print this page
Deaths from stroke in the United States reached a high in 1979 of 160,000, then went down to 135,000 in the early nineties, then it started going back up and is at 150,000 a year now, costing 60 billion healthcare dollars. That baby boomers are approaching their stroke-prone years is usually the reason given for the increase in stroke incidence. If so, the burden on our health care system can be expected to increase. Reason for the decrease during the 1980s is more than likely due to lifestyle changes in response to the increased health education for cardiovascular disease.
Strokes have been documented as long as there have been people to document them. Known as apoplexy, the Hebrews wrote about it while in Babylon and Hippocrates talked about them in 400 BC, noting that 'men between the ages of 40 to 60 years old are most likely to suffer one, and that a strong attack will not go away while a weaker one is more likely to do so.' His observations were probably the first to distinguish Transient Ischemic Attacks (TIAs) from the more permanent Cerebrovascular Attacks (CVAs). Since Hippocrate's observations we've learned that 80 percent of strokes are ischemic, from a clot, 20 percent are from vessels rupturing. Most strokes are first strokes up to 70 percent.
Although there are some interesting and exciting new treatments that surprisely seem to work real well, they are all contingent on the recognition of stroke and time to treatment. In fact the acute stroke patient and the required treatment need to meet within 90 minutes of the onset of stroke for the best results. This evolving area of stroke management will be further addressed in Part II of this special series The Stroke Epidemic - Can We Turn It Around?
The message is clear, the incidence is increasing and there is no effective widely-available treatment. so prevention and recognition of stroke is becoming more important than ever. Prevention focuses on recognizing your risk factors and then hopefully managing and ultimately lowering your risk of stroke. Some risk factors cannot be changed, like your genes and family history, or your race. But others clearly can be.
High Blood Pressure
High blood pressure is the most commonly known risk factor and control of high blood pressure has long been known to reduce the chance of stroke.
The surprise is how much of a difference it makes. Researchers with the National Heart, Lung, and Blood Institute (NIH) measured a reduction in strokes by 40 percent in their group of subjects with previously untreated hypertension. And the data indicate the effect is different for the various types of medication. And nobody knows why exactly. One of the oldest medications, Hydrochlorothiazide, appears to be just as effective as the newer beta-blockers and ACE inhibitors.
Experts seem to agree your blood pressure should be controlled to at least 140/90. If you have diabetes make it 130/80. Buy a blood pressure measuring device and measure your blood pressure the same time every day.
Diabetes and Obesity
If you've walked through any mall lately you won't be surprised to learn the incidence of diabetes has risen 60 percent since 1990. And it's younger people more than older. Over the past few years professional healthcare providers have had to get used to the sight of young obese men and women in their clinics who are taking oral diabetes medications.
Using some of the newer tools for assessing how well diabetes is controlled makes better control possible with large reductions in stroke incidence. A combination of treatment for diabetes and it's associated conditions of hypertension and elevated lipids can reduce the incidence of stroke by 40 percent.
And with regard to the overweight issue don't live in Mississippi, it's always in the top three fattest states. Try to live in Hawaii if you can, it's always the skinniest state. If you can't afford Hawaii, live in Colorado. But seriously, find your ideal weight at any of several websites. Try to attain it. Don't be a victim of the national obesity disgrace.
Dyslipidemias, high cholesterol and triglycerides
Believe it or not, despite all the studies about cholesterol, there is no documented consistent relationship between cholesterol levels and strokes. Heart attacks, yes. Strokes, no. What has been found is low levels of high density lipids (HDL), below 40, are associated with an increased incidence of stroke. Cholesterol control remains essential for risk factor modification for heart disease, of course. But keeping the HDL over certain levels appears to be the important factor for stroke. Also, the class of drug known as Statins plays an interesting role. These lipid lowering agents, lower your cholesterol but they seem to change the nature of the arterial fatty deposits that cause stroke, by reducing their size and making them less prone to rupture and form clots. And niacin significantly raises HDL by 20 percent.
The National Cholesterol Education Program III guidelines are accessable on the internet and suggest a range of cholesterol control levels depending upon one's risk for disease. Basically someone with few risk factors should aim for LDL cholesterol of less than 160, someone at high risk should be less than 100. Recommendations for HDL cholesterol are to keep it over 50.
Atrial Fibrillation
One quarter of strokes in people over the age of 80 are due to atrial fibrillation. Coumadin is more effective in preventing strokes than aspirin but the benefit may be outweighed by the increased incidence of complications, including hemmorhagic stroke.
The American College of Cardiology recommends patients in irreversible atrial fibrillation over the age of 75 be anticoagulated, and all those over 65 with diabetes, hypertension, coronary artery disease, or prior history of stroke.
Smoking
What's to be said, stop smoking. There's only one addiction harder to beat than smoking, and that's food. Keep trying, it's going to take three or four tries, but stop, Use the patches, use the gum, use anything that works.
A good friend of mine needed to stop smoking, so I gave him a box of nicotine patches for his birthday. "I did it!" He told me later. "Do you want to know how?" "I kept the patch on for the whole weekend, but I still wanted to smoke. I never smoke in my car because I don't want it to smell, so I got in my car and started driving. I drove from West Covina to Laughlin to Las Vegas and back to West Covina." It took three round trips, but two days later he felt it was safe enough to come back home. "My biggest challenge was stopping for gas. I had to go inside to pay and I was afraid I was going to buy a pack of cigarettes." It was in the days before Pay-at-the-Pump gas.
