking

Smoking is also a major risk factor for cerebrovascular disease because the toxins in tobacco can damage and narrow the blood vessels that supply the brain. Smoking also causes high blood pressure.

It is estimated that a person who smokes 20 cigarettes a day is six times more likely to have a stroke than someone who does not smoke.

Therefore, if you smoke it is strongly recommended that you give up as soon as possible. Your GP will be able to provide you with helpful advice, and they can prescribe medication to help you stop smoking.

The NHS Smokefree service also provides useful information, advice and support. You can speak to an adviser by calling their free helpline on 0800 022 4 332 (Monday to Friday, 9am-8pm and Saturday and Sunday, 11am-4pm).

Diet

A diet that contains a high amount of saturated fat and salt can lead to high blood pressure, high cholesterol and narrowing of the arteries, which are all risk factors for cerebrovascular disease.

A low-fat, high-fibre diet that includes whole grains and at least five portions of fresh fruit and vegetables a day is recommended for a healthy heart.

You should limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day. Too much salt will increase your blood pressure.

Also, avoid eating foods that are high in saturated fat as these foods will increase your cholesterol level. Foods that contain high levels of saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter
• ghee – a type of butter that is often used in Indian cooking
• lard
• cream
• hard cheese
• cakes and biscuits
• foods that contain coconut or palm oil

Foods high in unsaturated fat can help decrease your cholesterol level. These foods include:

• oily fish
• avocados
• nuts and seeds
• sunflower oil
• rapeseed
• olive oil

Read more about healthy eating.

High blood cholesterol

High blood cholesterol can cause your arteries to narrow, increasing your risk of developing a blood clot.

Not exercising regularly puts you at risk of getting high blood pressure and high cholesterol. Being physically inactive also increases your chances of becoming overweight (see below).

Exercise

To maintain a good level of health, the Department of Health recommends that you do at least:

• 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week, and
• muscle-strengthening activities on two or more days a week that work all major muscle groups (the legs, hips, back, abdomen, chest, shoulders and arms)

Alternatively, you could do:

• 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity, such as running or a game of singles tennis every week, and
• muscle-strengthening activities on two or more days a week that work all major muscle groups (the legs, hips, back, abdomen, chest, shoulders and arms)

Another alternative would be to do:

• a equivalent mix of moderate- and vigorous-intensity aerobic activity every week, for example two 30-minute runs plus 30 minutes of fast walking, and
• muscle-strengthening activities on two or more days a week that work all major muscle groups (the legs, hips, back, abdomen, chest, shoulders and arms)

Read more about the physical activity guidelines for adults.

Weight

Being overweight or obese increases your risk of developing a number of serious health conditions, such as diabetes and high blood pressure.

To lose weight, you need to combine regular exercise with a calorie-controlled diet. After you have reached your ideal weight, you should aim to maintain it by eating healthily and exercising regularly.

You can use the healthy weight calculator to calculate your body mass index (BMI) and get tips about how to lose weight. You can also read more about losing weight.

Diabetes

The high blood sugar levels associated with diabetes can damage the body’s organs and arteries.

If you have type 1 diabetes, you will need regular insulin treatment to keep your blood sugar levels normal. You will also need to look after your health very carefully and, if necessary, make changes to your lifestyle.

If you have type 2 diabetes, it may be possible to control your symptoms by making some simple lifestyle changes, such as exercising regularly and eating healthily. However, you may eventually need medication (tablets or injections) to keep your blood glucose normal.

Read more about living with type 1 diabetes and living with type 2 diabetes. 

Alcohol

Drinking excessive amounts of alcohol can increase your cholesterol and blood pressure levels.

If you drink, you should not exceed the recommended daily alcohol limits. These are:

• 3-4 units a day for men
• 2-3 units a day for women

One pint of ordinary strength beer, lager or cider contains two units of alcohol, and a small glass of wine (125ml) or a single pub measure (25ml) of spirits contains one unit.

You should visit your GP if you are finding it difficult to moderate your drinking. Treatments such as counselling and medication are available to help you reduce your alcohol intake.

Read more about alcohol units and alcohol misuse.

