Stroke: Are you at risk?

The news that Fernando Poe Jr. suffered a stroke – and subsequently died of it – last December shocked many Filipinos. How could one who looked so robust, strong, and healthy get a stroke?

Yet, we know that a stroke can strike without warning – even in apparently healthy individuals. There are many people, however, who have no idea they are at risk for a stroke. That’s because conditions that increase risk, such as high blood pressure, often have no symptoms and thus often remain hidden and untreated. When tests do detect the warning signs – even the most ominous, such as an abnormal heartbeat and a noise in the neck’s arteries – they are often downplayed by patients or mistreated by doctors who underestimate the threat or the benefit of treatments. And even when a stroke does occur, the symptoms may initially be minimal that one may not realize what’s happening until it’s too late.

Indeed, according to a research done by the US National Stroke Association, a major factor in the rising stroke mortality rate is that an overwhelming number of people simply do not have a clear understanding of what a stroke is, how to prevent it, what its symptoms are, or what to do when such symptoms arise.

What A Stroke Is

A stroke – also referred to as a "brain attack," as its mechanism is similar to that of a heart attack – occurs when blood vessels in the brain either burst (known as hemorrhagic stroke) or become blocked (an ischemic stroke, which was what happened to FPJ). In either case, the blood supply to the adjacent brain cells is cut off. Deprived of the oxygen and glucose carried by the blood, brain cells quickly begin to die, a process that can lead to neurologic deficits including impaired speech, vision, and movement, as well as paralysis and coma. Severe strokes are often fatal.

The good news is that stroke is one of the most preventable life-threatening health problems facing older people today. "It appears that, to a great extent, we control our own destiny when it comes to stroke," says JoAnn Manson of the Harvard Medical School. "From what we know, most deaths from stroke can be prevented by lowering blood pressure, quitting smoking, exercising, controlling weight, and perhaps eating a diet high in fruits and vegetables."

How To Prevent It

Lifestyle habits to prevent stroke are similar to those for preventing heart attack. But the emphasis is a little different. The US National Stroke Association (www.stroke.org) says the following 10 steps are crucial in raising stroke awareness and prevention:

1) Maintain healthy blood pressure. Whereas smoking is the biggest risk factor for heart disease, high blood pressure is the leading cause of stroke. Ideally, systolic blood pressure (the top number) should be lower than 120 and diastolic (the bottom number), lower than 80. Untreated hypertension increases the risk of stroke fourfold. Adults should have their blood pressure checked at least once every two years.

2) Ask your doctor to determine if you have atrial fibrillation. It’s an irregular heartbeart that sometimes allows blood to collect and form a clot in the heart chamber, which can potentially make its way up to the brain. Atrial fibrillation can easily be diagnosed with an electrocardiogram (EKG), and the doctor can prescribe medication to control the condition. The presence of atrial fibrillation raises stroke risk three to five times in people 65 and older who have other risk factors. Proper treatment cuts the risk up to 68 percent.

3) Don’t smoke. If you do, quitting will reduce your risk for stroke by more than 50 percent. One year after quitting, the risk drops by half. After five years, the risk is about the same as that of a non-smoker.

4) Limit alcohol consumption to no more than two drinks per day. More than that may triple your stroke risk.

5) Maintain healthy cholesterol levels – with medication, if necessary. In men, high cholesterol levels increase stroke risk 1.8 to 2.6 times. In men who also have coronary heart disease, medication can reduce stroke risk by 20 to 30 percent.

6) If you have diabetes, control it through proper nutrition, regular exercise, and taking medication as prescribed by your doctor. Diabetes compromises blood circulation.

7) Aim to get at least 30 – preferably 60 minutes of physical activity every day.

8) Eat a diet low in saturated fat and sodium and rich in fruits, vegetables, whole grains, and fiber.

9) If you have circulation or blood problems, make sure you are under a doctor’s care and being treated.

10) Know the symptoms of stroke and seek care immediately. (See below.)

What The Other Risk Factors Are

Aside from the 10 preventive measures, here are some of the other known risk factors for stroke:

• Clogged neck arteries (asymptomatic carotid stenosis). Up to 10 percent of people over age 65 have carotid (neck) arteries that are more than half clogged, thanks to a lifetime of high cholesterol and other factors. Talk to your doctors about taking aspirin or statins or, in severe cases, undergoing surgery to clear out the neck arteries.

• Obesity. Excess body fat increases the risk of stroke. Abdominal obesity is the most harmful, particularly for men. Although there is no proof that slimming down will reverse that risk, it certainly can’t hurt.

• Sleep apnea. This condition, in which breathing is intermittently interrupted during sleep, boosts stroke risk, mainly by raising blood pressure. People who snore heavily, experience morning headaches, or are unusually drowsy during the day, should be evaluated by a sleep specialist because each symptom could indicate sleep apnea.

• Psychological factors. The mind-body connection should apply to the brain as much as any organ. Depression, anger, and long-term life stresses are linked to an increased likelihood of stroke, while an optimistic outlook is associated with a reduced risk. A happy mind will help preserve a healthy brain as well as a sound body.

What Its Symptoms Are

When prevention fails, the next best option is to recognize the signs of stroke as soon as they occur. Symptoms include sudden:

• Numbness or weakness in the face, arm(s), or leg(s) – especially on only one side of the body.

• Confusion, trouble speaking, or difficulty understanding.

• Trouble seeing in one or both eyes.

• Difficulty walking, dizziness, loss of balance, or poor coordination.

• Severe headache with no known cause.

• Nausea, fever, or vomiting.

• Fainting, confusion, or disorientation.

• Convulsion, coma, or brief loss of consciousness.

Perspectives

Stroke is a complex disease. Diagnosis and treatment have come a long way, and we’ve also made great strides in prevention, thanks largely to improved blood pressure control. Despite these gains, stroke remains one of the leading causes of death and disability in many countries of the world, including the Philippines. It doesn’t have to be that way.

To prevent a stroke, avoid tobacco, eat well, and exercise regularly. Try to stay slim and reduce the stress in your life. If you choose to drink, be moderate and responsible. Have your doctor check your blood pressure, cholesterol, and blood sugar regularly, and work with him to be sure all three are under good control. And if you have heart disease, atrial fibrillation, carotid narrowing, or other major risk factors, collaborate with your doctor to select the treatment that will best reduce your risk of the clots that lead to strokes.

Finally, listen to your body. If you have symptoms of TIAs (transient ischemic attacks) or strokes, get prompt medical care to prevent further problems. It’s neither too early nor ever too late for prevention!