Progress in Stroke Prevention
Medical experts are quietly but determinedly advancing the field of stroke prevention. Although the total number of deaths from stroke continues to rise, its death rate (deaths per 100,000 people) has dropped by approximately 12.3%. This partial success may be attributed to healthier lifestyles and improved medical care. Here is a summary of recent developments that are helping to prevent strokes in those most at risk.
Who Is at Risk for a Stroke?
A stroke occurs when an artery in the brain becomes blocked. This may occur from a blood clot or a burst blood vessel. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.
Many of the risk factors for stroke, such as high blood pressure, heart and blood vessel disease, high cholesterol, physical inactivity, obesity, diabetes, smoking and alcohol or drug abuse can be lowered or treated. Others, such as increasing age, family history of stroke, African American race, or prior stroke cannot be.
Developments in Prevention
- High blood pressure: The most common and most preventable risk factor for stroke is high blood pressure. According to a review published in the September 18, 2002 issue of the Journal of the American Medical Association (JAMA), lowering blood pressure reduces the risk of stroke an average of 42%. The American Heart Association (AHA) recommends all adults have their blood pressure checked at least once every two years. A healthy blood pressure is less than 140/90. People with other conditions, such as diabetes, heart failure, or kidney failure should aim for a blood pressure of less than 130/85. There is evidence that reduction of blood pressure below these levels may provide further benefit in decreasing stroke.
- High cholesterol: Lowering cholesterol levels with diet or medication may help reduce the buildup of fatty arterial plaque that can trigger a stroke. The JAMA review found that people taking statins (an effective class of cholesterol-lowering drugs) reduced their risk of stroke by as much as 25%. In a separate recent clinical trial of daily atorvastatin (one type of statin) after recent stroke or "mini-stroke" (and no known coronary heart disease), atorvastatin reduced the risk of repeat stroke or heart attack. * There is benefit in decreasing repeat strokes by treating with “statins” even in individuals with normal cholesterol levels. The AHA recommends adults have a fasting cholesterol check at least every five years. A desirable cholestrol is less than 200 mg/dl (5.2 mmol/L); 180 mg/dl (4.7 mmol/L) or lower in patients with known cardiovascular disease (CVD) or mulitple CVD risk factors.
- Heart arrhythmias: Patients who have an irregular heart rhythm called atrial fibrillation and take warfarin (a blood thinner) may lower their risk for stroke by as much as two thirds. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.
- Diabetes: If you have diabetes, keeping your blood pressure below 130/85 can reduce your risk of stroke by as much as 44%, according to the JAMA review. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors are especially helpful for this purpose. Control of blood sugar is important as well in decreasing stroke risk.
- Smoking: Cigarette smokers have twice the risk of suffering a stroke as nonsmokers. However, if you stop smoking, your risk of stroke will fall to the same level as someone who never smoked within about five years. There are many smoking cessation aids available today, including working with your physician, taking support classes, or using nicotine patches, sprays, gum, or certain antidepressant drugs.
- Aspirin and aspirin derivatives: These drugs make blood platelets less sticky and therefore less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a warning stroke (called a transient ischemic attack (TIA), or a "mini-stroke") may benefit from taking an anti-platelet agent. Aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), or the combination of aspirin plus dipyridamole (Aggrenox) are usually reserved for patients at high risk for stroke because they may have adverse effects such as bleeding.
- Carotid artery surgery: Patients who have fatty arterial deposits in their neck, which can lead to stroke, may benefit from a surgical procedure called carotid endarterectomy. In patients with severe arterial blockage and a history of previous stroke or warning stroke, this procedure may reduce their risk of a second stroke by as much as 44%.
Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke discuss your options with your health care provider. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes the time to diagnosis and treatment is extremely important.
American Stroke Association
National Heart, Lung, and Blood Institute
National Stroke Association
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
About stroke: Impact of stroke. American Stroke Association website. Available at: http://18.104.22.168/presenter. Accessed Sept. 22, 2003.
About stroke: What are the risk factors of stroke? American Stroke Association website. Available at: http://22.214.171.124/presenter. Accessed Sept. 22, 2003.
Chalmer J, Todd A, Chapman N, et al. International society of hypertension (ISH): statement of blood pressure lowering and stroke prevention. J Hypertension. 2003;21:651-63.
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Llinas FH, Aldrich E, Wityk R. Update on stroke prevention and treatment. Advanced Studies in Medicine. 2003;3:93-101.
Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guidline from the American Heart Association/American Stroke Association Stroke Council: co-sponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity and Metabolism Council; and the Quality of Care and Outcomes research Interdisciplinary Working Group. Circulation 2006;113:e873-923.
Preventing stroke with evidence-based care. Patient Care. 2002; June:48-57.
Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: Scientific review. Journal of the American Medical Association. 2002;288:1388-1395.
*Updated on 9/19/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-59.
Last reviewed May 2008 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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