Progress in Stroke Prevention
Who Is at Risk for a Stroke?
A ]]>stroke]]> occurs when an artery in the brain becomes blocked or a blood vessel carrying blood to the brain bursts. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.
Many of the risk factors for stroke can be lowered or treated. Others, such as increasing age, family history of stroke, African American race, or prior stroke cannot be.
Developments in Prevention
High Blood Pressure
The most common and most preventable risk factor for stroke is ]]>high blood pressure]]>. The National Stroke Association recommends all adults have their blood pressure checked every year. High blood pressure is defined as having a systolic pressure greater than 140 mmHG and diastolic pressure greater than 90 mmHg. If you have a certain condition, like diabetes, your doctor may have stricter blood pressure goals for you.
Lowering cholesterol levels with diet, exercise, and medicine may help reduce the build-up of fatty arterial plaque that can trigger a stroke. The American Heart Association (AHA) recommends adults have a fasting cholesterol check at least once every five years. A desirable total cholesterol level is less than 200 mg/dl.. If you have cardiovascular disease or diabetes, your doctor will have you follow stricter cholesterol guidelines.
If you have ]]>atrial fibrillation]]> (an irregular heart rhythm) and using a blood thinner such as ]]>warfarin]]> may be able to lower your risk for stroke. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.
If you have diabetes, keeping your blood pressure low (eg, 130/85 mmHg) can reduce your risk of stroke. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors can be helpful for this purpose. Control of blood sugar is important, as well, in decreasing stroke risk.
]]>Smokers]]> have twice the risk of suffering a stroke as nonsmokers. However, if you ]]>stop smoking]]>, your risk of stroke will fall—within about five years—to the same level as someone who never smoked. There are many smoking cessation aids available today, including online support groups, nicotine patches, sprays, gum, or certain antidepressant drugs.
]]>Aspirin]]> makes blood platelets less sticky and, therefore, less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a ]]>transient ischemic attack]]> (TIA) may benefit from taking an anti-platelet agent. Medicines like ]]>clopidogrel]]> (Plavix), or the combination of aspirin plus ]]>dipyridamole]]> (Aggrenox) are usually reserved for patients at high risk for stroke because they may have adverse effects, such as bleeding.
Carotid Artery Surgery
If you have fatty arterial deposits in their neck, which can lead to stroke, you may benefit from ]]>carotid artery surgery]]>. If you have severe arterial blockage and a history of previous stroke or TIA, this surgery may significantly reduce your risk of a second stroke.
]]>Exercising regularly]]> can reduce your risk of stroke. Researchers found that people who participate regularly in sports had a lower incidence of having a stroke. Work with your doctor to create an exercise routine that is safe for you.
Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke, discuss your options with your doctor. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes, the time to diagnosis and treatment is extremely important. If you think you are having a stroke, call 911 right away.
American Stroke Association
National Stroke Association
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
About stroke: impact of stroke. American Stroke Association website. Available at: http://220.127.116.11/presenter . Accessed September 22, 2003.
About stroke: what are the risk factors of stroke? American Stroke Association website. Available at: http://18.104.22.168/presenter . Accessed September 22, 2003.
Chalmer J, Todd A, Chapman N, et al. International society of hypertension (ISH): statement of blood pressure lowering and stroke prevention. J Hypertension. 2003;21:651-663.
Chatfield J. American Heart Association scientific statement on the primary prevention of ischemic stroke. American Family Physician. 2001;64:513-514.
Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: co-sponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity and Metabolism Council; and the Quality of Care and Outcomes research Interdisciplinary Working Group. Circulation. 2006;113:e873-923.
High blood pressure. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated September 2009. Accessed April 26, 2010.
Llinas FH, Aldrich E, Wityk R. Update on stroke prevention and treatment. Advanced Studies in Medicine . 2003;3:93-101.
Preventing stroke with evidence-based care. Patient Care . 2002; June:48-57.
Risk factors. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=PREGUIDE#1. Accessed April 26, 2010.
Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: Scientific review. JAMA. 2002;288:1388-1395.
Wood D. Screening for lipid profile. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated September 2009. Accessed April 26, 2010.
9/19/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med . 2006;355(6):549-559.
2/24/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Grau AJ, Barth C, Geletneky B, et al. Association between recent sports activity, sports activity in young adulthood, and stroke. Stroke. 2009;40:426-431.
Last reviewed April 2010 by ]]>Brian Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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