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How to Reduce the Risk of Stroke

About every 40 seconds, someone in the U.S. suffers a stroke, the No. 3 cause of death and the No. 1 cause of disability in the U.S.
Many of these strokes can be prevented, and a new report from Consumer Reports Health tells 11 ways to do it.
But if a stroke does occur, recognizing it and getting help immediately may save one’s life and even prevent or limit the stroke’s disabling effects.  For maximum benefit, treatment must begin within three hours of a stroke’s onset. Because more than 77% of strokes in the U.S. are first-time events, learning how to tell when one is having a stroke and knowing about the three-hour window for best treatment is critically important.
Now is an ideal time to raise one’s stroke learning curve, not only because time can be of the lifesaving essence, but also because May is National Stroke Awareness Month.

“Many people don’t realize that by making healthier lifestyle changes, they can cut their risk of stroke dramatically,” says Orly Avitzur, M.D., medical adviser, Consumer Reports Health, and a board-certified neurologist.   “American adults have their work cut out for them; only a very small fraction of people in their 40s and 50s have a handle on the major cardiovascular risk factors for stroke. Fortunately, many of those risk factors can be reduced or eliminated by controlling blood pressure, improving cholesterol levels, reining in diabetes and quitting smoking.”
Stroke is caused by sudden loss of blood flow to the brain, or bleeding in or around the brain, either of which can cause brain cells to die.  “Hypertension is the most important and treatable risk factor for stroke, yet more than half of Americans with high blood pressure don’t have it under control,” Avitzur says.
These medical and lifestyle changes can help prevent a stroke:

Medical Changes

Lower blood pressure – High blood pressure damages arteries so they clog or burst more easily, escalating the risk of both types of stroke, respectively: ischemic, and the less common but deadlier hemorrhagic.  Consumer Reports Health recommends having blood pressure checked regularly – at least once every two years, more often for adults 50 and older.   People with a reading that is high-normal—above 120/80 mmHg but below 140/90 mmHg, the cutoff for hypertension, should try lowering their blood pressure by adopting lifestyle measures.   Those with a blood pressure reading of 140/90 mmHg or higher should talk to their doctor about an antihypertensive drug.   Consumer Reports Best Buy Drugs (BBD) identifies “best buys” for treating high blood pressure and other conditions based on a review of the medical evidence. 

Improve cholesterol levelsLDL (bad) cholesterol, a fatty substance in the blood, builds up plaque on artery walls, causing arteries to narrow. If plaque ruptures, a blood clot can form and block a blood vessel to the brain, causing a stroke.  All men 35 and older and women 45 and over at high risk for heart disease should get a complete lipid profile at least every five years.   People with a low risk should aim for an LDL level under 160 milligrams per deciliter; those at intermediate risk, under 130 mg/dL; and those at high risk, under 100 mg/dL or lower. If exercise and a diet minimizing saturated fat and cholesterol don’t improve cholesterol levels, talk to a doctor about using statin drugs. (To determine risk, use Consumer Reports’ online calculator.)

Rein in diabetes – High blood-sugar levels damage blood vessels over time. In addition, people with diabetes are likely to have hypertension, high cholesterol and excess weight.   Adults who are 45 or older should have their blood sugar measured at least once a year if they’re prediabetic (or every three years for those who aren’t).  Adults with diabetes should keep their blood pressure below 130/80 mmHg with lifestyle approaches and medication if needed.   Aggressive lowering of blood pressure and the use of statins can reduce the risk of stroke.   Consumer Reports Health notes that an ACE inhibitor or angiotensin receptor blocker (ARB) is useful because those antihypertensive drugs slow the progression of kidney disease in people with diabetes.  In addition, try lowering LDL cholesterol to below 100mg/dL.

Consider low-dose aspirin – Aspirin wards off heart attack and stroke by preventing artery-blocking blood clots. But it’s not for everyone. For example, the benefit against heart attacks applies mainly to men 45 and older and the benefit against strokes applies mainly to women 55 and older.  Consumer Reports Health notes that aspirin can cause dangerous gastrointestinal bleeding, but recommends that people of any age who are at very high risk of stroke (including those who have already had a stroke or mini-stroke or have heart disease or diabetes) should almost always take aspirin to protect their heart.

Have pulse checked – Atrial fibrillation, a heart-rhythm disorder, can lead to blood clots that can travel to the brain, amplifying the risk of an ischemic stroke.  It’s best to have a doctor check for irregular rhythms at every visit and follow up with an electrocardiogram or other heart monitoring if necessary.

Neck surgery: Think twice – Surgery to remove blockages in neck arteries – or carotid arteries – can reduce stroke risk for those who have already had a stroke. But for those with a narrowed carotid artery that hasn’t triggered any symptoms, the risk of stroke is much lower, and the benefit of surgery is small. Screening for blockages in neck arteries is not recommended for people without stroke-risk factors because it generates so many false-positive test results.

Lifestyle Changes

Follow a brain-healthy diet – Diet has a strong influence on an individual’s risk of stroke. In a study that assessed people’s consumption of fruits and vegetables, each extra daily serving reduced stroke risk by 6%. Other studies have linked high-potassium diets with lower stroke risk, while sodium-heavy diets are tied to greater risk.  Consume a diet low in sodium and saturated fats, but high in potassium rich fruits and vegetables, and low-fat dairy. (Check out the DASH diet.)

Be physically active – Excess fat, especially around the abdomen, raises blood pressure, LDL (bad) cholesterol, and the risk of type 2 diabetes. Do at least 30 minutes of moderate-intensity aerobic exercise five days a week or more.  Adults should consult a doctor if they have a chronic health problem, chest pain or if they’re middle-aged and have been sedentary.

Trim the waist – To determine body mass index (BMI), try Consumer Reports’ online calculator. If one’s BMI is 25 or higher or waist measures more than 40 inches for men or 35 inches for women, commit to regular exercise and a weight-loss diet.

Drink moderately, if at all – Excessive drinking, associated with a 64% increased risk of stroke, raises blood pressure, promotes clot formation, and heightens the risk of atrial fibrillation. But light drinking appears to reduce stroke risk.  Limit alcohol to no more than two drinks a day for men, one for women.

Quit smoking – Cigarette smoking raises blood pressure, decreases exercise tolerance, promotes plaque buildup in arteries, and makes blood more likely to clot. Smokers should talk to their doctor about options to help quit, including, counseling, nicotine replacement and other medications.

TIPS FOR RECOGNIZING A STROKE

If one thinks a person may be having a stroke, remember to act F.A.S.T. and do this simple test:

F – FACE – Ask the person to smile. Does one side of the face droop?
A – ARMS – Ask the person to raise both arms. Does one arm drift downward?
S – SPEECH – Ask the person to repeat a simple phrase. Is his or her speech slurred?
T – TIME – If one observes any of these signs, call 911 immediately.

To view the report, visit www.ConsumerReportsHealth.org.


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