What can people do to reduce the risk of stroke?
December 21, 2010 11:30 AM   Subscribe

What can people do to reduce the risk of stroke?

Stroke seems to a leading cause of death in our family, and as my father is approaching the age at which my grandfather died of it, I am wondering is there is anything that people can do to reduce the risks.

In my father's case, if it's relevant, he is generally in decent health, doesn't drink or smoke, and is vegetarian.

Also, though it is rather an uncomfortable thing to think about, what should people know about helping others in the event of a stroke? For example, what are the signs and symptoms to be aware of, and what action can be taken by those on hand apart from calling an ambulance? Is there anything that it would be useful to keep in a first aid kit?

Naturally YANMD, and any general advice from health professionals will be gratefully received.
posted by philipy to Health & Fitness (13 answers total) 5 users marked this as a favorite
 
Contrary to popular belief, daily Aspirin is not a good idea. As for the signs and symptoms, act FAST.
posted by dougrayrankin at 11:40 AM on December 21, 2010 [1 favorite]


IANAD...

FAST can be a helpful acronym- Face, arms, speech, and time. If you think someone's had a stroke, ask them to smile. Is it lopsided? Can they speak clearly? Can they move both arms? Do they know what time it is/where they are? Time also= Medical attention is super, super important to get quickly in the event of a stroke.

FAST is from the Stroke Awareness Foundation.
posted by ShadePlant at 11:44 AM on December 21, 2010 [1 favorite]


Dah, repost. My bad.
posted by ShadePlant at 11:44 AM on December 21, 2010


My wife has had a bunch of TIA's (mini-stroke) as well as one recent minor stroke. It is all about the symptoms-shrinking vision, weakness on one side, confusion in speaking. Always be on guard for these symptoms, and be prepared to get him to the hospital. Once you say "stroke" you go to the front of the line (hopefully).
posted by chookibing at 11:48 AM on December 21, 2010


Here is the National Stroke Association's Controllable Risks. FWIW, here are the Uncontrollable Risks.
posted by two lights above the sea at 12:05 PM on December 21, 2010 [1 favorite]


It sounds as if you feel that your family is especially at risk of stroke. In that case, it's important to find out what kind of strokes your family is prone to.

One type of stroke is an intracerebral hemorrhage. This means that you start bleeding into your brain. Blood is poisonous to brain tissue.

Another type of stroke is ischemic. This means that your blood clots someplace and blocks flow of blood to your brain.

The reason you want to find out what kind of strokes your family is prone to is because risk factors for these two types of strokes are kind of opposed. For instance, if you choose to take a daily aspirin, you reduce your risk of ischemic stroke and exacerbate your risk of hemorrhagic stroke. That's one of the big things behind Doug's link-- so if it turns out your family is at high risk of ischemic rather than hemorrhagic stroke, it's worth speaking to a doctor about the wisdom of taking a daily aspirin in your specific case.

There are other illnesses that aren't generally considered to be stroke, but are essentially the same thing. Traumatic brain injury is an example. So while you may understand your family members to have had strokes, that might not be true.

In general, prevention of ischemic stroke is the same as prevention of coronary heart disease: manage your blood pressure, manage your cholesterol, don't smoke, exercise, don't overeat, tightly control your diabetes if you have it, aim for less coagulable blood.

Prevention of intracerebral hemorrhage is more tricky. Wear a helmet, don't get into any accidents, avoid anticoagulation, pay attention to heaaches, let doctors know about your predisposition. Circulatory malformations can be a big risk factor, but I don't think anybody's going to prescribe any pricy diagnostics on the basis of your family history.

The classic signs and symptoms of a big stroke: paralysis or numbness, especially one one side of the body; difficulty speaking (slurred words, inability to speak, or being unable to think of the right words, aka "word search") or swallowing, loss of vision. A big stroke might catapult one straight into unconsciousness. These findings aren't specific to stroke, but in general, they suggest a medical emergency even if stroke isn't the culprit. Slurred speech or word search is an exception to this, so a decision to treat this as a medical emergency should be informed by how bad the symptoms are and recent history (too much to drink? Age of sufferer?)

If you see someone that you think has suffered a stroke, call an ambulance right away. Anticoagulation can be effective when administered really really fast (last I heard, window was 3 hours-- keep in mind the time necessary for transport and diagnostics). Stay with the person and follow the instructions of emergency personnel.

If you think someone has suffered a stroke, DO NOT give that preson an aspirin. As mentioned, should the stroke be hemorrhagic, an aspirin will only make things worse.

