A stroke occurs when blood supply to a part of the brain is interrupted. Without oxygen and nutrients, brain cells die within minutes, damaging areas that control movement, speech—and even involuntary activities, such as breathing.
Stroke is the most preventable cause of death and disability in the US. Yet more than 750,000 Americans suffer strokes each year...about 160,000 of these people die...and 200,000 live with lasting disability. What are we doing wrong?
You can't change some risk factors, such as family history. If you have a parent or sibling who has suffered a stroke, you are at greatest risk yourself. Your age also plays a role. While strokes can occur even in young children, overall risk steadily increases as we grow older. That's why more than two-thirds of strokes occur in people over age 65.
Beyond these factors, whether we suffer a stroke is largely up to us.
STROKE PREVENTION
What most affects stroke risk...
- Smoking. Everyone knows that smoking increases heart disease risk, but did you know that smoking is actually more likely to cause a stroke than a heart attack? Not only does smoking promote the development of fatty deposits that narrow arteries (atherosclerosis), but the nicotine in tobacco causes blood vessels in the brain to constrict.
Result: Smokers have up to four times the stroke risk of nonsmokers.
What you can do: Quit smoking. If you've tried but can't kick the habit, consider using nicotine-replacement patches or gum.
- Blood pressure. High blood pressure gradually damages blood vessels and substantially increases the risk for both ischemic and hemorhagic strokes. The risk is greater because high blood pressure rarely causes symptoms, so the problem goes unrecognized in an estimated 30% of sufferers.
What you can do: lf your blood pressure exceeds 120/80, take steps to reduce it. Weight loss and exercise may be enough, but you also may need medication, such as diuretics or beta blockers.
- Cholesterol. For stroke prevention, maintain the same cholesterol levels that are recommended to reduce heart disease risk-total cholesterol under 200...LDL "bad" cholesterol under 100...HDL "good" cholesterol above 40.
What you can do: Weight loss and exercise help control cholesterol levels. If these strategies are insufficient, cholesterol-lowering medication may be needed.
- Diabetes. Maintaining tight control of blood sugar (glucose) will minimize small blood vessel damage that can lead to stroke.
What you can do: Work with your doctor to create a treatment plan that keeps your hemoglobin A1C (blood sugar over time) level at less than seven.
- Diet. Stroke risk, like heart disease risk, can be related to diet.
What you can do: Maintain a diet that's low in saturated fats (no more than 30% of total fats per day) and high in fruits and vegetables (five to nine one-half cup servings per day).
Research shows that people who are deficient in potassium are 1.5 to 2.5 times more likely to suffer a stroke. Aim for the government's recommended potassium intake of 4,700 mg daily. Although bananas are a popular source of potassium (one medium banana contains 457 mg of potassium), cantaloupe can be an even richer source (one cup of cantaloupe balls contains about 547 mg).
If you determine that sodium raises your blood pressure, limit your daily sodium intake to 2.4 g (slightly more than one teaspoon of salt).
- Exercise. Physical activity reduces risk for heart disease, diabetes and hypertension—and may offer stroke protection as well.
What you can do: \Work with your doctor to create an exercise program based on your history of heart disease, smoking, etc.
- Daily aspirin. Aspirin reduces the tendency of platelets to clump, which helps prevent blood clots that can lead to ischemic stroke.
What you can do: If you're over age 55 and have diabetes, high cholesterol or other stroke risk factors, ask your doctor about starting daily low-dose (81-mg) aspirin therapy.
In patients who have never had a stroke or heart attack, and who do not have hypertension, diabetes or elevated cholesterol, the risk of hemorrhage may outweigh the potential benefits of aspirin.
- Alcohol. Moderate drinking has been shown to benefit the heart, but it does not curb stroke risk.
What you can do: Men should limit alcohol intake to two drinks per day...one drink per day for women. A drink is defined as 1.5 ounces of hard liquor, 4 ounces of wine or 12 ounces of beer. Risk for hemorrhagic stroke jumps substantially if you exceed this amount.
OTHER RISK FACTORS
Some medical conditions significantly raise your stroke risk…
- Atrial fibrillation. About 2.2 million Americans are affected by atrial fibrillation (AF), a heart rhythm disturbance that increases stroke risk five- to sixfold.
AF can cause dizziness, shortness of breath and constriction or other uncomfortable sensations in the chest. Or it may cause no symptoms and be found during a routine examination or when you have an electrocardiogram.
What you can do: Taking a blood-thinning drug, such as warfarin (Coumadin), can virtually eliminate AF's added stroke risk by preventing the formation of blood clots. Aspirin may be nearly as effective.
- Transient ischemic attack (TIA). If you have had one or more of these brief stroke like episodes, your risk for a full-blown stroke increases dramatically. A TIA can cause dizziness, numbness or paralysis on one side of the body, difficulty speaking, double vision or other stroke symptoms that disappear after minutes or hours.
What you can do: After a TIA, ask your doctor about taking antiplatelet medication, such as aspirin, clopidogrel (Plavix) or dipyridamole and aspirin (Aggrenox).
- Carotid stenosis. When fatty deposits accumulate in the carotid artery, which carries blood up through the neck, they can impede brain circulation enough to cause a stroke. Up to half of all ischemic strokes are associated with carotid stenosis.
What you can do: If you have had a stroke or TIA, get an ultrasound of your carotid artery. If blockage is 70% or more, ask your doctor about surgery.
