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Stroke prevention

A stroke occurs when blood flow to the brain is blocked, either by blood clots or narrowed blood vessels, or when there is bleeding in the brain. Deprived of nutrients, brain nerve cells begin to die within a few minutes. As a result, a stroke can cause sensory and vision loss, problems with talking and walking, or difficulty in thinking clearly. In many cases, the effects of stroke are irreversible.

There are 2 broad categories of stroke:

Ischemic strokes are caused by a blood clot or blockages in the arteries, and hemorrhagic strokes occur when blood vessels rupture. Ischemic strokes are most commonly caused by blockages in the carotid arteries and are responsible for up to 80% of strokes. As people age, arteries become narrowed with rough deposits of plaque called "stenosis". Diseased arteries can clog up completely as the plaque accumulates or can be shut down by clotting conditions called "embolism" and "thrombosis". When the arteries become plugged, the blood is no longer able to reach the brain and stroke results.

Thrombotic strokes are caused by fatty deposits (plaque) which have built up in the arteries carrying blood to the brain. This slows blood-flow and can cause clots to form on the plaque that narrows or blocks the flow of nutrients and oxygen to the brain.

An embolic stroke is caused by a blood clot formed in another part of the body which breaks loose, travels through the bloodstream, and then blocks an artery carrying nutrients and oxygen to the brain.

A hemorrhagic stroke takes place when an artery supplying blood bleeds into the brain. The ruptured blood vessel prevents needed oxygen and nutrients from reaching brain cells. One type of hemorrhagic stroke is caused when an artery which has weakened over time, bulges (called an aneurysm) and suddenly bursts.

Strokes are the 3rd leading cause of death in the U.S

Some people are more at risk for stroke than others. Chronic health conditions such as high blood pressure and diabetes can increase your risk, as well as lifestyle choices such as being overweight, smoking cigarettes, or drinking excessively. Men, African Americans, and people with a family history of stroke have a higher risk as well. If you have already had a stroke or a transient ischemic attack (referred to as a TIA or "mini-stroke"), you are also at highest risk. Warning signs include sudden unexplained numbness or tingling sensation especially on one side), blurred vision, slurred speech, clumsiness or stumbling.

What is a Transient Ischemic Attack (TIA)?

A TIA, or mini stroke, is a kind of ischemic stroke. Symptoms last a few minutes to a few hours and then disappear. Always report a TIA to your doctor. A TIA is often a sign that a more damaging stroke is on its way. Seek treatment right away, even if symptoms go away quickly.

Are you at risk for a stroke?

Having many risk factors does not automatically mean you will have a stroke and those with no or few risk factors may not necessarily avoid a stroke.

Of the 700,000 strokes that occur in the U.S. each year, a staggering 600,000 of these could be prevented! It is estimated that 50% of these strokes occurred in asymptomatic patients, people who had no symptoms of their impending strokes.

The National Stroke Association "Stroke Prevention Guidelines" advise patients to:

• Know your blood pressure, have it checked at least once a year
• Find out if you have atrial fibrillation, which encourages the formation of blood clots that could cause a stroke
• If you smoke, stop
• If you drink alcohol, do so in moderation
• Find out if you have high cholesterol
• If you have diabetes, take measures to control the condition
• Include exercise in your daily routine
• Eat a low-salt diet
• Ask your physician if you have circulation problems that could increase the risk of stroke and
• If you experience any stroke symptoms, including sudden weakness of the face or a limb, a blurring of vision, dizziness, or an intense headache, seek immediate medical attention.

High blood pressure is the leading cause of stroke.

Signs and Symptoms of a Stroke

These symptoms signal a medical emergency! It is vital to seek emergency medical care at once. Call 911. Every minute counts! The majority of patients do not report to the emergency room until 24 hours after the onset of stroke symptoms. The longer a stroke victim waits before showing up at the emergency room, the more damage a stroke can do and the less recovery can be achieved.

Your goal is to show up at the emergency room less than 3 hours after the onset of stroke symptoms.

If you report to your doctor that you suffered a Transient Ischemic Attack (TIA), he or she will perform some tests.

A neurological and general physical examination will be taken first. As part of the history, the doctor will want to know which, if any, risk factors for stroke you have: high blood pressure, diabetes, irregular heartbeat, oral contraceptive use, heredity, other heart diseases, smoking, diet (especially high sodium and high cholesterol), obesity, lack of exercise, blood disorders, and heavy alcohol consumption.

