Many of us here in Anguilla know someone who had a stroke. We are aware how a stroke can be devastating to individuals and their families – robbing them of their independence. Stroke is a common cause of adult disability and death, in Anguilla, and we must do more to prevent strokes.
What is a stroke?
A stroke occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow, and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding into the brain. A blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke called hemorrhagic stroke. Knowing the warning signs of a stroke and controlling stroke risk factors are important in stroke prevention.
What are some risk factors for getting a stroke?
• High blood pressure/hypertension
Hypertension is by far the most potent risk factor for stroke in Anguilla. Hypertension causes a two-to four-fold increase in the risk of stroke before age 80. If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range.
• Cigarette smoking
Cigarette smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke. Your doctor can recommend programmes and medications that may help you quit smoking. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.
• Heart disease
Common heart disorders, such as coronary artery disease, valve defects, irregular heart beat (atrial fibrillation), and enlargement of one of the heart’s chambers, can result in blood clots that may break loose and block vessels in or leading to the brain. Atrial fibrillation—which is more prevalent in older people—is responsible for one in four strokes after age 80, and is associated with higher mortality and disability.
• Warning signs or history of TIA or stroke
If you experience a TIA, get help at once. If you previously had a TIA or stroke, your risk of having a stroke is many times greater than someone who has never had one. Many communities encourage those with stroke’s warning signs to dial 911 for emergency medical assistance. If you have had a stroke in the past, it’s important to reduce your risk of a second stroke.
• Diabetes
In terms of stroke and cardiovascular disease, having diabetes is the equivalent of aging 15 years. You may think this disorder affects only the body’s ability to use sugar or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Hypertension is common among diabetics here in Anguilla and accounts for much of their increased stroke risk. Treating diabetes can delay the onset of complications that increase the risk of stroke.
• Cholesterol imbalance Low-density lipoprotein cholesterol (LDL) carries cholesterol (a fatty substance) through the blood and delivers it to cells. Excess LDL can cause cholesterol to build up in blood vessels, leading to atherosclerosis. Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke.
• Physical inactivity and obesity Obesity and inactivity are associated with hypertension, diabetes, and heart disease. Waist circumference to hip circumference ratio equal to or above the mid-value for the population increases the risk of ischemic stroke three-fold.
There are some risk factors for stroke that cannot be modified by medical treatment or lifestyle changes. These include the following:
• Age. Stroke occurs in all age groups. Studies show the risk of stroke doubles for each decade between the ages of 55 and 85. But strokes also can occur in childhood or adolescence.
• Gender. Men have a higher risk for stroke, but more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.
• Race. People from certain ethnic groups have a higher risk of stroke. For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States.
• Family history of stroke. Stroke seems to run in some families. Several factors may contribute to familial stroke. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes. The influence of a common lifestyle among family members also could contribute to familial stroke.
What can you do to prevent a stroke?
There are a number of things we can do to reduce our chances of getting a stroke. The following will prove helpful for many residents of Anguilla.
Maintain ideal weight
Being overweight or obese increases your risk for stroke. To determine whether your weight is in a healthy range, doctors often calculate your body mass index (BMI). Doctors sometimes also use waist and hip measurements to measure excess body fat. If you are overweight or obese talk to your healthcare provider.
Physical activity
Physical activity can help you maintain a healthy weight and lower your cholesterol and blood pressure levels. For adults, most experts recommend 20- 30 minutes of moderate-intensity exercise, like brisk walking or bicycling, most days of the week. Children and adolescents should get 1 hour of physical activity every day.
No smoking
Cigarette smoking greatly increases your risk for stroke. If you do not smoke, don’t start. If you do smoke, quitting will lower your risk for stroke. Your doctor can suggest ways to help you quit.
Limited alcohol
Avoid drinking too much alcohol, which can raise your blood pressure. Men should have no more than 2 drinks per day, and women only 1.
Other things you can do to prevent a stroke especially if you have a medical disorder, include the following:
Check cholesterol
Visit your doctor and have a lipid profile done. Talk with your health care team about this simple blood test. If you have high cholesterol, medications and lifestyle changes can help reduce your risk for stroke.
Control blood pressure
High blood pressure usually has no symptoms, so be sure to have it checked on a regular basis. Talk to your healthcare team about how often you should check your levels. You can check your blood pressure at home, at a clinic or at a doctor’s office.
If you have high blood pressure, your doctor might prescribe medication, recommend some changes in your lifestyle, or advise you to lower the levels of salt in your diet.
Manage diabetes
Know your blood sugar levels. If you have diabetes, monitor your blood sugar levels carefully. Talk with your healthcare team about treatment options. Your doctor may recommend certain lifestyle changes to help keep your blood sugar under good control. Those actions will help reduce your risk for stroke.
Manage heart disease
If you have certain heart conditions, such as atrial fibrillation (irregular heartbeat), your health care team may recommend medical treatment or surgery. Taking care of heart problems can help prevent stroke.
Take your medications
If you take medication to treat heart disease, high cholesterol, high blood pressure, or diabetes, follow your doctor’s instructions carefully. Never stop taking your medication without talking to your doctor or pharmacist.
Regular medical checkups
It is important to have regular medical checkups even if you do not have any abnormal signs or symptoms. Many persons only discover that they have a medical disorder following a routine medical checkup.
Conclusion
Every year many residents of Anguilla get a stroke. Getting immediate treatment, as soon as one develops signs and symptoms, is important in the management of strokes, but it is also very important to prevent strokes from developing in the first place. You may be able to prevent a stroke by reducing your risk through healthy lifestyle changes. In addition, medication can reduce stroke risk for some people. Talk to your healthcare provider today.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
