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10 Health Tips for Women Age 65 and Older

I just found this health related video on YouTube … and thought you might enjoy it!

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This video provides 10 health tips for women age 65 and older. These recommendations are based on expert clinical opinion presented in UpToDate online version 18.3. This video was produced by Dr. Nicholas Cohen, MD. The content of this video is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

Tell us what you think about this video in the comments below, or in the Battling For Health Community Forum!
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Widely used OTC drugs increase stroke risk in healthy people

The latest class of drugs whose safety is being questioned are the so-called nonsteroidal anti-inflammatory drugs (NSAIDs). You may not know it but you probably have taken NSAIDs at least once in your life. NSAIDs are widely used both as over-the-counter (OTC) and prescription drugs. Do the names aspirin, ibuprofen and rofecoxib ring a bell? Well, these are the most well-known NSAIDs.

NSAIDs are supposed to be safe and non-addictive with very few side effects. Until the results of this Danish study was published recently that reported that short-term use of NSAIDs can increase the risk for stroke, especially ischemic stroke, even among those without any history of cardiovascular disease. The study was presented at theEuropean Society of Cardiology (ESC) 2010 Congress last week.

According to study author Dr. Gunnar Gislason:

“First we found an increased risk of MI with NSAIDs. Now we are finding the same thing for stroke. This is very serious, as these drugs are very widely used, with many available over the counter. We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully.”

The NSAIDs analyzed in the study were ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib. Most of these are used as analgesics and anti-inflammatory agents. Diclofenac (86%) was associated with the highest increase in stroke risk, followed by celecoxib whereas ibuprofen was associated with lowest but still significant increase in risk (30%) among the drugs analyzed. The study participants were healthy individuals who did not have underlying cardiovascular problems.

So how do NSAIDs increased cardiovascular risk?

There have been several hypotheses about the mechanism linking NSAIDs with cardiovascular events, including increased thrombotic effect on platelets, the endothelium, and/or atherosclerotic plaques; increasing blood pressure; and effect on the kidneys and salt retention.

The authors believe that the results of their have “massive public-health implications”. However, it is unlike that the use of NSAIDs will decrease any time soon because even health care professionals are reluctant to limit prescription of these drugs.

“The problem is that we don’t have randomized trials, and it is very hard to change the habits of doctors. They have been using these drugs for decades without thinking about cardiovascular side effects.” says Dr. Gislason, whose group was able to convince Danish health authorities to declare diclofenac as a prescription-only drug. However, diclofenac and other NSAIDs are available as TOC drugs in many countries.

Alcohol and heart health: the latest updates

Alcohol. Is it or is it not good for our health? Over the years, there have been hundreds of studies investigating this topic but the results have been contradictory. Below, we look at 3 of the most recent studies and what they have to say.

More evidence of benefit of light/moderate drinking
In a large study of 245,000 Americans, researchers at the Beth Israel Deaconess Medical Center in Boston report that light to moderate alcohol consumption is actually better than complete abstention when it comes to benefits for cardiovascular health. According to the authors:

“These data bolster previous epidemiological studies that have found lower rates of incident cardiovascular disease among moderate drinkers but also provide cautionary evidence that drinking above recommended limits eliminates this risk reduction.”

Binge drinking heightens death risk in those with high blood pressure
Binge drinking? Watch your blood pressure! This is according to Korean researchers at the Yonsei University in Seoul. Heavy drinking brings you closer to the grave. And the main effect of too much alcohol is on the cardiovascular health, especially on the blood pressure. Thus those with hypertension should especially be careful because binge drinking increases their risk of dying 12-fold.

The study participants consisted of 6100 residents of Kangwha County. The authors defined binge drinking as having six or more alcoholic drinks within a short period of time. Based on this classification, 20.4% of the study participants are actually binge drinker. Although the cardiovascular mortality risk increased with heavy drinking, the specific risk for stroke is not increased.

Does drinking alcohol temporarily heighten stroke risk?
Ok, so heavy drinking is bad for the health, that is clear. And light to moderate alcohol consumption can actually do one some good. Or does it? Results from the Stroke Onset Study indicate that even 1 single alcoholic drink can double the risk of ischemic stroke 1 hour after its consumption. The researchers looked at 390 patients who were hospitalized for stroke. The patients were interviewed about their activities and alcohol consumption during the hours before stroke attack as well as their habitual drinking pattern. The interview revealed that 3.6% of interviewees consumed alcohol an hour before stroke symptoms started, 27% imbibed within 24 h, and 64% within the year prior to their stroke. Statistical analysis showed that alcohol, no matter how little, increases the risk for a stroke even within 1 hour of consumption.

