Risk Reduction 
The risk of stroke can be reduced in a number of ways:
Risk Reduction through lifestyle modification
Click on any underlined words for more information.
Risk Reduction - Medical Management
Risk Reduction through Surgery
Controlling High Blood Pressure
Because there are rarely any outward symptoms of hypertension, it's important to have blood pressure checked regularly. According to the Seventh Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure, everyone should have his or her blood pressure checked at least every two years (more often if there is a history of high blood pressure).
Pre-hypertension is classified as having blood pressure consistently over 120/80. Doctors may choose to treat Stage One hypertension (blood pressure consistently more than 140/90) in one or more of the following ways:
A low-salt diet
Too much salt may contribute to high blood pressure and make it more difficult to control. Doctors may ask people with high blood pressure to stop using table salt and to eat as many fresh foods as possible, since a lot of salt is "hidden" in processed or prepared foods. According to the National Heart, Lung and Blood Institute, if everyone in the United States ate 1 less teaspoon of salt each day, their collective blood pressures would drop enough to decrease the national stroke rate by 11 percent.
Other methods
In addition to a low-salt diet, doctors may choose to lower blood pressure by having patients lose weight, stop smoking and exercise regularly. These lifestyle modifications are often all that is needed to successfully control hypertension. For some patients, lifestyle modification will not adequately lower blood pressure, so their physicians may prescribe high blood pressure medication.
Return to Article Beginning
Controlling Heart Disease
Coronary Heart Disease and High Cholesterol
A doctor may choose to treat high cholesterol (more than 200) or prevent coronary heart disease by reducing cholesterol with one or more of the following methods:
Diet
A diet that's low in fat and cholesterol will likely include fruits and vegetables, lean meats such as chicken and fish, low-fat dairy products, whole grains and a limited number of eggs. Changing cooking habits to include baking and broiling rather than frying will also cut down on fat intake.
Exercise
Active people tend to have lower cholesterol levels, and regular exercise seems to slow down or stop the clogging of blood vessels by fatty plaque deposits. Doctors may recommend a program of regular exercise to lower cholesterol. Aerobic exercise is best for lowering cholesterol because it strengthens the heart and lungs by maintaining an accelerated heart rate for an extended period of time. Walking, swimming and cycling are examples of aerobic exercise. For best results, exercise at an aerobic level at least three times a week for 20 to 30 minutes each time. Brisk walking for 30-45 minutes on most days is also very effective. Having an "exercise buddy" -- someone to exercise with -- can help people stick to an exercise program.
Other Methods
For some patients, lifestyle modification will not adequately lower high cholesterol and prevent coronary heart disease, so their physicians may prescribe cholesterol-reducing medication.
Return to Article Beginning
Controlling Smoking
Once someone stops smoking, stroke risk will drop significantly within two years. Within five years of quitting, the stroke risk may be the same as someone who's never smoked. Doctors can give information about quitting and prescribe medicine to help. It's especially advisable for women over 30 who smoke and also take high-estrogen birth-control pills to quit smoking. This combination of factors makes a woman 22 times more likely to have a stroke than the average person. However, most physicians no longer prescribe high-estrogen birth control pills to smokers.
National Stroke Association is pleased to partner with National Jewish Medical & Research Center to help you give up smoking for good! JustQuit(TM) offers an on-line smoking cessation program with proven results. Click for more information.
Controlling Alcohol Consumption
For most people, moderate drinking doesn't greatly affect their risk of stroke. "Moderate" drinking means limiting intake of alcohol to no more than one drink per day (one drink = 1.5 oz. of hard liquor; OR 4 oz. of wine; OR 12 oz. of beer). For more information on alcohol and lifestyle, click here.
Return to Article Beginning
Controlling Weight
Doctors can recommend a sensible weight loss and exercise program for people who are at increased stroke risk because they are overweight. Together with their doctors, overweight patients should set reasonable weight loss and exercise goals. A common goal is to aim for losing one pound a week and exercising three times a week for 30 minutes at a time. Losing excess weight can also help control other stroke risk factors, such as high blood pressure, high cholesterol, heart disease and diabetes.
Return to Article Beginning
Nutrition and Stroke Risk Reduction
Eating a well balanced diet including protein, carbohydrates, vegetables and fruit is a vital part of stroke risk reduction. Healthy eating habits may help lower blood pressure rates, cholesterol levels and reduce complications from diabetes.
A recent Harvard University study concluded that eating five daily servings of fruits and vegetables might lower your risk for an ischemic (clot-caused) stroke by 30 percent. Citrus fruits and green leafy vegetables such as broccoli or cabbage are particularly beneficial. Their higher concentrations of folic acid, fiber and potassium, may be a key to reducing risk for stroke or heart disease.
