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Stroke prevention

What to do to reduce the risk of stroke?

You can prevent yourself from developing a first or a recurrent episode of stroke. Stroke is preventable in 80% of the cases.

Once you develop a stroke, there are 25% chances of recurrence of stroke. Half of the recurrent strokes occur within the first 90 days after the first episode of stroke.

There are 17% chances of developing a stroke within 90 days of an episode of TIA. The risk is even higher within the first week of the TIA episode.

The prevention of stroke consists of following:

• Lifestyle changes

• Medicines

• Preventive surgical procedures

Lifestyle changes

AHA has suggested certain lifestyle changes that can help you to minimize the risk of stroke. These are as follows:

 

1. Manage Blood Pressure

BP automatic machine scaled

High blood pressure is a significant risk factor for stroke. Keeping a good control on the blood pressure can significantly reduce the chances of stroke.

AHA/ASA has advised the following things to lower the blood pressure:

• Weight loss

• Reduced sodium intake

• Regular aerobic physical activity

• Mediterranean-style diet

• Limited alcohol consumption

• Medicine: anti-hypertensive medicine is given in patients with a TIA or recurrent ischemic stroke with a systolic BP higher than 140 mm Hg or diastolic BP higher than 90 mm Hg. The medicine is given for several days following the event. Drugs such as thiazide diuretics alone or with an angiotensin-converting enzyme (ACE) inhibitor is given.5–7

 

2. Control Cholesterol

High cholesterol level is associated with the formation of fatty plaque in the arteries. The plaque in brain arteries causes reduced blood flow to the brain leading to stroke. Thus, controlling your cholesterol levels potentially reduce the chances of stroke.

Medicine: Recurrent stroke or TIA of suspected atherosclerotic origin, should receive a statin (lipid-lowering drug) such as rosuvastatin (20 mg) or atorvastatin (40 mg or more).

 

3. Manage Blood Sugar

blood-sugar-monitor

High levels of blood sugar for long damages your heart and blood vessels, which may lead to the development of clots or blockages in the arteries of the brain.

Controlling your diabetes with lifestyle changes and medicines or insulin can help to reduce the risk of stroke.

The AHA/ASA suggests diabetic screening in all patients of ischemic stroke. Tests done are HbA1C, fasting plasma glucose, or oral glucose tolerance test.

 

4. Do Physical Activity

Exercise-information

Doing regular physical activity reduces the stroke risk factors such as diabetes, high cholesterol levels, and BP.

It is advisable to do aerobic physical activity for at least 120 to 150 minutes a week. You should perform a medium-intensity exercise (brisk walking) or a vigorous-intensity exercise (jogging), preferably spread evenly.

 

6. Lose Weight

Losing extra weight can help to reduce the associated risk factors such as high triglycerides, diabetes, etc. A weight loss of 5% to 10% results ina fall of HbA1c by 0.5 percent and systolic blood pressure by 3 to 6 mm Hg. It also increases the good cholesterol (HDL) by 3 mg/dL.

 

7. Eat healthy diet

You should eat a diet that is low on sodium, cholesterol, and sugar. If you had a stroke or TIA, you should restrict your sodium intake to less than 2.4gm per day. A Mediterranean-type diet is advisable, consisting of whole grains, vegetables, fruits, low-fat dairy products, poultry, fish, and legumes.

 

8. Smoking

Smoking is a significant risk factor for the first stroke and a recurrent stroke. According to the AHA guidelines, if you have a history of stroke or TIA, you should quit smoking.

 

9. Alcohol

alcoholic-liver-disease

If you are a heavy drinker (more than two drinks per day) or does binge drinking (more than 4 drinks in a sitting), you may have a high risk of developing a recurrent stroke.

If you have a stroke history and are a heavy drinker, you should stop or reduce alcohol consumption.

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Medicines- Blood thinners

Antiplatelet drugs

These medicines restricts the aggregation of the platelets to form a blood clot. There are three drugs approved by the FDA:

1. Aspirin: Most commonly used medicine to prevent recurrent stroke.

Dose: 50 to 325 mg daily. Benefits doesn’t change with treatment but side effects increase with increased dose.

Side effects: Bleeding inside gut (3%), bleeding within the brain (0.5%), and aspirin allergy.

 

2. Clopidogrel: as effective as aspirin but has a lower rate of bleeding. Good alternative for people with aspirin allergy.

Dose: 75 mg daily

Side effects: Bleeding inside gut (2%), bleeding within the brain (0.35%)

 

3. Aspirin/dipyridamole: as effective as aspirin, but less well tolerated.

Preventive surgical procedures

Angioplasty

angioplasty-and-stenting

This procedure opens up the narrowed arteries to the brain and re-establish normal blood flow to the brain.

It is done by a neuro-interventionalist who inserts thin specialized tubes into the arteries of the groin and steer it to a narrowed artery. Once the tube (catheter) is positioned in the narrowed artery, a balloon is inflated. This causes flattening of the plaque against the wall opening the artery.

Carotid endarterectomy

This procedure is done when blockage of the artery is severe-more than 70%. The surgery reduces the risk of stroke by 65%.

In this surgery, a cut is made on the neck, and the neck artery (carotid) is opened to remove the accumulated plaque.

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