Alas, which study results do we believe? In research, the bigger the sample size, the more robust and reliable the data that come out. The third study, with its preliminary data from less than 400 participants is less credible than the first one with almost 250,000.

For me, the safest bet is to stick to light alcohol consumption and avoid heavy binge drinking. And that is what I do.

Parents pass on stroke risk to offsprings

Here is another health problem that might be passed on from parent to offspring – stroke. Those whose parents had suffered a stroke before the age of 65 are three times more likely to suffer from the same disorder, according to the latest findings coming out of the Framingham Heart Study.

Researchers from Boston University, led by Dr Sudha Seshadri looked at 3,443 offsprings of the original Framingham participants. Like their parents, the offsprings were monitored and followed up for health outcomes. The results showed

• The majority of stroke reported were ischemic.
• Parental stroke was associated with increased risk of the same type of stroke in the offsprings.
• Stroke risk in offsprings was not dependent on the gender of the parent who suffered from stroke.

The authors concluded that:

“Documented parental stroke by 65 years of age was associated with a 3-fold increase in risk of offspring stroke. This increased risk persisted after adjustment for conventional stroke risk factors. Thus, verified parental stroke may serve as a clinically useful risk marker of an individual’s propensity to stroke.”

Ischemic stroke occurs when a blood clot blocks a blood vessel that supplies blood to the brain. It is the most common type of stroke. Ischemic stroke can happen in two ways. A thrombotic stroke occurs when a blood clot or thrombus forms in an artery in the brain, say due to atherosclerosis. In an embolic stroke, the blood clot or plaque on a blood vessel dislodges and travels to the narrower arteries of the brain where it cuts off the blood supply.

The researchers believe that doctors should conduct a thorough family history of their patients to assess stroke risk. For those who had stroke family history, the risk is increased three-fold.

“He or he should make it a point to check for and address modifiable risk factors such as a higher blood pressure, smoking, and low levels of physical activity.”

The results indicate that genetic factors play a major role in risk assessment for certain diseases.

Dr Ralph L Sacco (University of Miami, Miller School of Medicine commented on the study:

“Although there are many environmental determinants of stroke such as smoking, physical inactivity, and diet, we also know that various factors are under genetic as well as environmental control, such as hypertension, diabetes, high cholesterol, and obesity.”

Stroke is not the only cardiovascular problem that is strongly linked to family history. Previous analysis of the Framingham data also indicated that parental heart failure increased the risk of heart failure in offsprings by as much as 70%.

Childhood stroke: it’s more common that you think

Stroke is something that we normally do not associate with children, much less infants. Unfortunately, children do suffer from strokes that might go unnoticed or undiagnosed.

Previous estimates of incidence of stroke among American children (0.54 to 1.2 cases per 100,000) were underestimations. A new study reports that the frequency is actually two to four more than previously reported. Researchers at the University of California at San Francisco calculated from re-examination of hospital records and imaging data the actual incidence in the US to be 2.4 cases per 100,000. Another report from UK researchers give estimates that range from .3 per 100,000 to 13.0 per 100,000.

So why the underestimation?

Because health professionals still cannot easily accept the fact that stroke does occur in children.

In fact, everybody can suffer from stroke regardless of age. This ABC report describes a case of a baby who had stroke while still in the uterus. This event affected the boy’s motoric development. A neurologist performed a brain scan when the boy was 19 months old and arrived at a diagnosis: cerebral palsy due to a stroke in utero.

Aside from problems with diagnosis, health professionals also have to deal with the fact that most stroke treatments are only meant for adults.

In another case, a 15-year old presented with stroke symptoms. The hospital staff took the risk and treated with the clot buster drug tissue plasminogen activator (tPA). He recovered. But can tPA be used in younger kids, even infants? Nobody knows.

So what happens to kids who suffer from stroke? They suffer from the following:

• Neuromuscular disorders such as cerebral palsy
• Developmental disorders, including motoric and speech problems.
• Seizures
• Subsequent strokes

Childhood stroke is a neglected health problem even though research indicates that it is among the top ten causes of children mortality. Like in many disorders, the earlier a stroke is a diagnosed in children, the better are their chances to recover fully and live normal lives. The recent study American hopes to increase awareness and vigilance about stroke among children.

Photo credit: stick.xchng

October 29 is World Stroke Day

“Stroke, what can I do?“ is this year’s World Stroke Day theme. Started in Capetown in October 2006, WSD has become a global initiative. This year, World Stroke day falls on October 29.

According to the American Stroke Association, stroke killed 143,579 people in 2005. 60.6% of stroke fatalities were women. Aside from being a leading cause of death, stroke also causes long-term disability.

