Stroke is the third leading cause of death and the number one cause of disability in adults, with close to 800,000 new strokes occurring each year in the U.S. With a growing aging population, it is estimated that stroke will be the leading cause of death worldwide in the next few decades.
Who is most at risk for a stroke?
A well-established fact, as you get older, the risk of stroke significantly increases. The risk doubles every 10 years after the age of 55. A common perception is that stroke happens only to much older people. The truth is: While stroke is more common after the age of 55, no one is spared from stroke. One-third of strokes occur before the age of 55 and can happen at any age. Women are just as susceptible as men – the difference is that it usually hits women about 10 years later than men. Unfortunately, this age difference also puts women at greater risk of dying from stroke, as they are likely to get it at an older age, possibly also less likely with less social support.
The encouraging news is today we have more knowledge and effective ways to prevent stroke by controlling the risk factors and using medications and interventions to prevent first and second-time strokes. Everyone should be screened or evaluated for the risk of stroke after the age of 55. An initial screening involves a patient history and physical exam.
If you want to know if you are at risk for stroke, ask yourself the following questions:
Did I ever have a stroke or a transient ischemic attack (TIA)?
A transient ischemic attack (TIA) results from a sudden but temporary interruption of the blood supply to a brain region resulting in symptoms that last several minutes and rarely several hours. Individuals who have experienced a TIA have a 10% chance of developing stroke within the next 90 days, though many will have a stroke in the following 48 hours. If a person has experienced a TIA, they should work with their doctor to be evaluated and treated to prevent a stroke.
Do I have an irregular heartbeat?
Check with your doctor to see if you have atrial fibrillation (AF), which is a specific type of irregular heartbeat. You can take your pulse to see if it is regular or irregular. If it is irregular, you should talk to your doctor. Many smartwatches or technologies may often reliably detect an irregular pulse or even diagnose atrial fibrillation. If you have AF, your risk of stroke will be significantly increased by an average of 5% per year. However, an appropriate treatment with oral anticoagulants like warfarin or other newer agents can reduce the risk by up to 80%.
Are the major blood vessels in my neck narrowed?
If so, treatment with medications, intervention, or surgery can dramatically reduce your risk for stroke, depending on if they are causing symptoms or not, in addition to other factors.
Do I have abnormally elevated cholesterol or other fats in my blood?
Elevated cholesterol is more strongly associated with heart disease than stroke, but it does contribute to increasing the risk of stroke. Medications can significantly lower cholesterol and lower the risk of future stroke by about 16% in those with a prior stroke.
Am I a smoker?
Smoking tobacco, in all its forms, is well documented to increase the risk of heart disease and stroke. It can also contribute to the narrowing of the arteries in the neck and inside the skull. The good news is there are indications that five years after stopping smoking, the risk decreases.
Do I have diabetes? Am I predisposed to have diabetes?
Controlling diabetes with medications, losing weight, and exercise can significantly reduce your risk of stroke and heart disease. Even if you do not have full-blown diabetes, being predisposed to diabetes (insulin-resistance) increases the risk for stroke. Treating patients with stroke and insulin-resistance with a diabetes medication significantly lowers the risk of stroke.
Is my blood pressure high? Am I predisposed to have hypertension?
Hypertension is probably responsible for more than half of all strokes. Even if you do not have hypertension but a family member does, this may increase your risk of developing it. If you do not measure your blood pressure, you will not know if you have hypertension since it does not cause specific recognizable symptoms. Check your blood pressure frequently and discuss your risk with your doctor. Ideal blood pressure is below 120/80. Losing weight, lowering salt in your diet, adopting a diet rich in vegetables and fruits, and exercising will prevent hypertension or will lower it.
Do I have heart disease?
Maintaining a well-functioning healthy heart through regular physical activity and a healthy lifestyle is an effective strategy for lowering the risk of stroke.
Do I drink alcohol excessively?
Excessive alcohol drinking, particularly in binges, can significantly increase the risk of hemorrhagic and ischemic stroke. Moderate alcohol intake (one drink/day for women and two drinks per day for men) may even reduce the risk of stroke and heart disease.
Am I too physically inactive?
Lack of regular exercise is associated with an increased risk of stroke and heart disease. It also increases the risk of obesity, hypertension, diabetes and high cholesterol. A moderate amount of exercise, like walking briskly for an hour, five days a week, is enough to lower your risk. You do not need to run marathons to decrease the risk of stroke.
What are the major warning signs (symptoms) of stroke?
If you are at risk for stroke, you need to know what the symptoms are, learn how to recognize them, and plan with your family and friends how your stroke should be handled if it happens.
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden trouble speaking or understanding speech
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, loss of balance or coordination
- Extremely severe headaches with no other known cause
Not all of these warning signs occur in every stroke. If at least one does, don’t wait. Get help immediately.
What do I do if I recognize that me or someone else is having symptoms of stroke?
CALL 911 IMMEDIATELY!!!
Why? Because there are extremely effective treatments once a stroke happens, but they have to be given within a few hours after the stroke occurs, and preferably in a recognized specialized certified stroke center. The earlier the treatments are given, the better the outcomes.
- Intravenous tPA or a clot buster, has to be given within four and a half hours, and sometimes longer in some circumstances. But the earlier it is given, the more effective it is.
- Another super-specialized treatment consists of placing a catheter in the groin and threading it into the blood vessel in the brain that is blocked, opening a "stent" (a cylindrical metal mesh), and pulling the clot outside the body to restore blood flow to the brain. The procedure is called "mechanical thrombectomy" and has to be done within 24 hours. Not all patients are candidates for that procedure.