Know the risk factors so you can prevent stroke
Published: May 9, 2013
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“I remember hearing him hit the floor.”
That is the memory of Edgar Kenton, M.D., now a neurologist with Geisinger Health System of an event that occurred when he was 14.
The man who hit the floor was his grandfather, the man who helped raise him. What struck him down was a stroke.
“I remember the medics taking him down the stairs, and the next time I saw him was at the funeral in the casket. That’s probably the reason I became a doctor, No. 1; then a neurologist, No. 2; and finally a stroke neurologist, No. 3.”
To remain a doctor with a low risk of stroke, Dr. Kenton does a few things. “First and foremost I control my blood pressure. I have high blood pressure, but it’s well-controlled blood pressure.”
High blood pressure (hypertension) is the single most important risk factor for stroke. If inadequately treated, even mild hypertension increases stroke risk.
A CDC report finds that nearly one in three American adults has hypertension and more than half of them (36 million) don’t have it under control.
The study found that the majority of those with hypertension have seen a physician twice in the past year and are being treated with medicine, but still don’t have their condition under control. Millions of others with hypertension aren’t being treated with medicine or aren’t aware that they have high blood pressure.
Blood pressure should generally be below 120/80. Elevated blood pressure breeds atherosclerosis (arteriosclerotic vascular disease or ASVD, hardening of the arteries) and puts abnormal pressure on blood vessel walls. In a weak spot, this can cause a rupture.
Often, hypertension presents with no obvious symptoms, living up to its nickname, “the silent killer.” It is imperative to check your blood pressure regularly. Controlling it through a low-sodium diet, weight control, stress management and medication will reduce your stroke risk.
Another important point concerns medicine. Using medication to control hypertension is effective only if taken on a regular basis, so it is crucial to follow physician’s instructions.
In older adults, treating hypertension is particularly important. That said, in elderly individuals, an abrupt fall in blood pressure may actually cause a stroke. So, treatment of high blood pressure may need to start with small doses of medication so blood pressure is reduced gradually.
Beside controlling his blood pressure, the next thing Dr. Kenton does may be surprising. “I take a baby aspirin, 81 mg, every day,” he said. Regular aspirin can help prevent a second stroke. But, before starting any kind of aspirin regimen, talk with your doctor to see if regular aspirin will help, because in some cases it can harm. Evidence that aspirin could protect the heart and brain appeared in the 1940s when a doctor advised all his male patients between the ages of 40 and 65 to take aspirin every day to prevent coronary thrombosis (clots in the heart’s arteries). The result? Surprisingly few had heart attacks or strokes.
Today, many recommend that people recovering from a heart attack continue to take aspirin. The goal is to prevent another attack.
However, you should take a daily aspirin only if your doctor advises you to do so. If you have a serious allergy or history of bleeding, aspirin may not be wise. According to the Mayo Clinic, if you have a high risk of having a first heart attack, your doctor might recommend aspirin after weighing the risks and benefits. You shouldn’t start daily aspirin therapy on your own. Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding.
The next thing Dr. Kenton does to prevent stroke is probably the largest stumbling block for people at risk of stroke — and the U.S. population in general. “Third thing I do is that I watch my diet,” he said.
Foods high in fat, salt, and cholesterol fatten your risk for stroke. Not sure if that entrée should be a ‘no-way’? If it is, are you wondering what to substitute? Ask your doctor what foods to befriend and de-friend. The foods you will limit or avoid will contain fats and/or cholesterol. Excess fat in food, particularly saturated fat, and cholesterol plant the seed for ASVD, arteriosclerotic vascular disease, the harbinger of stroke.
Often, dietary fat and cholesterol may be reduced by limiting fat or oil added in cooking, trimming fat and skin from meats and poultry, using low-fat or non-fat dairy products, broiling and baking foods rather than frying, and limiting eggs to three a week.
Salt is another thing to limit in your diet. Consumed in excess, sodium cultivates hypertension. Table salt is the primary source of dietary sodium, and it’s right out there on the table. But there are also “hidden” salts in most processed and canned foods. Sodium nitrate, disodium phosphate, monosodium glutamate and similar compounds are listed on food packaging and indicate a high-sodium content. People who want to preserve their health should try to eat fresh food when possible, but grow adept at reading food packaging labels when they can’t.
Try a diet rich in fruits and vegetables. If need be, get your fruits and vegetables in drink form. Try V8 and V8 Fusion. Just be sure to mix the real thing into your diet too. Daily doses of veggies will help keep that diet-related demon, obesity, at bay.
Being too heavy strains the heart and blood vessels and is associated with hypertension. Obesity also predisposes a person to hypertension and diabetes, both of which are stroke risks.
Finally in regard to diet, people who drink more than two alcoholic drinks a day have an increased risk of stroke. People who drink more heavily are at an even greater risk. And, healthy young adults are just as susceptible to the risk of stroke incurred by heavy alcohol consumption as are older persons.