Some facts about stroke:

• Stroke is preventable but rising globally.
• Aging, unhealthy diets, tobacco use, and physical inactivity, fuel a growing epidemic of high blood pressure, high cholesterol, obesity, diabetes, stroke, heart disease and vascular cognitive impairment.
• Worldwide, stroke accounts for 5.7 million deaths each year and ranks second to ischemic heart disease as a cause of death; it is also a leading cause of serious disability, sparing no age, sex, ethnic origin, or country.
• Four out of five strokes occur in low and middle income countries who can least afford to deal with the consequences of stroke.
• If nothing is done, the predicted number of people who will die from stroke will increase to 6.7 million each year by 2015.
• Six million deaths could be averted over the next 10 years if what is already known is applied.
• Much can be done to prevent and treat stroke and rehabilitate those who suffer the devastating consequences of stroke.

Here’s what you can do in your own small way in observing this day and helping fight stroke:

• Know the signs and symptoms of stroke. The American Stroke Association (ASA) gives tips on how to recognize the warning signs of stroke, namely:
  • o   Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • o   Sudden confusion, trouble speaking or understanding
  • o   Sudden trouble seeing in one or both eyes
  • o   Sudden trouble walking, dizziness, loss of balance or coordination
  • o   Sudden, severe headache with no known cause
• Know your and your loved ones’ risk factors. The Power to End Stroke initiative of the ASA provides an online, easy-to-do personal stroke risk assessment.
• Concentrate on prevention. Stroke can be prevented through lifestyle change strategies. Know what you can change in your lifestyle to lower your risk for stroke and other cardiovascular disorder.
• Spread the news to increase awareness. You can download posters and e-cards which you can send to friends, families and colleagues. Posters and e-cards are available at the World Stroke Day site.

Stress and stroke

Many stroke victims believe that it is stress that triggered their attack. However, there isn’t enough scientific evidence to support this. Until now.

A Swedish study found a strong association between the two “S” – stress and stroke. And not just any stroke but certain types. The researchers looked at 566 ischemic stroke patients and compared them to 593 controls (e.g. non-stroke patients but similar in age, ethnicity, or gender). The patients were then asked to fill out a questionnaire about their stress levels, which on a 6-point scale ranged from never stressed to permanently stressed for a year or more. The researchers found that the study participants who reported prolonged stress are more likely to suffer from large vessel disease, small vessel disease and cryptogenic stroke. These are basically types of stroke that is caused by atherosclerosis or by blood clots which developed locally in the small blood vessels in the brain. However, there was no link found between stress levels and blood clots from the heart

According to study author Katarina Jood of the University of Gothenburg:

“We found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype.”

Strokes are also cerebral infarction or brain attack. There are two kinds of stroke. Ischemic stroke is the most common type and is caused by a blood clot in a blood vessel supplying blood to the brain. The less common hemorrhagic stroke occurs when a blood vessel breaks thus causing bleeding into the brain. In the US, 780,000 people suffer from a stroke which may be a first attack or a recurrent. There are also so-called mini strokes or silent strokes that are seldom detected. Risk factors for stroke are smoking, high blood pressure, high BMI, high cholesterols and sedentary lifestyle.

In the current study, it is not clear why stress in only linked to certain types of stroke but not to others. Jood continues:

“We do not know why stress appears to play a greater role in particular types of stroke, but it is an important finding as it prompts further studies on what role stress plays in the development of stroke.”

Smokeless tobacco is deadly for the heart, too.

The use of smokeless tobacco products is on the rise. This has probably something to do with the widespread implementation of anti-smoking bans in many countries of the world. Thus, the age old practice of using products such as snuff and chew or spit tobacco, used to be thought as “unhip” and “gross” has recently been revived. Of course the very hip goes for e-cigarette, an electronic nicotine-containing smokeless cigarette.

It is a common misconception that it is the smoke that  makes cigarette smoking unhealthy. Without the smoke, chewing tobacco or using snuff are supposedly harmless. However, there is a growing body of evidence that indicates that smokeless tobacco products can be just as deadly. They have already been linked to several types of cancer, including pancreartic and esophageal cancer.

A recent meta-analysis by Swedish researchers shows that the use of chewing tobacco and snuff also significantly increase the risk for suffering and dying from a heart attack or a stroke.

In all in all, the researchers looked at eight studies from Sweden, where the use of snus (wet snuff)  is quite common and three studies from the US. Except for 2 studies, all participants of the other studies never smoked tobacco. Here some of the results of the study:

• It is estimated that in 2000 alone, 0.5% of deaths from heart attack and 1.7% of deaths from stroke in American men were due to the use of smokeless-tobacco.
• Among Swedish men, 5.6% of deaths from heart attack and 5.4% of deaths from stroke were due to smokeless-tobacco use.