Your doctor should then perform a detailed physical examination evaluating the heart, the blood vessels, and the nervous system in addition to specialized tests which will help determine whether other conditions might be causing the symptoms. One of those specialized tests is the non-invasive duplex evaluation of the carotid arteries.

Doppler ultrasound - a microphone-like device is placed on the neck and uses sound waves to measure blood flow. Ultrasound imaging - a small probe is placed on the neck and uses high-frequency sound waves (ultrasound) to create an image of the artery and its interior, which is projected on a video screen.

Both of these tests are completely painless. No needles, x-rays, or dyes are used. They can be performed quickly, in about 10 minutes, and hospitalization is unnecessary.

The tests are performed using ultrasound equipment. This is the same safe technology used by doctors to look at unborn fetuses in pregnant women.

In a recent study published in The New England Journal of Medicine, it was concluded that ultrasound scanning of the carotid arteries is the single best predictor of stroke and heart disease.(2)

If the test results and symptoms point to carotid artery disease, the patient may have an angiogram, an x-ray test in which dye is injected into the arteries which lead to the brain. This shows the exact location of any narrowing, blockage, or other defect.

So what steps can you take to help prevent a stroke?

Aspirin for stroke prevention?

Some recommend aspirin on a daily basis to prevent a heart attack or stroke. In one study (3), UK researchers reviewed 287 trials of treating high-risk individuals with anti-platelets such as aspirin. The 135,000 patients involved either had cardiovascular disease or conditions which predisposed them to heart attacks and strokes, such as peripheral artery disease, which is characterized by blockages in arteries supplying the legs and feet, and diabetes.

The investigators, all part of a team known as the Anti-thrombotic Trialists' Collaboration (ATC), looked at whether or not the anti-platelets cut patients' risk of heart attack, stroke and death from a cardiovascular cause.

They found that, overall, any anti-platelet therapy led to a 1/3 drop in heart attack risk, while the risk of non-fatal stroke fell by 25% and cardiovascular death risk declined by 16%.

Aspirin was the most widely studied anti-platelet. Based on this review, the evidence "supports daily doses of aspirin in the range of 75-150 mg for the long-term prevention of serious vascular events in high risk patients.

However the risks and benefits of aspirin therapy vary for each person. While the benefits may be significant for people who are at higher risk, healthy individuals should weigh the pros and cons of aspirin therapy carefully, in my opinion.

First, if you're going to start an aspirin regimen, I would recommend you take the baby aspirin - 81 mgs - not the adult aspirin. Whatever benefits aspirin offers can be derived from the 81 mgs dosage. Even then, unless you are in the high-risk category, I would advise you not to take aspirin more often than every other day. The problem with aspirin is the risk of bleeding, gastrointestinal hemorrhage and a possible increased risk of renal failure.

Taking aspirin isn’t advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could actually make these bleeding strokes more severe.

If you’re taking aspirin and you must undergo even a simple surgical procedure or dental extraction, you must tell the surgeon or dentist your aspirin dosage.

Vitamin E to reduce the risk of stroke?

Vitamin E may have a protective effect against ischemic strokes, researchers reported on April 20 2000 at the annual meeting of the American Academy of Neurology in Toronto, Canada. Their study showed that vitamin E supplements can reduce stroke risk by 53%.

Also, researchers from Columbia Presbyterian Medical Center (CPMC) of New York Presbyterian Hospital found a person's risk of stroke is reduced by 50% if he or she takes a vitamin E supplement each day.

So there appears to be some protective effect offered by vitamin E, although it must be said that not all the evidence is conclusive in this regard. In my opinion the best price for high quality vitamin E on the internet can be found here.

Gum disease leads to higher stroke risk

Common, chronic bacterial infections, including gum disease, urinary tract and lung infections, may increase the risk of atherosclerosis, a build-up of fatty plaques in the arteries that could lead to heart attack, study findings suggest.

People with gum disease may be at greater risk for stroke because of an increased tendency to have blockages in the carotid arteries of the neck. A buildup of fatty plaque in the carotid arteries increases the risk of stroke by reducing blood flow to the brain, as well as by promoting formation of a blood clot that can cause a stroke.

Periodontal, or gum, disease is caused by a chronic, low-grade infection that is often not linked by physicians to other conditions such as conditions causing stroke. However, gum disease involves a large amount of bone and there is a lot of tissue in contact with that bone. From this contact, bacteria and inflammatory, toxic compounds can gain access to the blood stream, where they may have a detrimental effect on the lining of blood vessels. It is believed that inflammation plays an important role in stroke and heart disease.

Fish oil reduces the risk of stroke?