Eating and cooking in a low fat manner reduces your waistline and decreases stroke and heart attack risk. Taking a few minutes to think through your food choices and how you cook them can make a difference.
Maintaining adequate nutrition through diet and vitamin supplements can reduce your risk for stroke, heart disease and other serious medical conditions. Speak with your healthcare provider before starting any vitamin regiment. Taking high doses of vitamins is not generally recommended.
Return to Article Beginning
Antihypertensive Medication
When blood pressure can't be controlled through lifestyle modification, a patient's doctor may prescribe an antihypertensive medication. There are more than 50 prescription antihypertensive drugs on the market from which to choose. In many patients, some antihypertensives may cause side effects such as dizziness or nausea. Doctors can work with patients to select the best antihypertensive for their medical profile and lifestyle. Various antihypertensive drugs work differently some decrease the volume of plasma in the blood or slow the rate of blood flow through the body, while others relax the heart by affecting the passage of certain elements in the blood. Factors to consider in the selection of antihypertensive drugs include cost, convenience, side effects and interaction with other drugs.
Compliance is Critical
One of the biggest obstacles doctors encounter in high blood pressure treatment is non-compliance. Medication for high blood pressure will only work if it's taken on a regular basis. It's important for patients to take their blood pressure medication as directed, even on days when they feel fine.
Fifty million Americans have elevated blood pressure or are taking antihypertensive medication, yet nearly 75 percent do not have their blood pressure adequately controlled.
The Systolic Hypertension in the Elderly Program (SHEP) demonstrated that treatment of systolic hypertension yielded a 36 percent decrease in stroke. Even a moderate reduction in diastolic blood pressure reduces stroke risk. Accumulated data from trials indicate that a sustained reduction of 6mm Hg in diastolic blood pressure reduces the risk of stroke by about 40 percent.
Return to Article Beginning
Controlling Heart Disease
Atrial Fibrillation
Atrial fibrillation (AF) is a very important controllable stroke risk factor. Some people with AF will experience heart palpitations -- often described as a "pounding," "racing" or "fluttering" heart beat. In other people, the only symptom of AF may be dizziness, faintness or light-headedness. Others may experience chest pains ranging from mild discomfort to severe pain.
A new simple self-screening technique can be conducted to determine if you may have an irregular pulse, a possible sign of AF. To properly conduct the technique, place the first two fingers of your right hand on your left wrist. Then check your pulse to feel for a regular or irregular heartbeat. A regular heartbeat is characterized by a series of even, continuous pulsations, whereas an irregular heartbeat often feels like an extra or missed heartbeat. To help determine the steadiness of your heartbeat, keep time by tapping your foot. This self-screening technique must be performed properly in order to obtain correct results and should not be considered a substitute for consulting with a physician. If you suspect you may have an irregular pulse, you have difficulty locating your pulse or performing the screening technique, discuss your concerns with your physician.
A thorough heart check-up in your doctor's office includes testing for blocked blood vessels and irregular heart rhythms, including AF. Because AF, like high blood pressure, cholesterol and some other heart diseases, often has no outward symptoms, the only way to confirm the presence of AF is to perform an electrocardiogram (ECG).
During an ECG, sensitive electrodes are placed on the chest. These electrodes pick up the electrical impulses generated by the body that cause the heart to beat. The impulses are sent to a T.V. screen or a piece of paper called an ECG strip. By examining the specific pattern of electrical impulses, a doctor can determine whether a patient has AF. Doctors may choose to treat this form of heart disease by prescribing medication or by an electrical shock to the chest to return the beating back to normal.
Return to Article Beginning
Cholesterol Reducing Medication for Coronary Heart Disease
Two cholesterol-reducing medications in the statin class have been approved by the U.S. Food and Drug Administration for prevention of first stroke or TIA in post heart attack coronary heart disease patients. Your doctor may also prescribe other medications specifically to reduce high cholesterol . Cholesterol-reducing medication will only work if it's taken as directed on a regular basis.
Blood Clot Prevention Medication
Since most strokes are caused by blood clots, it makes sense to try to prevent strokes by preventing blood clots from forming. There are two primary classes of blood clot prevention drugs: anticoagulants and antiplatelet drugs.
Return to Article Beginning
Carotid Endarterectomy
Surgical removal of obstructions to cerebral blood flow has been in place for 40 years. Carotid endarterectomy is the most common vascular surgery in the United States, and the third most common surgery overall. Today, the surgery is proving more successful than ever in preventing stroke, reducing risk by as much as 55 percent. Carotid arteries are the major contributor to the most common type of stroke, thrombotic.
Carotid Endarterectomy Q and A
Q.What is a carotid endarterectomy?
