There are many risk factors that cause stroke and some are listed below. However, by far the most common and preventable risk factor is high blood pressure, also known as hypertension.
There is plenty of evidence from around the world to support the view that reducing BP will reduce the chance of stroke. In fact, for every 3-5mmHg drop in BP there is an approximate 40% reduction in the chance of stroke. Therefore it is critical to get regular BP measurements and ensure any history of high BP is followed up and treated appropriately. Some risk factors of course are not treatable. The largest of these non-modifiable factors is age.
More than half the strokes are caused by high blood pressure. The lower the BP the better it is. The optimal BP should be less than 120/80. A diagnosis of high blood pressure or hypertension is usually made when your blood pressure is consistently above 140/90, and at his point treatment is offered.
Obviously any underlying treatable causes of high BP should be sort and treated appropriately eg kidney disease.In order to reduce high blood pressure most people will need treatment with medication. However, there are lifestyle changes that could help reduce it without medication.
If you have AF your risk of having a stroke increase by five timesAtrial Fibrillation is a type of irregular heart beat with no fixed pattern – irregularly irregular pulse. This doesn’t allow one of the chambers (left atrium) in the heart to contract properly and can lead to the development of a clot forming within that chamber. If a bit of the clot breaks off it could lodge in one of the arteries supplying the brain and this could result in an ischaemic stroke.
The symptoms of AF include:
Atrial fibrillation is usually be picked up by simply palpating the pulse and is confirmed by doing an Electrocardiogram (ECG) which shows the typical pattern of AF.There are basically 3 types of AF:
Treatment of AF depends on a number of things depending on if an underlying cause is found, how long it has been present and the nature of the rhythm and the symptoms it is causing.If there is no reversible cause for your AF, then treatment is targeted at trying to dissolve the clot and to prevent further development of clots within the heart. The drugs used are called anticoagulants. The two main group of drugs used are either warfarin (a Coumarin) or novel oral anticoagulants (NOAC).
With warfarin one needs have regular monitoring of the “coagulability” of the blood – the unit of measure used is international normalized ratio (INR). The dose may vary after each testing, also the INR can be affected by food stuffs and interactions with may common medication. If the blood becomes dangerously thin then the effects of the warfarin can be reversed almost immediately by giving vitamin K.
NOACs do not require as close monitoring and the dose remains the same throughout the treatment. There is no immediate reversal for this group of drug, in an emergency e.g. life threatening haemorrhage then IV Tranexamic acid can be given and also platelet transfusion is given.
Cholesterol is a fatty substance that is found in our blood and is vital to allow are bodies to function properly. Most of the cholesterol found in our bodies is in fact made by our livers and but it can also be absorbed by the gut from what we eat. The amount made by the liver is determined by our genes i.e. it is inherited. However, we can obviously adjust the amount we eat.
Cholesterol is transported around the body, in the blood, by being bound to proteins. These bound cholesterol and protein units are called lipoproteins. There are two main groups of lipoproteins:
It is not only the total amount of cholesterol you have in your body that is important but, the ratio of good cholesterol to the total cholesterol.
If there is too much “bad” cholesterol compared to “good” cholesterol, then your risk of having a stroke is increased. This is because there is more cholesterol being deposited in the arteries and plaques form which can narrow the arteries and also clots can form on the plaques which can be dislodged and carried off into the brain where they can cause an ischaemic stroke.
There is no “symptoms” of high cholesterol and therefore one needs to have a blood test looking for it. If you have a family history of high cholesterol or diabetes or cardiovascular disease, then it is important to have your cholesterol levels checked.
Cholesterol can be reduced somewhat by reducing the amount of saturated and trans fats in your diet. Some foods are high in cholesterol content and others help to reduce the cholesterol.
The most commonly prescribed class of medication used to reduce are statins. These work on the liver to reduce the amount of cholesterol that it makes. This process normally happens whilst we are sleeping at time and therefore statins should be taken at night.
Atherosclerosis is a condition where arteries become clogged up by fatty substances (cholesterol and triglycerides) known as plaques or atheroma. The plaques cause affected arteries to harden and narrow, which can restrict blood flow can damage organs and stop them from working properly.
If the plaque ruptures a small part of the atheroma or clot can get lodged in one of the arteries supplying the brain and cause as an ischaemic stroke.
What exactly causes atherosclerosis is not completely clear but we do know that some diseases and activities we undertake can increase the risk of developing atherosclerosis:
Treatment of atherosclerosis involve reducing or eliminating the risk factors of developing it in the first place. Therefore smoking cessation, healthier diet (including 5-a-day of fruit and vegetables), reducing intake of saturated and trans fats, weight loss, increasing activity / exercise, controlling ones diabetes BP and cholesterol with appropriate medication if needed.
(Ref: www.NHS.UK website)
Diabetes mellitus (DM) is a disorder of having too much sugar in your blood. And diabetes doubles your risk of having a stroke.
There are 2 types of diabetes
High levels of sugar in the bloodstream can damage the arteries and also other organs; for example, the kidneys which in turn can lead to high blood pressure which again damages the blood vessels. And damaged blood vessels can lead to stroke. Diabetes can also affect cholesterol levels.