According to author Dr Kurt Straif, researcher at International Agency for Research on Cancer

“Given the recent increase in use of smokeless tobacco, it is important to stress that all forms of tobacco are harmful and that the best prevention is not to start using any kind of tobacco, or-for users-to stop using all kinds of tobacco.”

The researchers think it is important that the public should be aware of the health risks of smokeless tobacco products. Several baseball players in the US are known to chew and spit tobacco during games, thus, setting a bad example to audience as well as TV viewers.

In addition, medical professionals tend to overlook smokeless tobacco products when taking medical history, assessing risks, and diagnosing symptoms.

American Heart Association spokesperson Dr Nieca Goldberg comments:

“Cardiologists [and other physicians] need to remember to ask patients not only about cigarettes but also about smokeless tobacco.”

Unfortunately, the meta-analysis did not elaborate on the substances responsible for the cardiovascular problems.  In view of the current controversy (and popularity) of e-cigs, it is of utmost importance whether the health risks in smokeless tobacco are also true for e-cigs.

Stroke patients: the years after

Over the years, the methods in stroke treatment, management and rehabilitation have greatly advanced. However, there is very little data available on the outcomes of stroke victims, years after recovery. This recent study indicates that the prognosis for stroke survivors can be poor as their functional abilities decline with time even they have been declared “fully rehabilitated.” This decline was evident even if the patients did not suffer a subsequent stroke or any other cardiovascular event.

Ischemic stroke is cause by blood clots in the brain and the first line of treatment is the clot-busting agent tissue plasminogen activator (tPA). With tPA use coupled with improved physiotherapeutic techniques, survival and rehabilitation rates have greatly improved and many patients are considered “functionally recovered six months after the stroke.”

What is less known is the fact that stroke victim’s functional ability actually deteriorate with time at a rate of about 9% per year for the first 5 years after recovery. The likelihood of becoming severely disabled increased by 11% per year.

This poor prognosis is due to many predictive factors. The patients most likely to suffer from functional decline and disability are:

• were older at the time of the stroke.

• had diabetes.

• were unmarried.

• had a more severe stroke.

• had a right-sided stroke.

• had urinary incontinence within a week of the stroke.

In addition, the type of health insurance seems to make a difference. Those uninsured and covered by Medicaid (state-run coverage for low-income groups) showed significantly faster functional decline. Those who are privately insured or covered by Medicare (state-run coverage for the elderly) showed lesser decline.

According to researcher Dr. Mandip Dhamoon

“Access to health care is not just important around the time of the stroke but in the years following, when those with poor access do worse in their functioning and ability to be independent. We can speculate that they may be less likely to get ongoing rehabilitation and may be less able to manage their blood pressure and other risk factors.”

Gender and race did not seem to influence outcomes.

The results of the study highlight the need for long-term follow up of stroke victims. It suggests that a 6-month rehabilitation program may not be sufficient to ensure that stroke victims have a good quality of life, years after a stroke attack.

Battling stroke by fighting salt: the Portuguese strategy

Portugal has one of the highest mortality rates due to stroke in Western Europe and this has been attributed to the high salt intake of the population. Many Portuguese traditional food – including the salted fish delicacy bacalhau (salted cod) – contains high amounts of sodium chloride. However, even the normal daily fare such as bread also contains a lot of salt. The result is that the Portuguese population, take in, on the average, twice the amount of the recommended daily salt intake. -the stroke rate there is twice that of coronary disease.

A group of health led by Dr. Luis Martin of the Fernando Pessoa University formed the Portuguese Action Against Salt and Hypertension (PAASH) and conducted studies on Portuguese salt consumption habits and the health consequences. The results show that:

• An adult consumes on average 11.9 g of sodium per day, two times the recommended daily intake.
• Portuguese bread contains an average of 19.2 g of sodium per kg, which is 53% more than what is found in bread in other European countries. This highly contributes (21%) to the daily sodium intake.
• The amount of salt by consumed by the population correlated with blood pressure and aortic stiffness.
• In 2007, only 29% of the Portuguese population was aware of the health risks of excessive salt consumption

The PAASH advocates saw an immediate need for action to increase awareness and reduce salt consumption. They estimated that “a reduction of just 1 g per day of salt intake would save almost 2500 lives per year in Portugal, which has a population of around 10 million.”

Dr. Martin then started a massive awareness campaign in print and web media, as well as on on radio and TV. They persuaded politicians and well-known celebrities, including star football players and children’s cartoon characters, to help spread the word about the health risks of salt.

Dr. Martin explains the success of

“If they want to influence the people, they must act like politicians. And to get the attention of the politicians, we needed the media. Without the media in Portugal, it’s not possible.”

