Hi everyone, After listening to all of your feedback and all of our meetings over the last year or so we have broadened our understanding of what Stroke-Proof is about and come to see that we need to go much further than just prevention. Maggie and I are keen to write Stroke-Proof the book as a guide for Stroke survivors to help navigate the situation they find themselves in post stroke, but we need your help to get it right. We will be pulling in other professionals to help us write this and we'll need you all to tell us if what we are writing is helpful, but firstly we need to make sure we cover the correct areas. After reflecting on all that we have learned from you the below are our proposed chapters. Please let me know if these look right to you or if you think we should add or remove any sections or change the order. Part 1: The Beginning of Recovery 1. A Message of Hope - Recovery is possible - The brain can adapt and rewire - Progress often continues for months and years - Setting realistic expectations - Finding purpose after stroke 2. You're Not Alone - Stroke survivor stories - Different ages and stroke types - Lessons learned from recovery - Common emotional experiences 3. Finding Support - Stroke Association - Different Strokes - Stroke Proof - Online communities - Family and carers - When and where to seek help Part 2: Understanding What Happened 4. What Is a Stroke? - Ischaemic vs haemorrhagic stroke - TIA - What happens inside the brain - Areas of the brain and how they impact symptoms in stroke - Why symptoms vary between individuals - Dementia - the other major brain health condition  5. Tests and Investigations - CT brain - CT angiography - CT perfusion - MRI - Carotid ultrasound - Echocardiogram - Heart rhythm monitoring - Blood tests - What doctors are looking for 6. Why Did My Stroke Happen? - Causes of stroke - Blocked arteries - Atrial fibrillation - Small vessel disease - Rare causes - When no cause is found

After a stroke, you may suddenly find yourself taking several tablets every day. But often we aren't clear about what each tablet does and why. Many of the medicines prescribed after a stroke have one very important job — reducing your risk of another stroke. Here are some of the common ones: 🩸 CLOPIDOGREL / ASPIRIN — stopping platelets sticking together If you’ve had an ischaemic stroke — a stroke caused by a blood clot blocking an artery — you will often be prescribed an antiplatelet medicine. The most common long-term medication is clopidogrel. Aspirin is another antiplatelet and is commonly used immediately after an ischaemic stroke or TIA. Some people take aspirin instead of clopidogrel, and in certain situations aspirin and clopidogrel may be used together for a short period. These medicines make platelets less likely to stick together and form another clot. ❤️ APIXABAN, RIVAROXABAN, DABIGATRAN or EDOXABAN — preventing clots from the heart These belong to a group called DOACs — Direct Oral Anticoagulants. They are particularly important if your stroke was associated with atrial fibrillation (AF). AF causes the heart to beat irregularly. Blood can pool inside the heart, allowing a clot to form. That clot can then travel to the brain and cause a stroke. DOACs reduce the ability of the blood to form these dangerous clots. They include: • Apixaban • Rivaroxaban • Dabigatran • Edoxaban Some people need warfarin instead — for example, in certain types of heart-valve disease or with a mechanical heart valve. Importantly, anticoagulants and antiplatelets are not the same thing, and most people do not need both long-term unless there is another reason. 🫀 ATORVASTATIN and other statins — reducing cholesterol and stabilising arteries Statins are not simply “cholesterol tablets”. After an ischaemic stroke or TIA, a high-intensity statin such as atorvastatin is commonly prescribed to reduce the risk of another event. Lowering LDL cholesterol reduces the chance of cholesterol-rich plaques (artery deposits) growing or causing further problems in your arteries.

Hi everyone. I'm currently reviewing the support that we provide to our stroke survivors in the NHS, through this community and beyond. I have lots of ideas for things that might help, but rather than starting with my ideas I'd like to start by understanding what the biggest issues that need improving are. Please could I ask all of the stroke survivors in this community to think about the following and post your thoughts below, if you are happy to? 1. What did you need after your stroke that wasn't provided for you? 2. How long after your stroke was it when you were ready to really engage with information about your stroke? 3. Did you feel that you understood what to do to prevent a future stroke? 4. What do you wish you were offered/given/told about your stroke but wasn't? 5. If you could go back in time to when you were leaving hospital what would you tell yourself then? 6. If you were designing a service to help stroke survivors what would it look like? 7. What would have made you engage with stroke prevention before your stroke? Thank you for your consideration.

