Lifestyle changes can reduce risk of stroke

By KRISTI EATON

VIEW ON HEALTH

In the United States, one in every 17 deaths can be attributed to stroke, with a death occurring every three to four minutes, according to the Centers for Disease Control and Prevention. As with many diseases and illnesses, stroke is a caused by a combination of factors that are both within and beyond our control. There is no way to predict what individuals will or will not suffer a stroke, taking steps to control modifiable risk factors can save your life.

WHAT IS A STROKE?

There are two types of strokes: ischemic, which accounts for 85 percent of all strokes, and hemorrhagic. In an ischemic stroke, blood supply to part of the brain is cut off, usually by a blood clot, leading to brain dysfunction. A hemorrhagic stroke, the more deadly of the two, involves a blood vessel in the brain rupturing and bleeding into the brain, which damages the brain cells. Within hours of a stroke, doctors can give patients the clot-reducing drug tissue plasminogen activator before later trying to remove the clot.

"Stroke is by far the no. 1 cause of disability, including cancer and heart disease. It's the third leading cause of death, but no. 1 in terms of disability," says Neurologist Christopher Milford, the medical director for Stroke Services at Southern Hills Hospital. "Patients can typically improve, but they don't usually get all their function back."

The National Stroke Association has developed an acronym, FAST, to help people determine whether a stroke has occurred. Check the following factors:

* Face: When the person smiles, does half of the face droop?

* Arm: When both arms are raised, does one drop down?

* Speech: When repeating a phrase, are the words slurred? Are the sentences repeated correctly?

* Time: Every second brain cells die. Call 911 immediately.

When dealing with stroke, every second matters, Milford says: "When patients think they might be having one-- either because of numbness or weakness on their body or slurred speech -- they should go to the hospital," the doctor says. But he adds, "You'd be surprised how many patients come in saying, 'my right side went numb three days ago' and they just now come in. If they'd come in sooner we might have been able to help them more."

WHAT CAN YOU DO TO PREVENT IT?

Risk factors for strokes can be divided into modifiable -- elements people can change -- and non-modifiable -- elements people can't change.

Modifiable risk factors include:

* High blood pressure, also called hypertension. High blood pressure can greatly increase the risk of stroke. High blood pressure weakens the arteries throughout the body, including the ones in your brain, placing you at a much greater risk of stroke. Damaged and weakened arteries are more prone to rupturing or fill up with blood and balloon out from the artery wall, causing a hemorrhagic stroke.

* Cigarette smoking. Numerous studies in recent years have shown that nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. Smoking injures the blood vessels and hardens the arteries faster, while the carbon monoxide reduces the amount of oxygen that your blood can carry.

* Diabetes, which can often be controlled through proper diet and exercise. Having diabetes -- a disease that causes blood to build up too much sugar instead of delivering it to body tissues -- can worsen the outcome of a stroke if it occurs.

* Carotid or other artery disease. When fatty plaque deposits narrow the arteries that supply blood to your brain, they may become blocked by a blood clot yielding a stroke, says Laurie Teitelman, a New York-based naturopathic doctor.

* Atrial fibrillation.This heart rhythm disorder raises the risk for stroke since the heart is not beating efficiently, which can let the blood pool and clot.

* Other heart disease. People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally.

* Sickle cell anemia. This is a genetic disorder that mainly affects African-American and Hispanic children where "sickled" red blood cells are less able to carry oxygen to the body's tissues and organs.

* High blood cholesterol. People with high blood cholesterol have an increased risk for stroke because the high cholesterol levels can build up fatty plaque deposits on blood vessel walls, blocking the blood flow to the brain, which can cause a stroke.

* Poor diet. An unhealthy diet can cause many of the conditions described above, leading to stroke. For example, a diet high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels, while diets high in sodium, or salt, can contribute to increased blood pressure. An of course, too much food can lead to obesity.

* Physical inactivity and obesity. Again, a lack of physical activity and obesity go hand in hand with contributing to high blood pressure, high cholesterol and heart disease-- all contributing to stroke.

Non-modifiable risk factors include age, sex, heredity, race and whether or not you have had a prior stroke. The older you get, the more likely you are to have a stroke. However, anyone at any age can have a stroke -- the CDC reports that nearly one-quarter of strokes occur in people under the age of 65, the chance of a stroke approximately doubles for each decade of life after age 55, according to the American Heart Association.

Men are more likely to have a stroke than women. However, stroke is more deadly in women. And if a parent, grandparent or sibling had a stroke, you are far more likely to have one in your lifetime as well.

Race is another factor that plays a large role. African Americans are far more likely to die of a stroke compared to Caucasians. This is believed to be because blacks have higher risks of high blood pressure, diabetes and obesity. Mexican Americans and Native Americans are also more prone to stroke than Caucasians.

"The exact reasons are not known," Milford says, "but it's presumed to be partially genetic."

Also, he adds, researchers believe the different cultural backgrounds play a role.

One of the strongest indicators of whether or not you might have a stroke is whether you have had a transient ischemic attack, or "warning stroke," which produces stroke-like symptoms but no lasting damage. People who have had TIAs are 10 times more likely to have a stroke than someone of the same age and sex who hasn't.