It seems that the campaign is starting to bear fruit.

• A recent survey showed that awareness has increased up to 75% of the population.
• They persuaded the Portuguese Bakery Association to cooperate by coming up with a recipe that provides for lower salt content without losing taste or quality.
• They lobbied with legislators, resulting in the passing of a law by the Portuguese Parliament that requires food labels to show salt content of food products as well as and limits the sodium content in processed foods to a maximum of 14 g/kg.

With these results, the Portuguese has set a good example to the rest of Europe and the world that health awareness campaigns do work.

Photo credit: stock.xchng

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

In the making: stem cell therapy for stroke victims

According to the American Stroke Association, about one American suffers from a stroke every 40 seconds. On average, stroke kills one person every three to four minutes.

In March of this year, researchers at the University of Texas Medical School at Houston enrolled the first patient in a Phase I safety trial to test stem cell therapy in stroke patients. Usually, in Phase I trials, healthy volunteers are enrolled to assess the safety of a drug or a therapy. In this case, the participant is a stroke patient. The 61-year old stroke survivor arrived at the hospital more than 3 hours after the onset of the symptoms, thus making him ineligible to be treated with tissue plasminogen activator (tPA). According to the American Heart Association, tPA is a thrombolytic agent (clot-busting drug). It is approved for use in certain patients having a heart attack or stroke. The drug can dissolve blood clots, which cause most heart attacks and strokes. tPA is the only drug approved by the U.S. Food and Drug Administration for the acute (urgent) treatment of ischemic stroke. However, tPA is a time-sensitive treatment that can only be effective when administered within 3 hours of symptom onset. Stem cell therapy might be a less time-sensitive alternative to tPA.

Here is how the stem cell therapy works:

Stem cells were harvested from the bone marrow in the iliac crest of the patient’s leg. The purified cells were then administered intravenously back to the patient several hours later. Because they were his own stem cells, the problem of rejection is very unlikely to occur.

The Phase I safety trial, funded with a pilot grant from The National Institutes of Health and support from the Notsew Orm Sands Foundation, will enroll nine more patients who have suffered a stroke and can be treated with the stem cell procedure within 24 to 72 hours of initial symptoms.

Research using lab animals has shown that stem cells given after a stroke enhance healing of the damage brain. Stem cells seem to have some kind of “guidance system” to find their way to the area of injury. Stem cells promote healing, not by creating new brain cells, but by helping the repair processes and reducing inflammatory damage. Animal research showed that the effects of the therapy can be observable within a week.

So far, the patient has been making a lot of progress. However, it is too early to tell whether the improvement can be attributed to stem cell therapy or some other factors. The long-term effects of the therapy also needs to be investigated

According to lead researcher Dr. Sean Savitz,

“It’s still very early in this safety study, but this could be an exciting new therapeutic approach for people who have just suffered a stroke.”

 

Photo credit: stock. xchng

Preventing a second stroke: are you doing enough?

Stroke is a preventable illness. But still millions of people suffer from stroke each year. Much more, many cases of strokes are not the first time but the second, maybe even then third. Now, the question is, does having had a first stroke make the patient and his or her healthcare provider more aware of the risks, thus more ready to take preventive measures? Does “forewarned is forarmed” apply here?

Researchers at the Mount Sinai School of Medicine in New York City report that although many services to avert a second stroke are available, not many patients avail of them. In fact, only about 50 to 70% of these facilities are generally used.

According to lead author Dr. Joseph S. Ross

“Alarmingly high numbers of adults did not receive stroke prevention services. Most usage rates for prevention services were between 50 percent and 70 percent. That’s a lot of people not getting recommended care.”

The study participants included 11,862 adults at least18 years old who have had a stroke. 54% of the participants were women. The services offered for secondary prevention are as follows:

• reduction of vascular risk, which includes taking preventive medications such as aspirin, and doing regular exercise
• annual testing for cholesterol testing
• management of high blood pressure;
• management of diabetes
• prevention of infectious disease

The key findings of the study are:

31% of patients received outpatient rehabilitation services;

52% reported influenza vaccination and 53 percent received pneumococcal vaccination;

57% percent exercised regularly;

77% percent used aspirin regularly;

66% percent received counseling to quit smoking;

62% percent with high blood pressure received low-fat diet counseling;

91% percent with high blood pressure reported currently taking hypertensive medication; and

89% percent of those with diabetes reported having annual glycosylated hemoglobin measurements for diabetes management. This measures the amount of sugar attached to the hemoglobin in red blood cells and shows the average blood sugar for several months before and can help regulate diabetic behavior.

There were no disparities in secondary stroke care in relation to gender, ethnicity, age or geographic residence.