Diabetes is not just a blood sugar problem. It is a blood vessel problem. And that means it is a brain problem too. People with diabetes have around a 1.5–2 times higher risk of stroke compared with people without diabetes. Some studies show the risk is even higher depending on age, duration of diabetes, blood pressure, cholesterol, smoking and other risk factors. But the problem often starts before diabetes is officially diagnosed. First there is insulin resistance (your body needing to produce more and more insulin tio achieve the same goal), then there is pre-diabetes (blood sugar starts creeping up as the ability to produice enough insulin is overwhelmed), then diabetes (blood sugar crosses a certain threshold). Over time this insulin resistance causes other problems: ❌ Higher blood pressure ❌ More abdominal weight gain ❌ Higher triglycerides (bad fats) ❌ Fatty liver ❌ Inflammation ❌ Damage to blood vessels ❌ Higher risk of full type 2 diabetes And for Stroke Proof, this matters because healthy brain arteries need healthy metabolic health. High glucose, high insulin, high blood pressure and abnormal cholesterol do not politely stay in separate boxes. They overlap and amplify each other, each contributing to blood vessel damage and narrowing and helping the other factors to do so too. For example, high blood sugar damages the glycocalyx (think of this as a teflon lining for the arteries), meanwhile high blood pressure makes little cracks in the artery walls. Both of these make it easier for LDL cholesterol to get through the artery's inner lining and get into the artery wall. The more LDL cholesterl there is floating around the more gets in. That is also why diabetes is also one of the recognised modifiable risk factors for dementia as those little blockages int he brain affect memory as well as causing full blown strokes. So what can you do? Not everything is in your control, and nobody should be shamed for developing diabetes. Genetics, medication, deprivation, sleep, stress, ethnicity, hormones and environment all matter.

8ú modern sense. It's not about: ❌ Calorie counting ❌ Cutting out entire food groups ❌ Drinking expensive green powders ❌ Surviving on lettuce Instead, it's a pattern of eating traditionally seen in countries such as Greece, Spain, and parts of Italy. It typically includes: ✅ Lots of vegetables ✅ Fruit ✅ Beans and legumes ✅ Nuts and seeds ✅ Whole grains ✅ Extra virgin olive oil as the main fat source ✅ Fish and seafood regularly ✅ Moderate dairy (often yoghurt) ✅ Limited ultra-processed foods ✅ Limited sugary drinks and sweets ✅ Less red and processed meat ✅ Social eating One of the most important studies ever performed on diet was the PREDIMED trial. Researchers studied over 7,000 people at high cardiovascular risk and put them on either: 🥄 A Mediterranean diet supplemented with extra virgin olive oil 🥜 A Mediterranean diet supplemented with mixed nuts 📋 A control low-fat diet Crucially, the nuts and Olive oil groups received a supply of the nuts or oil every month so we can be confident they ate more of these than their usual. After around 5 years of follow-up, the Mediterranean diet groups experienced roughly a 30% reduction in the combined risk of heart attack, stroke, or cardiovascular death compared with the control group. Stroke reduction was one of the strongest signals seen in the trial at nearly 40% reduction. And this isn't just one study. A major BMJ systematic review and network meta-analysis (essentially a study pulling together data from all the high quality research on the topic that could find to give very reliable results) examining randomised dietary programmes found that Mediterranean dietary programmes reduce death, heart attacks, and cardiovascular events in people at increased cardiovascular risk. Importantly, they also reduce stroke risk. Why might it work? The Mediterranean diet appears to improve many of the key drivers of stroke and cardiovascular disease: 🩸 Blood pressure 🧈 LDL cholesterol 🔥 Inflammation 🍬 Blood sugar control