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Breakthroughs in Stroke Prevention and Treatment

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These new findings can save lives

Nearly 800,000 times a year — every 40 seconds — someone in the US has a stroke.

An ischemic stroke occurs when a clot blocks the flow of blood to the brain. This accounts for 87% of strokes. A hemorrhagic stroke results when a blood vessel in the brain ruptures and accounts for 13% of strokes.

These “brain attacks” often are deadly or disabling. Stroke is the third-leading cause of death (after heart disease and cancer), killing more than 143,000 Americans yearly. It’s the leading cause of disability and can result in paralysis, spasticity, pain, speech problems and memory loss.

Good news: Researchers are discovering more effective ways to prevent and treat stroke. In a recent 10-year span, the death rate from stroke has fallen by 30% and the actual number of stroke deaths has declined by 13.5%.

The latest findings…

DECREASE YOUR RISK

Scientists at Harvard School of Public Health identified five lifestyle factors that can cut the risk for ischemic stroke by 80% and all strokes by almost 50% — not smoking, maintaining a normal weight, eating a prudent diet, exercising regularly and moderate alcohol intake. Also…

Consider statin medication. A report in the May 2009 issue of The Lancet Neurology analyzed the results of using LDL cholesterol–lowering statin medications to prevent stroke in 165,792 people. For every decrease in LDL of 39 mg/dL, there was a 21.1% decrease in the risk for stroke. Ask your doctor about whether a statin is right for you.

Eat more fish. A study published last August in Neurology showed that people who ate tuna and other fish high in omega-3 fatty acids three times or more per week had a nearly 26% lower risk of having brain imaging findings of stroke, compared with people who didn’t eat the fish regularly.

Drink tea. Researchers at UCLA analyzed studies involving nearly 195,000 people and found that, compared with people who didn’t drink tea, those who drank six cups of green or black tea a day reduced their risk for stroke by 42%, while those who drank three cups had a 21% reduction.

KNOW THE SYMPTOMS

Researchers in the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention surveyed 86,573 adults about the five warning signs of stroke. They reported their results at the American Stroke Association’s 2009 International Stroke Conference.

New finding: People at the highest risk for stroke — the elderly and those who have had a previous stroke — were the least likely to know the five stroke warning signs. Overall, only 37% of those surveyed knew all five signs and knew to call 911 immediately.

If you suspect stroke…

Don’t call the doctor’s office. Calling a primary care doctor at the first sign of stroke delays patients from reaching the emergency room (ER), say researchers at West Virginia University-Morgantown. In their study, the researchers called primary care physicians’ offices seeking advice for hypothetical stroke or heart attack symptoms. Nearly one-third of receptionists recommended scheduling an appointment for later in the day if symptoms continued.

Don’t call the hospital help line if you’re having strokelike symptoms. The operator may tell you to call your doctor. A study in Stroke showed that nearly one-quarter of hospital help-line operators mistakenly routed a caller describing classic stroke symptoms to primary care doctors rather than to 911.

5 SIGNS OF A STROKE

If you experience one or more of these signs, call 911 immediately…

  • Sudden numbness or weakness in the face, arm or leg, particularly if on only one side of the body
  • Sudden, severe headache with no known cause
  • Sudden visual disturbance in one or both eyes
  • Sudden confusion or difficulty speaking
  • Sudden dizziness, loss of balance, loss of coordination or difficulty walking.

RUSH TO THE ER

If you’re having a stroke, the faster you call 911 and get to the emergency room… and the sooner you are treated with tissue plasminogen activator (tPA), the blood-thinning, clot-dissolving intravenous drug… the less amount of brain tissue is likely to die… and the better the likely outcome, in terms of preventing death and disability. But many people who are having a stroke don’t get to the ER right away — mostly because they don’t think they’re having a stroke.

Mayo Clinic researchers reported in the November 2008 issue of Emergency Medicine Journal that the average time of arrival at the ER was after the three hours from the onset of stroke during which tPA was considered effective.

New finding #1: Researchers have found significant benefits — and no increased risk for brain injury — in people with stroke who were treated with tPA up to four-and-a-half hours after the onset of symptoms. Consequently, at the end of May of this year, treatment guidelines expanded the time to four-and-a-half hours that some patients can get the clot-busting drug.

Caution: It still is important to get treatment as soon as possible.

New finding #2: Three out of five stroke deaths occur in women. Women are 30% less likely than men to receive tPA in the ER, reported researchers from Michigan State University at the 2009 International Stroke Conference.

Possible reason: Women may not have any of the five classic stroke symptoms. Instead, they may suffer a loss of consciousness or sudden body pain other than a headache. If you or a loved one experiences these symptoms, ask to be checked for stroke.

PREVENT A SECOND STROKE

Each year, of the 795,000 Americans who have a stroke, 185,000 will have a second stroke. To reduce your risk…

New finding: A study reported at the American Academy of Neurology’s 61st Annual Meeting in April 2009 proved that stroke victims who achieve “optimal levels” of four risk factors — LDL cholesterol, HDL cholesterol, triglycerides (blood fats) and blood pressure — were 65% less likely to have another stroke, compared with people who did not reach an optimal level of any risk factor. Those who reached optimal levels of three risk factors were 38% less likely to have another stroke… two risk factors, 22% less… and one risk factor, 2% less.

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Source:
Source: Ralph L. Sacco, MD, professor and chairman of the department of neurology at University of Miami Leonard M. Miller School of Medicine. He is an international authority on the prevention and treatment of stroke and president-elect of the American Heart Association (AHA). Dr. Sacco also is the Olemberg Family Chair in Neurological Disorders and the Miller Professor of Neurology, Epidemiology and Human Genetics at the Miller School and neurologist-in-chief at Jackson Memorial Hospital, Miami.
Date: July 1, 2009 Publication: Bottom Line Personal
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