The reasons behind the suboptimal use of secondary preventive care among stroke victims are not very clear. However, there is clearly a need for health care providers to focus on improving care for all stroke patients regardless of age, race or gender to uplift the level of care, thereby avert a subsequent stroke.

Photo credit: stock.xchng

Traffic exposure can trigger a heart attack

We are exposed to traffic everyday, whether as a commuter or as a driver. Some of us are even exposed as part of our jobs, e.g. as traffic policemen, bus drivers, tec. This post explores the link between traffic exposure and cardiovascular health.

Previous studies have shown that heart attacks may be triggered by strenuous activities. This recent study by German researchers suggest that exposure to traffic can have some serious consequences on people’s heart health. The researchers looked at time spent on any form of traffic exposure by using some form of transport, be it by car, by public transport, or by bicycle and its triggering effect on heart attacks. However, driving a car was the most common source of traffic exposure among the 1,454 study participants. The results of the study indicate that people exposed to any form traffic exposure have a 3.2 times higher risk of having a heart attack than those without exposure. For those exposed, there is a small but significant increase in the likelihood that a heart attack can occur with 6 hours of exposure. Those who were especially at risk were

• women
• elderly men
• people who are unemployed
• people who have a history of angina pectoris (chest pains)

According to lead author Dr. Annette Peters

“Driving or riding in heavy traffic poses an additional risk of eliciting a heart attack in persons already at elevated risk. In this study, underlying vulnerable coronary artery disease increased the risk of having a heart attack after driving in traffic… one potential factor could be the exhaust and air pollution coming from other cars. But we can’t exclude the synergy between stress and air pollution that could tip the balance.”

This isn’t the first study to find a link between cardiovascular disorder and air pollution. British and Swedish researchers found that diesel exhaust increased the rate of blood clot formation as well as blood platelet activity even in healthy people – leading to increased risk of having heart attack and stroke. The increased cardiac event risk due to traffic pollution is evident even when fine particulate matter concentrations are considered low or safe.

In a previous resource post, I have reviewed the most recent medical evidence that linked air pollution to cardiac events. In one study, it was shown that fine particulate matter can interfere with the heart’s electrical functioning.

In the same way, stress can be a triggering factor towards a cardiac event. In a previous post, I discussed about the effect of stress on driving and vice versa.

We all need some form of transport to get somewhere and many of us are on the move to get to our jobs 5 days a week. What would be interesting to find out is a risk comparison between drivers and public transport commuters, e.g. which form of traffic exposure has the least adverse effect on our cardiovascular health.

Phot credit: stock.xchng

The power to predict a heart attack may be right at your fingertips

Could it be that predicting a cardiac event is as easy as raising a finger? Researchers at the Mayo Clinic have studied and seemed be quite satisfied with a test that is simple and noninvasive but is still “highly predictive” of a major cardiac event, such as a heart attack or stroke, for people who are considered at low or moderate risk.

The EndoPAT I a noninvasive finger sensor test device which measures the health status of endothelial cells that line the walls of the blood vessels and regulate blood flow. When endothelial cells are unhealthy, a condition called endothelial dysfunction occurs and can mark the start of atherosclerosis or hardening of the arteries, which in turn lead to cardiovascular disorders. The finger device measures blood flow which is indicative of endothelial function.

During the testing process

“…researchers at Mayo Clinic and Tufts-New England Medical Center in Boston used the device to test 270 patients between the ages of 42 and 66 and followed their progress from August 1999 to August 2007. These patients already knew that they had low-to-medium risk of experiencing a major heart event, based on their Framingham Risk Score. The score is the commonly used risk predictor and was developed from the Framingham Heart Study, a longitudinal study of heart disease.”

The study results showed that 49% of patients who had poor endothelial function as measured by EndoPAT had a major cardiovascular event (e.g. heart attack or stroke) during the 7-year follow up.

The EndoPAT is a product of Itamar Medical. I was approved by the US FDA for diagnostic use in 2003. It consists of a digital recording equipment plus two probes attached to the fingers like large thimbles. During the test, one probe is placed on each index finger and attached to a small blood-flow measuring machine. In parallel, a cuff, the kind that is used during blood pressure reading is placed around one arm. The cuff is inflated, then deflated “to occlude and then release blood flow to assess reactive hyperemia (RH), the normal blood flow response that occurs when occlusion is released.” Three timed readings are performed during the 15-minute test and the results are expressed in RH scores. A low RH score indicates low blood flow response, endothelial dysfunction and impaired vascular health.