So with these risk factors in mind, what things should people do in their day-to-day life to control their chance of having a stroke?

DRINK YOUR COFFEE -- IN MODERATION

A study that came out earlier this year showed that people who drink coffee --no matter what kind or how much -- are nearly one-third less likely than nondrinkers to develop a stroke. Researchers at the University of Cambridge in England analyzed health records of more than 20,000 European men and women between the ages of 39 and 79 who were free of stroke history, heart disease and cancer when they provided lifestyle information for a health study in the mid-1990s. Over the next 12 years, 855 strokes occurred. After taking into account risk factors like smoking and high blood pressure, researchers found that coffee drinkers were only 71 percent as likely to have had a stroke as the coffee avoiders.

Other studies, however, show coffee can increase the risk. In November, a study was released that said drinking a single cup of coffee could increase the risk of an ischemic stroke, especially among infrequent coffee drinkers. Led by Elizabeth Mostofsky, of Harvard Medical School, the researchers found a two-fold increase for stroke in the hour after drinking a cup of coffee.

Milford, the neurologist at Southern Hills Hospital, says coffee plays a role in stroke because of the caffeine in it. It's an indirect effect, because the caffeine can raise blood pressure, one of the modifiable risk factors for stroke. "Indirectly drinking coffee could have an effect," he says. "I wouldn't say people shouldn't drink coffee, it just depends if they have problems with their blood pressure. If they do, they should be careful with it and consider drinking decaf."

CONSIDER WHERE YOU LIVE

The "Stroke Belt," a group of states in the Southeastern United States, has been recognized as having a far higher incidence of stroke, although it's not known for sure why. The region is usually defined as consisting of 11 states: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.

SAY NO TO TOO MUCH BOOZE

Drinking too much alcohol increases your blood pressure, therefore increasing your chance of a stroke, according to the CDC. Alcohol can also increase your level of triglycerides, a form of cholesterol that hardens the arteries in the body.

In large quantities, alcohol can also affect platelet function in the blood, says Milford, which can lead to an increases risk of hemorrhagic stroke because of bleeding into the brain.

"That can happen because blood is not able to clot well enough," the doctor says. "One of the things alcohol can do, when a person drinks a large amount, it can cause platelets not to clump together normally, so people don't bleed as well."

Conversely, though, the doctor adds, studies show that alcohol in moderation -- one to two glasses per day -- has been shown to decrease the risk of having a stroke over time compared to those who don't drink at all.

"Nobody knows really why," he says, "but alcohol in moderation has good effects on the risk."

EAT THAT ONE PIECE OF CHOCOLATE

An analysis presented by the American Academy of Neurology of several studies looking at chocolate consumption and stroke risk shows that eating chocolate may lower your risk of stroke. One study looked at 44,489 who ate one serving of chocolate once per week. Those people were found to be 22 percent less likely to have a stroke than people who ate no chocolate. Another study showed that people who ate 50 grams of chocolate once a week were 46 percent less likely to die following a stroke than people who did not eat chocolate.

However, it's important to remember that too much chocolate could also actually cause a stroke indirectly. Dr. Milford notes that chocolate contains a lot of sugar. Over time, high levels of sugar can cause vascular disease, which could lead to stroke, and obesity. In addition, chocolate contains caffeine, which can increase blood pressure, a leading cause of stroke.

The main thing is moderation, says the doctor. "If someone has their weight under control, and they don't have high blood pressure or diabetes, then it shouldn't be a problem at all."

WOMEN: CONSIDER AN ALTERNATIVE TO ORAL CONTRACEPTION.

Oral contraceptives have been found to double the risk of developing a stroke, according to a study by three Loyola University Health System neurologists appearing in MedLink Neurology. While many women believe the benefits of birth control pills outweighed the potential dangers, the increase was noticeable. There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to the study. The risk is significantly higher for women on birth control pills who have two of the other modifiable risk factor -- high blood pressure and smoking -- and a history of migraine headaches.

"When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient," says senior author Dr. Jose Biller. "For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives."

EAT WELL AND EXERCISE

The hallmarks of staying healthy, eating right and getting regular exercise will cut down on your risk of many of stroke's modifiable risk factors.

Milford says the best diet to follow is the traditional food pyramid, where the majority of calories come from carbs, lean protein, fruits and veggies.

It's important to keep fat intake to a minimum because fat contains cholesterol, which can cause vascular disease.

GET ENOUGH SLEEP

Sleep apnea, or nighttime breathing problems, has been shown to significantly increase the chance of a stroke. A 2005 study looking at 1,475 people found that those with moderate to severe sleep apnea at the beginning of the study were three to four times more likely to have a stroke than a comparable group of patients without sleep apnea during the next four years.

Senior researcher Douglas Bradley, M.D., professor of Medicine and director of the Centre for Sleep Medicine and Circadian Biology at the University of Toronto conducted the study. He believes the increase may be due to the fact that obstructive sleep apnea is known to cause high blood pressure. Another possible explanation is that when a person stops breathing, the lack of oxygen kicks in the body's "fight or flight" response, which makes the blood clot more. Blood clots in the brain can cause stroke.

Another study shows that people with sleep apnea faired much poorer after having a stroke.