Your guide to preventing strokes

Stroke is a major threat for everyone. Fortunately, the treatment of strokes has improved greatly and neurologists are making more progress every year. But the treatment, as always, is prevention.

Prevent strokes? It seems too good to be true, but it is not. In fact, the incidence of stroke, at least in more medically advanced countries in the world, has declined by 70 percent since 1950. Which goes to prove that prevention is possible – but you have to work at it to make it a reality.

Different Strokes

Any preventive program must encompass the two types of stroke – ischemic and hemorrhagic (see figure). Accounting for 80 percent of the total, ischemic strokes occur when a blood clot blocks the flow of blood, depriving an area of the brain of oxygen. Most often, the clot originates in the heart, the aorta, or one of the carotid arteries. The clot breaks off and travels to the brain, where it lodges in a small artery and does its damage (embolic stroke). In the other type of ischemic stroke, the blood clot develops in a diseased artery in the brain itself (thrombotic stroke).

In contrast, hemorrhagic strokes are caused by bleeding, not clots. The problem originates with damage to the wall of an artery in the brain; if the artery bursts, blood flows into the brain tissue (intracerebral hemorrhage) or into the fluid that surrounds the brain and spinal cord (subarachnoid hemorrhage).

If you’ve had a stroke, you can cut your odds of having another one with medical treatment as well as changes in your diet or other healthy habits. If you’ve never had a stroke, you can reduce your risk of ever having one.

Healthy Living

Preventing stroke is largely a matter of healthy living and having regular checkups to detect conditions that can lead to stroke, such as hypertension, heart disease, high cholesterol and diabetes. You should have your blood pressure checked every two years if it is normal and at least yearly if it is higher. All adults, aged 20 and older, should have their cholesterol checked every five years using a fasting lipid profile. All healthy people, 45 and older, should be tested for diabetes. People under 45 with a family history of the disease should talk to their doctors about having their blood glucose levels tested. Here are some of things you can do to lower your risk of stroke:

• Maintain a normal blood pressure.

• Maintain a normal cholesterol level.

• Maintain a normal weight.

• Don’t smoke.

• Reduce animal fats in your diet, including butter and other dairy fat.

• Exercise regularly.

RISK FACTORS

You can’t control some risk factors, such as age. But you can reduce or eliminate other risk factors through lifestyle changes or medical treatment.

Risk factors you cannot control:

• Age. People over 55 are at higher risk of stroke than are younger people.

• Race. Some races, such as people of African descent, have a higher risk of stroke.

• Family medical history. Your risk of stroke is higher if someone in your immediate family has had a stroke.

• Heart disease. Your risk of stroke is higher if you’ve had a heart attack or if you have certain other conditions, such as atrial fibrillations.

• Diabetes. Your risk of stroke is higher if you have diabetes.

Risk factors you can control:

• Hypertension

• High cholesterol

• Smoking

• Obesity

• Physical inactivity

• Heavy alcohol consumption

• A diet high in salt and saturated fats

• Use of combination estrogen/progestin hormone therapy

BLOOD PRESSURE

Much of the progress against stroke has been the result of diagnosis and treatment of hypertension. How low should your blood pressure be? To prevent strokes, heart attacks, and kidney disease, the lower the better. That’s true of both your systolic and diastolic blood pressures. Readings below 140/90 have been considered acceptable, but doctors are now saying that pressures below 120/80 are normal.

Cholesterol

Cholesterol damages arteries. Stroke is an arterial disease. Cholesterol contributes to strokes. You can reduce your overall stroke risk by bringing your cholesterol down. As with blood pressure, there is no "normal" or "safe" number; the better your numbers, the lower your risk. Aim for an LDL below 130 (100, which is optimal, is the goal for people with heart disease, diabetes, hypertension, and other risk factors) and an HDL above 40 (the higher the better).

Smoking

Smoking doubles the risk of stroke. That’s the bad news. The good news is that quitting helps, and the risk reduction starts almost immediately. Within just five years of quitting, former smokers face the same likelihood of stroke as nonsmokers. If you use tobacco in any form, quit now. And even if you don’t smoke, be sure to minimize your exposure to second-hand smoke which may also increase your stroke risk.

If there are Four Horsemen of the Apocalypse in stroke, diabetes belongs high in the saddle with smoking, high blood pressure and high cholesterol. Although the figures vary from study to study, diabetics are about two times more likely to suffer strokes than nondiabetics.

What to do? First, reduce your risk of diabetes with diet, exercise and weight control. Second, keep your blood sugar under control. While there is no direct proof that tight control will reduce your risk of stroke, it will surely go a long way towards preventing other vascular complications. Third, be sure your blood pressure is optimal. Diabetics need even more protection against stroke than nondiabetics, so they should aim for lower levels – 130/80 or less. ACE inhibitors are particularly desirable hypotensives for diabetics and the Heart Outcomes Prevention Evaluation (HOPE) trial showed that a member of this drug class, ramipril (Ramace, Tritace), could lower diabetics’ risk of stroke by 33 percent, even in the absence of hypertension.

Exercise

It’s true: You can walk away from a stroke – or at least reduce your risk with regular exercise. Studies from Honolulu to Oslo prove the point. The Harvard Alumni Study of 11,130 men found that activity equivalent to walking 10-20 miles a week can reduce risk by 24 percent, while 20-30 miles a week can cut risk by a whopping 54 percent. Invest at least 30 minutes of walking nearly every day to get this benefit.

Alcohol

The US Physicians’ Health Study found that men who consume light to moderate amounts of alcohol are about 20 percent less likely to have strokes than men who don’t drink. Other studies agree, but add that heavy drinking increases the risk of stroke. So, drink responsibly and set your limit at one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor as one drink.

Obesity

Excess body fat increases the risk of stroke. Abdominal obesity is the most harmful, particularly for men; a high waist-hip ratio boosts the risk of stroke by a factor of 2.3. Although there is no proof that slimming down will reverse that risk, it certainly can’t hurt.

Psychosocial Factors

The mind-body connection should apply to the brain as much as any organ. Depression, anger, and long-term life stresses are linked to an increased likelihood of stroke, while an optimistic outlook is associated with a reduced risk. A happy mind will help preserve a healthy brain as well as a sound body.

The take-home message is this: As far as stroke is concerned, it’s never too early for prevention nor is it ever too late.