Is this a good time to ask? Why is tobacco still legal. It kills a lot more people every year than heroin does. A whole lot. Heroin is illegal. Why isn't tobacco? It's illegal to not wear your seat belt, but 75 percent of traffic fatalities are in people who are not wearing their seatbelts. Tobacco kills 5 times more people than not wearing your seat belt. Why isn't tobacco illegal?
Other Risk Factors
Some are modifiable like limit alcohol to two or three drinks a day, have five to six servings per day of fruits and vegetables.
Obstructive sleep apnea, often associated with obesity, should be evaluated by a sleep specialist. Habitual snoring is the sentinel symptom.
African Americans, Hispanics, and Asians have more strokes, probably because of their having more high blood pressure as well.
And a condition known as carotid artery stenosis, blockage of the main artery to the brain is a risk factor. If you have risk factors for stroke, your doctor may want an ultrasound of the arteries.
Could prevention be the answer in dealing with the stroke epidemic. It definitely won't make it worse. Controlling the major, modifiable risk factors of blood pressure, diabetes and weight will not only help you decrease your risk for stroke but may ultimately turn around the worldwide incidence of stroke.
Part II of HWN's special series on The Stroke Epidemic - Can We Turn It Around will feature amazingly effective treatments for stroke and the need for early recognition. One of the big differences between heart attacks and strokes is that heart attacks usually happen when patients are awake wheras strokes usually occur while asleep. Therefore there's no reliable way to determine when the stroke happened. Nonetheless, any reader of stroke treatment literature will soon get the impression there are going to be some major improvements in treatment of stroke.
References and Citations and further reading:
Rundek, T. Risk Factor Management to Prevent First Stroke; Neurologic Clinics, V26-4, Nov. 2008
www.Blood-pressure-updates.com How to Measure Blood Pressure
www.halls.md/ideal-weight/body.htm How to calculate ideal body weight
www.strokeassociation.org
Chobanian A.V. National Heart, Lung, and Blood Institute Joint National Committee on Prevention and Treatment of High Blood Pressure; JAMA 289.
LIPID Study Group Prevention of cardiovascular events and death with pravastin. N Engl J Med339. 1998
www.whlbi.nih.gov/about/ncep National Cholesterol Education Program
J. Linder Jones MD MHA practiced emergency medicine for over two decades in Southern California and now writes on occasion for Health WorldNet.
Previous Articles from "The INSIDER"
|
|
| 9/3/2010 | |
| The Big Egg Recall: Who is Watching the Hens? | |
| Since May 2010, a higher than usual incidence of salmonellosis was reported in several parts of the US that covered 10 states. Salmonellosis is a potentially life-threatening foodborne illness caused by the bacterium Salmonella. Salmonella infection manifests as gastroenteritis, food poisoning or typhoid fever. Symptoms, which take up to 72 hours to appear, include vomiting, diarrhea, fever and abdominal cramps.[1] Even after recovering from salmonellosis, those infected may still suffer from recurring joint pain and reactive arthritis. | |
| Read the full article >> | |
| 8/3/2010 | |
| Who's Minding The DRUG Store? | |
| Billions of people use medications each day. In the US alone, an estimated 3 billion prescriptions are issued each year. As a result, the pharmaceutical industry has become one of the most profitable businesses worldwide. Drugs are meant to treat, provide relief from or cure an ailment. But, taking drugs comes with a price - adverse drug reactions - and we are not even talking about the cost of medications, which can be exorbitant. | |
| Read the full article >> | |
| 6/4/2010 | |
| Autism Sites - Best of the Best | |
| As most of us know, parenting is always a big job. Every parent wants the very best for their child and most parents work hard to be sure that their children’s needs are well met. When your child suffers from special circumstances, your job becomes even more crucial and more complicated. Parents of children with autism know that only too well. | |
| Read the full article >> | |
| 4/14/2010 | |
| Food Safety - What’s On Your Plate? | |
| Part Two of a Three part series 'Is Our HealthCare System Safe?' Time was when people did not question the food that was placed on the table. Food was to eat, not for analyzing and rationalizing. But those days are over. Consumers nowadays are more informed, more conscious of their health, and more discriminate. They also expect more value for their money. And with this change in consumer behavior and outlook comes the questions about the quality and safety of the food we eat including both fresh produce and manufactured food. And as FoodInc, the movie, so vividly portrays, the answers to these questions are not so reassuring. | |
| Read the full article >> | |
| 1/4/2010 | |
| Medical Errors: Are We in Safe Hands? | |
| Part One of a Three part series 'Is Our HealthCare System Safe?' Mistakes are not something that we usually associate with the medical field. But medical mistakes do happen mainly because medical professionals are only humans who can err. In medical terms, they are called iatrogenic events, defined as unintended harm or suffering caused by health care. Medical mistakes are usually something that people associate with health care in developing and low-income countries where they lack the right infrastructure and trained personnel. The fact is, a lot of medical mix ups and mistakes in hospitals and clinics occur all over the world, including Europe and North America. One gets to wonder how many medical misadventures go unreported! | |
| Read the full article >> | |