This positive news about EndoPA is very welcome because cardiovascular health problems, most of which are preventable, have become a major global health concern. Millions of people suffer from heart attack and stroke each year, sometimes without any warning. Indeed, a predictive but still non-invasive instrument such as EndoPAT can help doctors and patients plan a preventive strategy to battle heart and stroke.

Stroke begins at 44 and beyond

The 40s. It’s when life is really supposed to start. It’s also when people get into the so-called midlife crisis.

A recent Finnish study also suggests that the 40s is the age when we have to take care of our cardiovascular health because the rates of ischemic stroke increase dramatically beyond our 44^th year of life. And most especially if you are male. The Finnish study looked at 1,008 ischemic stroke patients aged 15 to 49 years old. Here are some of the figures the researchers found:

• a high frequency of stroke risk factors in young patients;
• a high percentage of “silent” and multiple strokes;
• the pattern of stroke-causing events begins changing in midlife to resemble that of the elderly.

The researchers looked at stroke incidence in different age groups and found that stroke under the age of 30 occurs more often in women. The incidence of stroke increases with age and by the age of 44, the incidence is almost equal between men and women. After this point, a sharp increase in first stroke incidence in males was observed.

Most of the risk factors observed were lifestyle related and modifiable, and the most frequent are:

• dyslipidemia (60%)
• smoking (44%)
• hypertension (39%)

In addition, less frequent risk factors but nevertheless potentially dangerous were observed such as heavy alcohol consumption, which is common among men, migraine among women, use of illicit drugs among younger patients.

What surprised the researchers are the high number of silent as well as multiple ischemic strokes occurring, sometimes with the patient being aware of them.

Other key findings are:

• The average annual stroke rate for all patients was 13.3 per 100,000 people for males and 7.8 per 100,000 for females. Among patients ages 15-44, the annual rate was 7.5 for males and 5.7 for females.
• Traditional stroke risk factors – high cholesterol, smoking, hypertension and obesity – were more common among males and those older than 44. Heavy drinking was more often found in males, and migraine headaches were more common in females as a risk factor. Illicit drug use and migraines were more frequent among younger patients.
• The leading causes of strokes were caused by a cardiac source (19.6 percent) and artery dissections (15.4 percent). Artery dissections are small tears in an artery’s inner lining that allow blood to seep underneath, push out the vessel wall, and narrow or block the artery.
• Multiple strokes had occurred in 23 percent of the patients, and silent strokes occurred in 13 percent of the patients.

As I approach that stage called midlife, I am very aware of the health problems that come with it and stroke is just one of them. The American Stroke Association gives a comprehensive patient-friendly overview of stroke and how we can prevent it.

Inequalities in stroke treatment: health insurance coverage does matter

All people are created equal. So why don’t people get equal treatment when it comes to stroke? Does it have something to do with health insurance coverage?

Ischemic stroke occurs when a blood clot blocks a blood vessel supplying blood to the train. The cutting off of the blood supply (and therefore oxygen) of the brain can lead to death of brain cells which can in turn cause permanent damage. Ischemic stroke is the most common type of stroke and is a major cause of disability.

The state of the art in the treatment of ischemic stroke is the tissue plasminogen activator (tPA). tPA is a thrombolytic or clot-busting agent and is the only drug of its kind which has been approved by the US FDA for the emergency treatment of acute ischemic stroke. It is also a time-critical type of treatment and should be given within 3 hours after the onset of stroke symptoms to be effective. Recent studies even suggest that tPA can still reverse the neurological effects of stroke and prevent death and disability when given up to 4.5 hours after the onset of stroke.

However, a recent study funded by the U.S. Centers for Disease Control and Prevention (CDC) showed that “between July 1, 2005 and June 30, 2007, the tPA treatment national average was 2.4 percent of all ischemic stroke patients in the Medicare database.” Reports of rates of tPA administration in hospitals all over the US range from 0 to 24%. The rate of 2.4% among Medicare patients is seemingly low. In addition, 64% of all hospitals in the US did not administer clot busters to Medicare stroke patients during this time period.

According to a Dr. Lee Schwamm, an associated professor of Neurology at Harvard University

“This study sheds important light on a major disparity in acute stroke care delivery…Individuals and agencies responsible for the equitable distribution of healthcare resources need to examine these and other data to identify strategies that will provide adequate acute stroke care to all their citizens.”

There are of course other factors to consider, including the size of the hospitals in question, as well as their geographical location. A previous study on emergency care of stroke victims also found that the following factors can make a difference in the kind of treatment received:

• the type of hospital (does it have a Primary Stroke Center?)
• the manner of patient arrival/delivery (walk in vs. ambulance delivery)
• gender (men get treated faster!)

The issue of health insurance coverage is a major issue in the US.  Read more about the “crisis of the uninsured” in a previous post.

