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REDUCING YOUR RISK FOR STROKE
Most of the controllable risk factors for stroke relate to cardiovascular
fitness. Because stroke is a form of cardiovascular disease,
it makes sense that keeping your heart and blood vessels as
healthy as possible will reduce your risk of stroke. The following
are the most important measures you can take to control your
stroke risk. These include changing risk factors by medical
treatment as well as by positive lifestyle modifications.
Regular Medical Check-ups - Risk factors such as heart disease,
high blood pressure, and elevated blood cholesterol and lipids,
must be monitored by your physician on a regular basis. These
risk factors can be changed or, at minimum, controlled, by proper
medical treatment and appropriate diet and lifestyle modifications.
Controlling Blood Pressure - High blood pressure (hypertension)
is the single most important risk factor for stroke. Even mild
hypertension, if not adequately treated, increases stroke risk.
In general, blood pressure should be below 140/90. Elevated
blood pressure promotes atherosclerosis and puts abnormal pressure
on blood vessel walls, which can cause a rupture at a weak spot.
Hypertension is often called the “silent killer” because
there may be
no obvious symptoms. It is important to check your blood pressure
regularly. Controlling blood pressure, whether by a low-sodium
diet, weight control, stress management and/or medication will
reduce your risk of stroke.
Remember: medication to control hypertension is effective only
if
taken on a regular basis, so it is important to follow your
physician’s instructions.
Treatment of hypertension in older adults is also important.
However, in elderly individuals, an abrupt fall in blood pressure
may actually cause a stroke. Therefore, treatment of high blood
pressure in the elderly may need to start with small doses of
medication, so that blood pressure is reduced gradually. In
general, people over the age of 60 should have blood pressure
less than 160/90.
Stop Smoking - Studies confirm that smokers have a higher
risk of stroke, regardless of other factors such as age, high
blood pressure, or heart disease. The risk declines dramatically
within a few years of stopping smoking.
Treat Heart Disease - A variety of heart conditions,
including
irregular heart rhythm (atrial fibrillation), heart attacks
and heart valve disorders, can cause stroke. Treatment of these
disorders can reduce stroke risk.
Treat Diabetes - The association between diabetes and increased
stroke risk seems to be related to the circulatory problems
caused
by diabetes. Good control of diabetes appears to reduce the
cardiovascular complications of the disease.
Improve Diet - Consumption of foods high in fat, cholesterol
and
salt increases the risk for stroke. The following recommendations
are among the most important for stroke prevention.
Ask your doctor for more help in identifying dietary culprits
and making appropriate substitutions.
Dietary Guidelines
1. Avoid excess fat: High intakes of fat, particularly
saturated fat, and cholesterol may contribute to atherosclerosis,
which is associated with stroke. Dietary fat and cholesterol
may be reduced by limiting fat or oil added in cooking, trimming
fat and skin from meats and poultry, using low-fat or non-fat
dairy products, broiling and baking foods rather than frying,
and limiting eggs to no more than three a week.
2. Avoid excess sodium: Excess sodium in the diet
is linked to hyper-tension. Table salt is the primary source
of dietary sodium. There
is “hidden” salt in most processed and canned foods.
Disodium phosphate, monosodium glutamate, sodium nitrate,
or any similar compounds in the list of ingredients indicate
a high sodium content.
Try to eat fresh food whenever possible.
3. Limit alcohol intake: Individuals who drink alcoholic
beverages (more than two drinks per day) have an increased
risk of stroke. For heavy drinkers, the risk of stroke increases
further. Healthy young adults are just as susceptible to the
risk of stroke incurred by heavy alcohol consumption as are
older persons.
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Lifestyle Changes
1. Maintain a Healthy Weight - Being overweight
strains the heart and blood vessels and is associated with
high blood pressure. Obesity also predisposes a person to
heart disease and diabetes, both of which increase the risk
for stroke. Keeping your weight to recommen-ded levels for
your height and build is a prudent preventive measure.
2. Exercise Regularly - The percentage of fat in
our bodies tends to increase with age. Regular exercise helps
keep this increase to a minimum. There appears to be an inverse
relationship between exercise and atherosclerosis, i.e., more
exercise is linked to lower levels of atherosclerosis.
3. If you have not exercised regularly and would
like to start an exercise program, or if your have medical
problems or family history
of serious disease, consult your physician before beginning
an exercise program. Select an exercise program that is most
suitable for you.
Experts recommend at least 20 to 30 minutes of aerobic exercise
three to four times a week in order to achieve and maintain
an improved level of fitness.
4. Reduce Stress - Because stress may increase
blood pressure,
it is linked indirectly to stroke risk. A one-time stressful
event rarely causes a stroke, but long-term unresolved stress
can contribute
to high blood pressure. Stress management, including relaxation
techniques, biofeedback, exercise and counseling, appear to
be
useful in the treatment of high blood pressure, thus lowering
the risk of stroke.
5. Use of Oral Contraceptives - Oral contraceptives,
especially those with high estrogen content, appear to increase
the risk of blood clots, including clots that cause stroke,
especially in women over age 30.
The risk is even higher in women who smoke. Consult your physician
for advice regarding alternative methods of birth control
if you have stroke risk factors and are currently using oral
contraceptives.
Post-menopausal estrogen use does not appear to increase
stroke risk.
Risk Factors That Cannot be Changed
Age - The chance of having a stroke increases with age.
Two-thirds of strokes occur in persons over the age of 65.
Gender - For reasons that are not yet clear, stroke is
25 percent more common in men than in women.
Race - The incidence of stroke varies among races for
reasons that are probably related to genetic factors. Social
factors, such as lifestyle and environment, can also play
a part. African-Americans have a higher incidence of hypertension
than Caucasians, and also a higher rate of stroke. Furthermore,
Africa-Americans are more likely to suffer strokes at an earlier
age.
Family or Individual History - A history of cerebrovascular
disease in a family appears to be a contributing factor to
stroke.
While you have no control over your family history, you can
take steps to decrease your risk through diet, exercise and
other means. If you have experienced a stroke or TIA in the
past, you are at increased
risk for having a stroke in the future. Therefore, all the
preventive measures discussed in this section are of particular
importance.
National Cholesterol
Education Month
The National Heart, Lung, and Blood Institute’s
2003 theme for National Cholesterol Education Month is “Know
your cholesterol numbers, know your risks.” Below are
6 Simple Steps to Help Reduce Your Risks
• Get a fasting (10-12 hrs prior to exam) lipoprotein
profile to find out what your total cholesterol, LDL (Bad)
cholesterol, HDL (good) cholesterol, and triglyceride numbers
are.
• Discuss with your physician or health care provider
what your risk for heart disease or stroke are and what steps
you can take to reduce the risk factors that put you at risk.
• Learn how to read a food label. Choose foods that are
low in saturated fat, trans fat, and cholesterol.
• Calculate your body mass index and see how your weight
measures up.
• Participate in physical activity of moderate intensity-like
brisk waling-for at least 30 minutes on most, and preferably
all, days of the week. No time? Break the 30 minutes into
three, 10 minute segments during the day.
• Don’t smoke. If you do smoke, contact your healthcare
provider to discuss ways in which they can help you quit.
If you would like more information on the National
Heart, Lung and Blood Institute’s Steps for Reducing
Your Cholesterol, visit their website at www.nhlbi.nih.gov/
and go to the Live Healthier, Live Longer webpage.
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