A. A carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits from one of the two main arteries in the neck supplying blood to the brain. Carotid artery problems become more common as people age. The disease process that causes the buildup of fat and other material on the artery walls is called atherosclerosis, popularly known as "hardening of the arteries." The fatty deposit is called plaque; the narrowing of the artery is called stenosis. The degree of stenosis is usually expressed as a percentage of the normal diameter of the opening.
Q. Why is the surgery performed?
A. Carotid endarterectomies are performed to prevent stroke. Two large clinical trials supported by the National Institute of Neurological Disorders and Stroke (NINDS) have identified specific individuals for whom the surgery is highly beneficial when performed by surgeons and in institutions that can match the standards set in those studies. The surgery has been found highly beneficial for persons who have already had a stroke or experienced the warning signs of a stroke and have a severe stenosis of 70 percent to 99 percent. In this group, surgery reduces the estimated 2-year risk of stroke by more than 80 percent, from greater than 1 in 4 to less than 1 in 10. In a second trial, the procedure has also been found highly beneficial for persons who are symptom-free but have a severe stenosis of 60 percent to 99 percent. In this group, the surgery reduces the estimated 5-year risk of stroke by more than one-half, from about 1 in 10 to less than 1 in 20.
Q. How important is a blockage as a cause of stroke?
A. A blockage of a blood vessel is the most common cause of 750,000 new strokes in the United States each year.
Return to Article Beginning
Q. How many carotid endarterectomies are performed each year?
A. In 1992, the most recent year for which statistics are available from the National Hospital Discharge Survey, there were about 91,000 carotid endarterectomies performed in the United States. The procedure has a 40-year history. It was first described in the mid-1950s. Its use increased as a stroke prevention measure in the 1960s and 1970s and peaked in the mid-1980s when more than 100,000 operations were performed each year.
Q. How much does a carotid endarterectomy cost?
A. The total average cost for the diagnostic tests, surgical procedure, hospitalization and follow-up care is about $15,000.
Q. How risky is the surgery?
A. The degree of risk varies with the hospital, the surgeon and the underlying disease conditions.
Q. How is carotid artery disease diagnosed?
A. In most cases, the disease can be detected during a normal checkup with a physician. Some of the tests a physician can use or order include:
History and physical exam: A doctor will ask about stroke symptoms such as numbness or muscle weakness, speech or vision difficulties or lightheadedness. Using a stethoscope, a doctor may hear a rushing sound, called a bruit (pronounced "brew-ee"), in the carotid artery. Unfortunately, some blockages with a low risk can make a significant sound but dangerous levels of disease some times fail to make a sound at all.
Doppler ultrasound imaging: This is a painless, noninvasive test in which sound waves above the range of human hearing are sent into the neck. Echoes bounce off the moving blood and the tissue in the artery and can be formed into an image. Ultra-sound is fast, risk-free, relatively inexpensive and painless. In carefully calibrated ultrasound laboratories, ultrasound studies can be up to 95 percent accurate and offer visualization of the anatomy, evaluation of the blood flow rate and turbulence and characterization of the plaque when performed by a skilled technician.
Oculoplethysmography (OPG): This procedure measures the pulsation of the arteries in the back of the eye. It is used as an indirect check for blockages in the carotid arteries.
Computed tomography (CT): This test produces a series of cross-sectional X-rays of the head and brain. It can't detect carotid artery disease but may be ordered by a doctor to investigate other possible causes of symptoms. The test is also called a CAT scan, for computer assisted tomography.
Arteriography and Digital Subtraction Angiography (DSA): Arteriography is an X-ray of the carotid artery taken when a special dye is injected into another artery in the leg or arm. A burning sensation may be felt when the dye is injected. DSA is also an X-ray study of the carotid artery. It is similar to arteriography except that less dye is used. These invasive procedures are more expensive and carry their own small risk of causing a stroke.
Magnetic Resonance Angiography (MRA): This is a new imaging technique that is more accurate than ultrasound, yet avoids the risks associated with X-rays and dye injection. An MRA is a type of magnetic resonance image that uses special software to create an image of the arteries in the brain. A magnetic resonance image uses harmless but powerful magnetic fields to create a highly detailed image of the body's tissues.
Frequently these procedures are carried out in a stepwise fashion: from a doctor's evaluation of symptoms to ultrasound, with arteriography, DSA or MRA reserved for difficult diagnoses.
Return to Article Beginning
Arterial Bypass Surgery
Extracranial-intracranial bypass surgery was developed as a way to re-establish blood flow to the brain when an internal carotid artery is blocked. Surgeons make a hole in the cranium and connect an artery serving the face or head to an artery serving the brain. This operation has failed to show any benefit for stroke prevention.
|
