Stroke Prevention: One, Two, Three

The fear of having a stroke is widespread, and it’s little wonder. Every year, stroke affects nearly 800,000 Americans. Despite significant progress in treating stroke, it’s still the fifth-leading cause of death in the United States and a leading cause of disability for those who survive.

In fact, stroke is the number one preventable cause of disability, according to the American Stroke Association, and therein lies hope for the fearful.

“Many of these strokes could be prevented, whether it’s with medications or a surgical procedure,” says Dr. Mark Wyers, a vascular surgeon in the CardioVascular Institute at Beth Israel Deaconess Medical Center.

Three Types of Stroke

Ischemic Stroke

Ischemic stroke occurs when a blood vessel supplying blood to the brain is blocked, by a blood clot or plaque, a waxy buildup of fat, cholesterol and other substances. Eighty-seven percent of all strokes are ischemic.

Hemorrhagic Stroke

Hemorrhagic stroke occurs when a weakened blood vessel in the brain ruptures, most often due to uncontrolled high blood pressure.

Transient Ischemic Attack (TIA)

TIA is caused by a temporary blood clot. Though these are often called “mini strokes,” TIAs should be taken seriously. Your risk of stroke can increase by up to 17 percent in the three months following a TIA.

Three Broad Approaches to Avoiding Stroke

1. Know Your Risk

There are many risk factors for stroke. And, of course, the more you have, the higher your risk. A number of medical conditions can predispose you to stroke.

• High blood pressure:The leading cause of stroke.
• Diabetes: Increases your stroke risk by 400 percent.
• Atrial fibrillation:An irregular heartbeat that causes blood to pool in the heart and clot.
• Carotid artery disease:Responsible for 25 percent of all strokes.
• Peripheral artery disease:A narrowing of the arteries to your legs, stomach, arms and head, caused by a buildup of plaque.
• Heart disease:Coronary artery disease, heart failure and cardiomyopathy (scarring of the muscle tissue in the heart), can all cause blood clots that can lead to a stroke.
• Brain aneurysm: Arterial bulges that can rupture in the brain.

Age, gender and race are contributing factors as well. Your risk of stroke doubles every decade after the age of 55. In general, women have more strokes then men. African-Americans are twice as likely to have a stroke, partly because they’re also more likely to have high blood pressure, diabetes and obesity. Other high-risk groups include Hispanics and Asian/Pacific Islanders.

If you’ve had a stroke before, you’re at a higher risk, as 25 percent of all strokes are recurrent events. A family history of stroke is also a risk factor.

What’s the takeaway? Have regular check-ups and work closely with your physician to manage these risk factors if they apply.

2. Take Preventive Steps

Lifestyle factors like hypertension, high cholesterol, obesity, diabetes and heart disease increase your risk of stroke. So, any steps you can take to prevent or manage these conditions will, in turn, decrease your stroke risk.

• Eat right:Focus on plant-based foods like fruits, vegetables, beans, whole grains and nuts. Avoid processed foods that are usually high in sodium, sugar, solid fats and refined grains. If you’re overweight, work with your doctor to come up with a sensible weight loss plan.
• Move more:The U.S. Centers for Disease Control (CDC) recommends a weekly 150 minutes of moderate-intensity activity (brisk walking, cycling, aqua aerobics) or 75 minutes of vigorous-intensity activity (jogging, running, lap swimming), plus two or more sessions of weight training exercises. It’s okay to break up your sessions into 10-minute segments.
• Drink responsibly: Excessive alcohol consumption can lead to high blood pressure. And, a recent study found that people aged 50 to 60 who average more than two drinks a day have a 34 percent higher risk of stroke. The CDC recommends that women limit themselves to one drink a day, and men to no more than two.
• Quit smoking:Smoking is a leading cause of both heart disease and stroke. It damages the lining of the blood vessels and causes stenosis (a narrowing of those vessels). It also makes your blood thicker and more likely to clot, and increases plaque buildup in the vessels leading to your brain.

3. Explore Your Treatment Options

Since high blood pressure is the leading cause of stroke, the first line of defense often involves treating that condition. Patients may be prescribed any number of medications including diuretics, alpha blockers, beta blockers or ACE inhibitors, just to name a few. Patients with high cholesterol may also take drugs called statins. A small daily dose of baby aspirin to thin the blood and prevent clots helps lower stroke risk.

At the CVI, Dr. Wyers’ specialty is carotid artery surgery. You have two carotid arteries, one on each side of your neck, which supply blood to your brain.

“Routine screening for narrowing of this artery is not necessary for everyone,” he says, “but if you have high cholesterol, high blood pressure or heart disease, your doctor may recommend an ultrasound to check for narrowing.”

Moderate narrowing can be treated with baby aspirin and statin medications, which have significantly lowered the risk of carotid-related strokes in recent years.If you’ve got a 70 to 75 percent blockage, you may be able to reduce the risk further by having a carotid endarterectomy. In this procedure, Dr. Wyers  (right) opens up the artery and cleans out the waxy plaque buildup. It’s one of the most common surgeries performed in BIDMC’s Division of Vascular Surgery.

“We probably perform a couple hundred a year,” says Dr. Wyers. “Patients generally come in for the surgery, spend a night here and then go home the next day.”

Patients who have had a previous carotid surgery, have been treated with radiation or are simply too sick are not good candidates for an endarterectomy. Instead, the vascular surgeon performs a carotid stent procedure. In this minimally invasive treatment, a metal mesh tube is inserted into the carotid where the plaque is the tightest. A tiny balloon is then inflated to expand the stent.

If you are diagnosed with carotid artery disease, Dr. Wyers recommends getting an evaluation from a vascular surgeon who can offer you all three treatment options — medication, carotid endarterectomy and the carotid stent.

You’ll never be able to eliminate your risk of stroke entirely, especially as you get older. But it’s heartening to know the power of some very simple preventive steps — like working with your doctor to manage risk factors, exercising regularly and eating right.

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.