Therefore, it is important to screen for and treat diabetes to reduce the risk of developing a stroke.Diabetics need to control their blood sugar to reduce their risk of stroke. In early type 2 diabetes it may be possible to control the sugar levels purely by reducing one’s sugar intake. Being overweight or obese alters the way that the cells respond to insulin – insulin resistance – this means that the cells are unable to utilise the sugar in the bloodstream despite there being enough sugar in the blood. Therefore, weight reduction might help to control DM. Exercise also affects blood sugar levels. Increasing one level of activity or exercise can also help to reduce the blood sugar levels, both in the short term and long term. Some patients need to take medication to help control their blood sugar levels and with long standing or poorly controlled diabetic then insulin may be necessary.[Stroke association website]
Smoking and tobacco use increases your risk of having a stroke by between 2-3 times that of non smokers. Smoking increases the thickness of the blood (making it more coagulable) and therefore increases the risk of developing clots, it also encourages plaque (atheroma) formation within the arteries and these can both lead to strokes.
Therefore, to reduce your risk of having a stroke it is important to try to stop smoking.
There are a number of therapies are now available to help people quit smoking. For example there is Nicotine Replacement Therapy (NRT) the choice of delivery of the medication is vast and include patches, microtabs, gum, lozenges, nasal sprays and inhalators. There are also two differnet tablet therapies to help smoking cessation – they are varenicline (Champix) and bupropion (Zyban). Whichever method you choice (after consultation with a healthcare professional trained in smoking cessation) there is strong evidence that you are more likely to succeed at stopping smoking if the medication is supplemented by psychological support – be it group sessions or one-to-one.
Drinking large amounts of alcohol increases your risk of having a stroke, this is because alcohol can adversely affect a number of medical conditions, for example it can lead to high blood pressure, it can increase cholesterol levels, it can increase sugar levels, it also increases the risk of developing atrial fibrillation, it can damage the liver and this in turn can affect blood clotting, it increase one’s weight and lead to obesity to name a few.
Therefore, it is important to seriously limit the amount of alcohol one drinks to reduce the risk of stroke.As with smoking, the chances of reducing and even giving up alcohol are better when there is psychological support.
UK health guidelines now recommend that both men and women should limit the amount of alcohol they drink to just 14 units per week, and try to have at least 2-3 alcohol free days each week.
There are many benefits to exercising and keeping active. Not only does it reduce the risk of having a stroke but the are plenty of other health benefits to boot. Exercise can boost both you physical and mental health by
By reducing the development of certain conditions that can lead to cardiovascular disease DM in particular:
Regular exercise of just 30minutes a day, 5 days a week can reduce the risk of a stroke by a quarter.
The level of exercise does not need to be very high, and you can gradually increase it as your fitness level improves. To start with the activity should make you feel warm, slightly out of breath and increase your heart rate for a sustained time.[Ref stroke association]
Obesity seems to be an independent risk factor for developing stroke (independent of BP and diabetes and raised cholesterol which are also increased in overweight or obese people).[ Kurth T, Gaziano JM, Berger K, Kase CS, Rexrode KM, Cook NR, Buring JE, Manson JE. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162:2557–2562.] Studies have shown that excess body fat causes release of pro-inflammatory chemical which can affect the walls of the arteries and encourage atherosclerosis.
It is important to try to reduce weight and BMI to within normal limits to reduce your risk of stroke.
For most adults:
a BMI of 40 or above means you are considered severely obese However for people of South Asian (from the Indian subcontinent) a BMI of greater than 23 is considered overweight.
Treatment for obesity in short lifestyle changes are needed. Healthier diets including increasing the amount of fresh fruit and vegetables consumed daily, reducing foods that release sugars quickly into the blood stream, and reducing fatty foods. Referral to see a dietitian may be beneficial, as is keeping a food diary where you record everything you eat or drink and how much. As with smoking and alcohol reduction support is very important and people find it easier if they find a friend to lose weight with or have access to a trained counselor. Other tricks to consider that have shown to be of benefit is to use a smaller dinner plate to encourage smaller portions.
The other side of the equation when trying to lose weight is to exercise (ie use up the calories already stored within the fat tissue).
Failing these lifestyle changes for some people it may be appropriate to take prescribed medication to help reduce the amount of fat being absorbed by the body – such a drug is oralistat. However this can have some unpleasant side effect such as stools that do not flush away easily, bloatedness and diarrhea and flatulence.
Bariatric surgery may be appropriate for some people.
The three most widely used types of weight loss surgery are:
Elevated homocysteine levels have been associated with increased risk of stroke.
Patent foramen ovale (or PFO) is a condition that also affects the heart. Foramen ovale is the name of the hole between the right and left side of your heart. This hole normally closes after birth, but in as many as one in four people it remains open or ‘patent’. Whilst it doesn’t make your blood more likely to clot, a PFO makes it possible for a blood clot to pass from one side of your heart to the other and up to your brain. The clot could have developed anywhere in the body. A PFO is sometimes referred to as ‘a hole in the heart’.
Currently, there are three main treatment methods for PFO: medicine, open-heart surgery and a newer procedure that closes the flap without major surgery.
Medical treatment of PFO is directed at preventing clot formation – ie blood thinners anti-platelet or anti-coagulant therapy, these would obviously be life-long medication.Open-heart surgery should be considered in reasonably fit individuals.
Another option is using a percutaneous procedure whereby a small device is put into the PFO which expands when released and this “plugs” the whole. This procedure is like having an angiogram, and the patient does not need a general anaesthetic.