A study released in the January 17, 2001 issue of the "Journal of the American Medical Association" (4)suggests that fatty fish and omega-3 polyunsaturated fatty acid, such as that found in fish oil and flaxseed oil, may be as effective as daily aspirin therapy at reducing the risk of thrombotic stroke, but without the side effects of aspirin therapy.

Investigators tracked 79,839 female nurses from 1980 to 1994. At the beginning of the study, the subjects ranged in age from 34 to 59 years. Food frequency questionnaires were used to determine the women's intake of fish and omega-3 oil.

After controlling for various risk factors of cardiovascular disease,
researchers found that, compared with women who ate fish less than
once a month, women who ate fish 1 to 3 times per month had a 7%
reduced risk of stroke, women who ate fish once a week had a 22% risk
reduction, women who ate fish 2 to 4 times a week had a 27% lower
risk; and women who ate fish 5 or more times a week had a 52% lower
risk.

Findings applied primarily to thrombotic strokes. The study found no
association between consumption of fish or omega-3 fatty acids and the risk of hemorrhagic stroke.

With increasing scientific evidence on the benefits of omega-3 fish oil, even the prestigious American Heart Association (AHA) has finally recommended the use of omega-3 fatty acids in the prevention of strokes and heart diseases. This was announced in the AHA meeting in Chicago, Illinois in December 2002.

Based on its review of all available scientific evidence, the AHA announced that omega-3 fatty acids benefit healthy people, people at high risk of cardiovascular disease as well as patients with cardiovascular disease.

Since omega-3 helps make the blood thinner to prevent it from clotting, it should not be taken by people on "blood thinners", as well as people on aspirin therapy.

I spend a lot of time researching the internet for the best price on supplements on the internet, and in my opinion the lowest price for high quality omega-3 fish oil can be found here.

There is an enormous amount of medical literature which testifies to the fact that omega-3 fish oils prevent and may help to ameliorate or reverse atherosclerosis, angina, heart attack, stroke, arrhythmias, congestive heart failure, and peripheral vascular disease. Fish oils help maintain the elasticity of artery walls, prevent blood clotting, reduce blood pressure and stabilize heart rhythm. (5-12)

(1) Lavenson, George S. Jr., MD, RVT, FACS. Carotid Screening Preparing for the Future. Vascular Ultrasound Today 1997, 2 (5), pg. 64.

(2) O'Leary, D.H., MD, Polak, J.F., MD, Kronmal, R.A., Ph.D., Manolio, T.A., MD, Burke, G.L., MD., MS, Wolfson Jr., S.K., MD, Carotid-Artery Intima and Media Thickness as a Risk Factor For Myocardial Infarction and Stroke in Older Adults. The New England Journal of Medicine, 1999; 340:14-22.

(3) British Medical Journal January 12, 2002;324:71-86, 59-60

(4) JAMA, 2001; 285: 304-312. "Intake of Fish and Omega-3 Fatty Acids and Risk of Stroke in Women"

(5).Simopoulos, Artemis. Omega-3 fatty acids in health and disease and in growth and development. American Journal of Clinical Nutrition, Vol. 54, 1991, pp. 438-63
(6). Pepping, Joseph. Omega-3 essential fatty acids. American Journal of Health-System Pharmacy, Vol. 56, April 15, 1999, pp. 719-24
(7). Uauy-Dagach, Ricardo and Valenzuela, Alfonso. Marine oils: the health benefits of n-3 fatty acids. Nutrition Reviews, Vol. 54, November 1996, pp. S102-S108
(8). Connor, William E. Importance of n-3 fatty acids in health and disease. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 171S-75S

(9). Daviglus, Martha L., et al. Fish consumption and the 30-year risk of fatal myocardial infarction. New England Journal of Medicine, Vol. 336, April 10, 1997, pp. 1046-53
(10). Christensen, Jeppe Hagstrup, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction. British Medical Journal, Vol. 312, March 16, 1996, pp. 677-78
(11). Simon, Joel A., et al. Serum fatty acids and the risk of coronary heart disease. American Journal of Epidemiology, Vol. 142, No. 5, September 1, 1995, pp. 469-76
(12). Flaten, Hugo, et al. Fish-oil concentrate: effects of variables related to cardiovascular disease. American Journal of Clinical Nutrition, Vol. 52, 1990, pp. 300-06

disclaimer: Throughout this website, statements are made pertaining to the properties and/or functions of food and/or nutritional products. These statements have not been evaluated by the Food and Drug Administration and these materials and products are not intended to diagnose, treat, cure or prevent any disease.

© 2002 by Marc Leduc