Stress

Reducing the amount of stress in your life may help you control your blood pressure more effectively, as well as keeping your blood sugar levels under control. Both of these will help reduce your risk of getting cerebrovascular disease.

Regular exercise has been shown to reduce stress levels, as have relaxation techniques such as deep breathing and yoga.

Read more about managing stress.

Cerebrovascular diseases are conditions that develop as a result of problems with the blood vessels that supply the brain.

Cerebrovascular disease is also a type of cardiovascular disease that affects the brain’s blood vessels.

Types of cerebrovascular disease

There are a number of different types of cerebrovascular disease. The four most common types are:

• stroke – a serious medical condition where the blood supply to the brain is interrupted 
• transient ischaemic attack (TIA) – a temporary fall in the brain’s blood supply, resulting in a lack of oxygen to the brain
• subarachnoid haemorrhage – an uncommon cause of stroke where blood leaks out of the brain’s blood vessels
• vascular dementia – problems with the blood circulation, leading to parts of the brain not receiving enough blood and oxygen

These are discussed in more detail below.

Stroke

To function properly, the brain needs oxygen and nutrients that are provided by the blood. However, if the blood supply is restricted or stopped, brain cells will begin to die. This can lead to brain damage and possibly death.

A stroke occurs when the brain’s blood supply is blocked or interrupted – for example, by a blood clot, where the blood thickens and becomes solid. This is the most common cause of stroke.

The main symptoms of a stroke can be remembered using the acronym FAST, which stands for Face-Arms-Speech-Time. Each symptom is explained below.

• Face – the person’s face may have fallen on one side, they may be unable to smile, or their mouth or eye may have drooped
• Arms – they may be unable to raise both arms and keep them there due to weakness or numbness
• Speech – they may have slurred speech
• Time – it is time to dial 999 immediately if you see any of these signs or symptoms

A stroke is a medical emergency. Prompt treatment is essential as the sooner treatment is received, the less damage is likely to occur.

Read more about stroke.

Transient ischaemic attack (TIA)

A TIA or “mini-stroke” is caused by temporary disruption in the blood supply to part of the brain. This results in a lack of oxygen to the brain.

This can cause symptoms that are similar to a stroke, although they tend to last for a short time (less than 24 hours).

A TIA should be taken seriously, as it’s an early warning sign of further TIAs or a stroke. 

If you or someone you know has had a TIA, you should contact your GP, local hospital or out-of-hours service immediately to arrange for a specialist assessment.

Read more about TIAs.

Subarachnoid haemorrhage

A subarachnoid haemorrhage is a less common cause of stroke. It occurs when blood leaks from blood vessels onto the surface of the brain.

The bleeding occurs in the arteries that run underneath a membrane in the brain known as the arachnoid, which is located just below the surface of the skull.

A subarachnoid haemorrhage is a medical emergency that requires immediate medical treatment to prevent serious complications, brain damage and death.

Three quarters of all subarachnoid haemorrhages are the result of an aneurysm rupturing (bursting). An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall.

Other causes of a subarachnoid haemorrhage include:

• severe head injury 
• arteriovenous malformations – a rare type of birth defect that affects normal blood vessel formation

Read more about subarachnoid haemorrhage.

Vascular dementia

Vascular dementia is a common form of dementia that affects more than 111,000 people in the UK.

The term “dementia” describes a loss of mental ability associated with gradual death of brain cells.

It is caused by reduced blood flow to the brain as a result of a problem with the blood vessels that supply it. Parts of the brain become damaged and eventually die from a lack of oxygen and nutrients.

Read more about vascular dementia.

Children

Cerebrovascular diseases are much less common in children than they are in adults. However, stroke can sometimes affect children.

The Stroke Association estimate that each week, childhood stroke affects around five out of every 100,000 children in the UK.

Abnormalities in the brain’s blood vessels, resulting in bleeding in the brain, are the leading cause of childhood stroke. The classic warning signs of a stroke are the same in adults and children (see above).

Children may also experience additional symptoms, including:

• a high temperature (fever) of 38ºC (100.4ºF) or above
• fits (seizures)
• nausea and vomiting
• vision loss

Dial 999 immediately to request an ambulance if you think your child has had a stroke.