There's nothing special you could carry in your first aid kit besides a cell phone. On a desert island, you might want a CT scanner, electrocautery device, and clot buster medication :)
posted by nathan v at 12:07 PM on December 21, 2010 [3 favorites]


FAST is taught to us as medical students in the UK, so it's a well-recognised thing.

Your dad seems to have a good start on risk reduction. The things that you can do to reduce the risk of stroke are all the same things you do for a healthy heart: it's great that he doesn't smoke as that's one of the big things. Beyond that, does he have general health checkups? Things like high blood pressure and high cholesterol don't have day to day symptoms, and are things that increase the risk of stroke. Get them checked, get them treated.

If there are a lot more people in your family having strokes than would be expected from their lifestyle (ie if all the family members who had strokes were forty a day smokers then this isn't a surprise), then your dad might want to talk to his doctor about some of the rarer causes of strokes, like blood clotting disorders. I'd stress this is pretty unlikely though - most strokes happen for the same sort of reasons that heart attacks do, and are a combination of lifestyle plus underlying tendency (I don't think that we're at the point where we can tell you what the genetic tendency is).

Nothing really exciting or out of the ordinary here - basic healthy living advice, the same as everything else.
posted by Coobeastie at 12:15 PM on December 21, 2010 [1 favorite]


Oh, one more thing:

One common cause of a stroke is atrial fibrillation. Atrial fibrillation is when one part of your heart stops contracting meaningfully and instead quivers like jello. That leaves a big area for clots to form that then tend to migrate into your cerebral circulation, blocking blood flow. Atrial fibrillation is one of the more common things that happen to people as they get older, and it isn't necessarily a big deal when adequately treated.

One of the big risk factors for atrial fibrillation is coronary heart disease. So all of those things that you might do to reduce your risk of ischemic stroke will also reduce your risk of contracting atrial fibrillation. Still, since it's so common, you might end up with it anyways.

The period of big risk is when you develop atrial fibrillation, because treatment of it involves anti-coagulation. So one way to prevent stroke is to be aware of the signs of atrial fibrillation and seek treatment immediately (say, the same day, not necessarily the same hour).

Atrial fibrillation can develop without any symptoms, but usually it's accompanied by a fast, irregular pulse. It can also be accompanied by chest pain or exercise intolerance. It's easy to check your pulse-- if it's over 100, you should see a doctor sometime; if it's over 120, you should probably go to an emergency room. (Clarification: that's a resting pulse. It's no problem if your pulse is elevated during or after exercise.)

The pulse associated with atrial fibrillation is very distinctive. The way it's described in medical literature is "irregularly irregular." As in, there's no discernible pattern to it.
posted by nathan v at 12:58 PM on December 21, 2010


In the hospital, I used to see a lot of stroke patients due to hypertension (high blood pressure) and/or diabetes (high levels of blood sugar). These patients had been previously diagnosed before, but refused to take their medications regularly.

It's very annoying. Most hemorrhagic strokes are due to uncontrolled hypertension, and hypertension can be controlled, first with diet and exercise, and then with meds. Same goes for diabetes.

These two are also risk factors for ischemic stroke, so it may be a good idea to have these two diseases ruled out and/or treated.

One more thing, if you do witness a stroke, please take note of the time. Clot-busting medications work best if given with three hours of stroke onset. (May still work afterwards, but no guarantees)
posted by onegoodthing at 5:16 PM on December 21, 2010 [1 favorite]


To piggyback on onegoodthing's final comment, many hospitals will not even give clot-busting medications if it has been more than 3 hours since the onset of stroke, because the risks at that point outweigh the potential benefits. If they don't know for sure when the stroke started, they will err on the side of caution by NOT giving this medication. So it's really, really important to take note of what time the symptoms start and communicate that to the ambulance team, the ER staff, the doctors, etc.
posted by vytae at 5:44 PM on December 21, 2010 [1 favorite]


Control blood pressure
Don't smoke
Don't sit for prolonged periods of time to prevent DVTs
Walk/exercise regularly
Control cholesterol and triglycerides
Have a good relationship with your family physician to address your family/personal risk factors
posted by buzzv at 6:38 PM on December 21, 2010


You might consider having yourself tested for what's sometimes called "sticky blood". My boyfriend had a stroke at age 40; his two risk factors were 20 years of smoking and a mild case of sticky blood.
posted by WorkingMyWayHome at 6:56 PM on December 21, 2010 [1 favorite]


Thanks for all the information everyone, much appreciated.

I'll take some time to digest it thoroughly and check out the issues mentioned.
posted by philipy at 2:12 PM on December 23, 2010


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