Resource post for May: Stroke awareness revisited

May is American Stroke Month

It is the month when we should examine what we know about stroke, its symptoms, the risk factors, how it can be managed, and how it can be prevented. At the forefront of this month-long awareness campaign are the American Heart Association (AHA) and the American Stroke Association (ASA).

Stroke: facts and figures

According to the AHA:

Stroke is the third highest cause of mortality after heart disease and cancer.

• 143,579 died of stroke in the US in 2005. Females accounted for 60.6% of these.
• Stroke is the leading cause of long-term disability in the US.
• About 6,500,000 stroke survivors are alive today; 2,600,000 are males and 3,900,000 are females.
• …about 795,000 people suffer a new or recurrent stroke each year. About 600,000 of these are first attacks and 180,000 are recurrent attacks.
• From 1995 to 2005 the death rate from stroke declined 29.7 percent, and the actual number of stroke deaths declined 13.5 percent.
• The 2005 death rates per 100,000 population for stroke were 44.7 for white males and 70.5 for black males, and 44.0 for white females and 60.7 for black females. 
• On average, a stroke occurs every 40 seconds in the US.
• Ischemic stroke (clots) accounts for 87% of all stroke cases, 10% are intracerebral hemorrhage, and 3% are subarachnoid hemorrhage.

Stroke: symptoms

Many people do not recognize the signs when they are having a stroke, according to research studies. This causes delay in treatment of a condition that is time-sensitive. The warning signs of stroke according to the AHA and ASA are (check also the video clip):

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Stroke: reducing your risks

The best strategy of preventing stroke is reducing the risks that can be reduced. But first we need to know the risk factors.

The risks that you cannot change are

• Age. The likelihood of having a stroke increases with age. Previous studies suggest that stroke risk doubles starting age at the age of 55. Finnish researchers report that stroke risk increases dramatically in men starting at age 44.
• Genetics. Family history and ethnicity predisposes a person to stroke. African American have higher predisposition to stroke than any other ethnic group in the US. The genetic disease sickle cell anemia which is very common among African-American and Hispanic children is a major risk factor for stroke.
• Gender. Men seem to be more susceptible to stroke than women but women suffer higher mortality rates from stroke.

But here are the risks that you can do something about:

• High blood pressure. Hypertension is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
• Cigarette smoking. Although cigarette smoking is usually associated with lung cancer, it is actually an important risk factor for stroke. And the damage is not only restricted to the smoker. Second hand or passive smoking has also been linked to cardiovascular damage that can lead to stroke.
• Obesity/excess weight. Obesity is another major controllable factor for stroke.
• High cholesterol levels. People with high blood cholesterol have an increased risk for stroke. High levels of LDL “bad” cholesterol and low levels of HDL “good” cholesterol are risk factors.
• Birth control pills. The use of oral contraceptives by women has been linked to cardiovascular damage. When this factor is combined with smoking, the risk for having a stroke increases drastically.
• Diabetes. Diabetes is an independent risk factor for stroke. However, it is also associated with other risk factors such high blood pressure, high blood cholesterol levels and obesity.
• Poor nutrition. Diet is a major but easily controllable risk factor for stroke and other related cardiovascular disease. “Diets rich in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity.” On the other hand, a daily diet containing five or more servings of fruits and vegetables – the so-called DASH (Dietary Approaches to Stop Hypertension) diet may reduce the risk of stroke.
• Physical inactivity. A sedentary lifestyle is not only a risk factor for stroke, it is a risk factor for other related problems, e.g. hypertension, high blood cholesterol, diabetes, and heart disease. The AHA and ASA recommend a minimum of least 30 minutes of physical activity each day. The more, the better.
• Other underlying conditions such as arterial diseases (e.g. carotid artery disease, peripheral artery disease) and heart disorders (e.g. coronary heart disease, atrial fibrillation, cardiomyopathy, congenital heart defects) also increase the risks of having a stroke.
• Geographic location. States in the southeastern United States have higher incidences of stroke than the rest of the country, earning the title the “stroke belt.” However, this is a risk factor that is neither well-understood nor well-documented.
• Socioeconomic factors. Studies suggest that stroke incidence is higher among low-income people than among more affluent people.
• Alcohol consumption. Although alcohol is said to have some cardiovascular benefits, excessive alcohol consumption has been associated to health problems including stroke and hypertension. Women also especially more susceptible to the adverse effects of alcohol than men.
• Illegal drugs. Illegal drugs such as cocaine, amphetamines and heroin, have been associated with an increased risk of stroke.

Stroke: treatment and management

Some of the treatment options for ischemic stroke are:

• Thrombolytic (clot-busting) drugs. The most commonly used drug in the emergency treatment of stroke is an intravenous injection of tissue plasminogen activator (tPA). tPA, however, is a time-sensitive medication that needs to be administered within 3 hours of symptom onset.
• Anti-coagulants or blood thinners. These drugs are prescribed after a stroke to reduce the chances of new blood clots forming.
• Anti-platelet drugs. These drugs are also used to prevent blood clots and can be used in stroke prevention strategy.
• Surgery and stents. Several surgical interventions can be done to prevent and manage stroke. A blocked or narrowed carotid artery can be opened by surgery to remove plaques. Stents can be inserted into the blood vessels to keep them open.
• Experimental treatments. New stroke treatments are currently being tested, including stem cell therapy and experimental neuroprotective medications.

Stroke resources:

• Heart and Stroke Statistics 2009
• Stroke Connection Magazine
• Caregiver brochure
• Power to End Stroke

 Photo credit: stock xchng

Video: www.youtube.com/watch?v=zjPPm_M_nPg