Brush up on your stroke awareness

Is your stroke awareness up to scratch?

Those who have it, don’t know they have it. I am referring to the high risk for stroke and people’s awareness. And that is exactly what one of the papers presented at American Stroke Association’s International Stroke Conference 2009 found out.

The researchers used data from the Centers for Disease Control and Prevention’s (CDC) 2007 Behavioral Risk Factor Surveillance System (BRFSS), the world’s largest ongoing telephone health survey. Since 1984, the BRFSS has been tracking health information of Americans. The data analyzed included responses from 86,573 adults from 11 states, as well as the District of Columbia and the Virgin Islands. The survey also included answering five questions specific for stroke, mainly on symptoms and actions during stroke (e.g. call 9-1-1).

The five most common warning signs of stroke are

• sudden weakness in the face, arm or leg, particularly if the weakness occurs on only one side of the body
• sudden severe headache
• sudden vision disturbance in one or both eyes;
• sudden confusion or difficulty speaking; and/or
• sudden dizziness, loss of balance, loss of coordination or difficulty walking.

The results of the survey were a bit disappointing and some key points are summarized below:

• 93% of those asked knew a couple of the obvious symptoms especially the numbness.
• 59% of those surveyed didn’t recognize the less obvious symptoms such as a severe headache.
• Only 37% of those surveyed recognized all five warning signs of stroke as listed above.

What is surprising is that some people who have had stroke have less stroke awareness than others who haven’t had one!

When looking at the data more closely, the researchers found that certain demographic factors play a role in stroke awareness.

Ethnicity: Whites have better stroke awareness (40%) compared to blacks (31%) and Hispanics (21%).

Education attainment: 46% of those with a college education knew more about stroke vs. 19% of those with high school level education.

Income: 45% of those with income above $50,000 a year are more aware of stroke that those who earn less $25,000 a year.

Gender: Women knew better (40%) than men (34%).

Marital status: Married people (40%) are more aware of stroke than their single counterparts (32%).

Need to brush up on your stroke awareness? The Stroke Collaborative (Give Me 5!) is a joint initiative by the American Heart Association, American Stroke Association, American College of Emergency Physicians and American Academy of Cardiology to help spread stroke awareness.

Here are five ways to check if someone is having a stroke:

WALK: Is their balance off?

TALK: Is their speech slurred or face droopy?

REACH: Is one side weak or numb?

SEE: Is their vision all or partly lost?

FEEL: Is their headache severe?

Remember: only one of these symptoms is enough to indicate a stroke. Call 9-1-1

Can coffee protect you from stroke?

Now you see them, now you don’t. I am referring the health benefits/adverse effects of coffee. Previous studies indicated that excessive  caffeine consumption may have some bad effects on our health. But this new study seems to bring good news to coffee lovers.

This joint study by American and Spanish researchers recently published in the journal Circulation however, says this is not the case. The study looked at the data of 83,076 women as part of the Nurses’ Health Study. The study participants were followed up for more than 24 years, their caffeine consumption recorded, as well as any cardiovascular events that occurred during the follow-up period. The results show that there is no evidence of increased stroke risk in women drinking 4 or more cups of coffee per day. On the contrary, the results actually suggest coffee consumption results in a modest but still observable decrease in risk for all types of stroke.

Compared with women who drank less than one cup of coffee a month, the stroke risk was found to be

• 20 percent less in women drinking four or more cups/day.
• 19 percent less in women drinking two to three cups/day.
• 12 percent less in women drinking coffee five to seven times a week.

Other caffeinated drinks such as tea and soft drinks did not show any association, positive or negative to stroke risk. However, decaf coffee also showed a trend towards lowering the risk. This suggests that whatever gives protection against stroke, it must not be caffeine but something else. The authors think coffee contains antioxidants that may reduce inflammatory processes and improve endothelial function. Previous data analyses indicate that coffee may have some beneficial affects that can be protective against coronary heart disease and type 2 diabetes.

Since coffee drinkers also tended to be cigarette smokers, the researchers also looked whether the protective effect of coffee can counteract the adverse effects of smoking. Well, smokers have to be disappointed. Coffee doesn’t help at all in lowering smokers’ stroke risk. But neither does it increase it. Thus, “the potential benefit of coffee consumption cannot counterbalance the detrimental effects smoking has on health“, according to the authors.

Thus, the researchers emphasize that this reduced stroke risk due to coffee is only true for healthy, non-smoking women.

And before you load up on coffee upon heating this good news, take note what the authors conclude:

“Anyone with health problems that can be worsened by coffee (insomnia, anxiety, hypertension or heart problems) should talk to their doctor about their specific risk.”

Photo credit: stock.xchng

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