The last ingredient in Dr. Kenton’s stroke prevention program is exercise. That’s another area in which the average American struggles.
The percentage of fat in our bodies usually increases with age. To keep this increase to a minimum, regular exercise helps. There is an inverse relationship between exercise and ASVD. More exercise is linked to lower levels of ASVD.
Consult your physician before beginning an exercise program, and select one that is best suited to you. If you want to achieve and maintain an improved level of fitness, experts recommend at least 20 to 30 minutes of aerobic exercise three to four times a week.
When Dr. Kenton slips up and fails to do one of his daily to-dos, what exactly does he tell himself? “What I tell my patients: Don’t get discouraged. By virtue of the fact that I do these things consistently, I can afford to slip up once in a while. The worst thing is to become discouraged and beat down.”
What is stroke
In medical jargon, it’s known as a cerebral vascular accident. When it occurs, said Dr. Jonathan Goldner, the blood supply to a portion of the brain is interrupted. Dr. Goldner, chief of staff at Pocono Medical Center and internal medicine practitioner with Pocono Internal Medicine Specialists, says brain tissue needs oxygen to survive and function. The oxygen is brought to the brain by red blood cells via a network of arteries.
According to the America Heart Association (AHA) and the American Stroke Association, there are three types of stroke:
* Ischemic, the most common type, which account for 87 percent of all stroke cases, is where a blood clot forms in the artery of the brain or somewhere else in the blood, like the heart, and then makes a beeline to the brain.
* A hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels typically cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs). However, the most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure).
* A transient ischemic attack (TIA), caused by a temporary clot, often called a “mini stroke”, is a warning strokes to be taken very seriously. A transient ischemic attack (TIA), caused by a temporary clot, often called a “mini stroke,” is a warning strokes to be taken very seriously.
Dr. Goldner says he carefully watches patients who have diabetes or who smoke. The link between diabetes and elevated stroke risk is related to the circulatory problems caused by diabetes.
Aggressive control of diabetes reduces the cardiovascular complications of the disease. Moreover, studies show that smokers have a higher risk of stroke, regardless of age, hypertension, heart disease and other factors.
However, the risk declines dramatically within a few years of quitting.
Know the warning signs of a stroke.
Pocono Medical Center has partnered with Spirit of Women, a national network of hospitals and health-care providers across the nation that ascribe to the highest standards of excellence in women’s health, education, and community outreach. Among the things they want to educate their patients on is stroke.
The first warning signs are:
* Sudden numbness of the face, arm or leg, especially on one side of body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance coordination
* Sudden, severe headache with no cause
Next are the classic symptoms. Goldner says they can be recalled with the acronym FAST:
* Face — Sudden weakness of the face, blurred, doubled or decreased vision
* Arm — Sudden weakness or numbness of arms
* Speech — Difficulty speaking; slurred, garbled speech
* Time — Time to call 911. Time is of the essence in stroke treatment. The sooner treatment starts, the better the chances for recovery.
“The only way to know for sure if you are experiencing stroke is to be evaluated by a health-care provider who is experienced in providing emergency care to people, such as in an emergency room of a hospital,” Dr. Goldner said.
Anyone who is concerned that he or she is having a stroke should call 911. Those who may be having a stroke, said Goldner, should not drive to the hospital and should not ask someone else to drive them — call for an ambulance.
“Time is of the essence — it is important for you to recognize when a stroke is occurring. Treatment that can open that artery and stop the stroke must be administered as soon as possible in order to minimize brain damage.”
According to the American Heart Association, stroke is the leading cause of serious, long-term disability in the United States and the third-largest cause of death, ranking behind diseases of the heart and all forms of cancer.
Finally, know excessive anger is the enemy. Escalating heart rate, breathing, arterial tension and cortisol levels all contribute to stroke.
Traffic jams, grief, rude behavior, being teased or bullied, injustice, embarrassment, financial headaches, humiliation, infidelity, physical pain, failure — all can summon stress or anger. Spirit of Women reminds us: When we recognize what makes us angry, we can then plan ahead and control our feelings in a positive way.
Some anger-management tips:
Keep an anger journal and write down which people and situations make you most angry. Also make note of how you react and what feelings are behind the anger. Learn to recognize when these feelings are triggering an angry reaction.
Put yourself in another person’s place and view the person with care and concern. Use self-talk to help yourself.
Step back from the situation, take several deep breaths and calm yourself down. You may need to move away from the situation before you can handle it.
Try not to curse, sigh, speak loudly, shake your fist or point your finger.
Get “angry” to “OK.” When you feel angry, use a three-step approach: stop, ask yourself questions, then react. The first question is: “Would a jury of people think I should be angry?” If the jury says “yes,” ask yourself, “Is this a situation I need to fix, and can I fix it?” If you decide you must fix the situation, wait until you cool off, then take action.