Strokes aren’t just grandma’s problem anymore. Alarming numbers of young women (even in their 20s!) are now suffering from strokes, according to a new study published in Neurology, the medical journal of the American Academy of Neurology.

Researchers looked at instances of first-ever strokes and found that people under 55 years of age make up about 19 percent of all stroke patients in 2005—up almost 50% from 1993. Meanwhile, the number of strokes among 20- to 44-year-old Caucasians (who are generally at less risk than African Americans) has nearly doubled.

“There is a disturbing trend, an epidemic of diabetes and obesity in young adults in this country,” says study author Brett Kissela, M.D., a neurology professor at the University of Cincinnati College of Medicine. “The longer you have these risk factors, the greater your chances for having a stroke.” What’s more, as many young women assume strokes only occur in the elderly, they aren’t addressing their risk factors. “They are less likely to go to the doctor, because they assume they’re in good health,” says Kissela, noting that women can go from feeling fine one second to suffering a stroke the next.

It’s no wonder that strokes rank as the fourth leading killer—and the most common cause of adult disability—in the United States.

And while you can’t change your family history of stroke–which may make you more susceptible, yourself–you can eliminate just about every other risk factor out there:

6 Ways to Reduce Your Risk of Stroke

Lower Your Blood Pressure “High blood pressure is the number-one risk factor for stroke, and many young women do not realize if they have it,” says Kissela. High blood pressure causes the heart to pump harder to move blood through the body, which can weaken blood vessels and damage organs (like your brain). While the ideal blood pressure is different for every person, a generally healthy range is less than 120 over 80, and everyone should have their pressure checked at least every two years.

Keep Your Cholesterol in Check Your cholesterol levels can say a lot about your health. While LDL or “bad” cholesterol has been shown to increase stroke risk, HDL or “good” cholesterol can actually decrease your risk. Oats, beans, legumes, fish, nuts, red wine, green tea, tomatoes, grapefruits, and even cocoa can help keep your cholesterol in balance. The National Stroke Association recommends that all adults age 20 and older have their cholesterol checked at least once every five years. Shoot for a cholesterol level of less than 200 mg/dL.

Feed Your Noggin What you eat influences your risk big time, Kissela says. While a typical Western-style diet ups stroke risk by 58 percent, consuming more whole grains, fruits, vegetables, and fish—the same foods that guard against so many other diseases—can lower your risk of stroke by 30 percent, according to the Nurses’ Health Study. When it comes to produce, look for folate (found in dark, leafy greens), potassium (in bananas and pumpkins), and lycopene (in tomatoes and watermelon). Another recent study from the American Academy of Neurology found that people who consume the greatest amounts of lycopene are 55 percent less likely to have a stroke than people who consume the lowest amounts.

Get Your Sweat On If you’ve been looking for some workout motivation, here it is: A regular exercise habit lowers blood pressure and bad cholesterol levels, and reduces your risk of obesity and diabetes. Basically, it slashes risk factors left and right—no matter when you jump on the fitness bandwagon. Increasing your exercise time by 3.5 hours per week can reduce your stroke risk by almost 40 percent, regardless of age, according to the American Medical Association.

Pop the Right Pill Taking estrogen, such as that contained in the combination birth control pill, can increase a woman’s risk of having a stroke. A 2012 study published in the New England Journal of Medicine found that risk of stroke is up to 1.7 times higher in women who take low doses of estrogen—and that taking a higher dose can increase that risk up to 2.3 times higher. If you have risk factors for stroke, talk to your doctor about progestin-only birth control options such as the “mini-pill” (a progestin-based oral contraceptive that’s free of estrogen), implant, shot, or IUD, which have not been found to significantly change the risk of having a stroke.

Avoid the D Word Diabetes quadruples your risk of suffering a stroke, since diabetes often comes with high blood pressure, cholesterol, and obesity—and treating diabetes can delay the onset of complications that increase the risk of stroke, according to the National Stroke Association. But 7 million Americans—many of whom are active and fit—don’t know they have it. If you’re over 45 or under 45 and overweight, have a family history of diabetes, high blood pressure, polycystic ovary syndrome, or have given birth to a baby weighing more than nine pounds, the National Institutes of Health recommends that you talk to your doctor about getting tested. While diabetes can affect young, fit women—including some surprising celebrities—there are ways to reduce your risk of diabetes and stroke.

More from WH:
Know Your Stroke Risk
Prevent Heart Disease
At-Home Medical Tests

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