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Take Control of Your Stroke Risk

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5 simple steps…

If you’ve ever needed strong proof that you can dramatically influence whether you’re struck by a serious medical condition, here’s some eye-opening news.

Stunning research finding: When it comes to stroke, the fifth-leading cause of death in the US, 90% of your risk is due to factors that you can control, according to a study published in The Lancet.

New development: To incorporate the latest scientifically proven actions that minimize risk for stroke—both ischemic (caused by a blood clot) or hemorrhagic (due to bleeding)—the American Stroke Association has updated its guidelines.  

THE STROKE-FIGHTING PLAN

Main steps that reduce one’s odds of having a stroke…

STEP 1: Test your blood pressure at home. It’s long been known that lowering high blood pressure (hypertension) is the best way to prevent strokes. Unfortunately, not enough is being done to effectively fight hypertension.

Part of the problem is that most people get their blood pressure checked only when they see a doctor. However, blood pressure readings can fluctuate widely throughout the day and from one day to the next—you might have normal pressure in the doctor’s office and higher pressure at home…or vice versa.

Important finding: Use of an automated digital upper-arm cuff to measure blood pressure at home helps. A recent study that looked at 450 patients with hypertension found that 72% of those who home-tested achieved good control, compared with 57% of those who did not test at home.  Even if you haven’t been diagnosed with hypertension, you may want to consider occasional home-testing. Ask your doctor for advice.

Latest thinking: With home-testing, you can see daily changes and identify trends over time that you can discuss with your doctor. It’s also a good way to track the effects of medications and/or dose changes. At first, your doctor might advise that you check your blood pressure a few times at different times of the day. After you have steady control, once a day (or even weekly) is usually enough.

STEP 2: Don’t focus so much on LDL “bad” cholesterol. Until recently, doctors depended on LDL targets when prescribing statins and/or choosing drugs or doses. A desirable reading was generally considered to be below 100 mg/dL…for very high-risk patients with existing cardiovascular disease, a reading below 70 mg/dL was considered optimal.

A better approach: The decision to take a statin—or increase (or decrease) your dose if you’re already on one—should be based less on a specific LDL target and more on a patient’s 10-year risk of having a stroke or heart attack, according to the new guidelines. Doctors are now advised to use risk calculators (such as CvRiskCalculator.com) before writing prescriptions or changing statin doses. The calculator also takes into account such factors as diabetes and HDL “good” cholesterol levels. Important: High-sensitivity C-reactive protein (hs-CRP) levels can also help guide treatment.

For people who have not yet had a stroke or heart attack, there is some disagreement about relying solely on such calculators. For now, anyone who has a greater than 7.5% risk of having a stroke in the next 10 years and is between the ages of 40 and 75 will probably need a statin—regardless of his/her LDL level. People with very high LDL (190 mg/dL or higher) will also benefit from taking a statin.

STEP 3: Don’t be afraid to take a blood thinner. Most strokes are caused by blood clots in blood vessels in the brain. Warfarin (Coumadin), the most widely prescribed drug for preventing clots, can reduce stroke risk by about 65% in people with atrial fibrillation, a common heart arrhythmia. But it’s a tricky drug to use because it requires frequent blood tests to check/correct the dose…can cause bleeding if it’s not carefully monitored…and intake of vitamin K, which affects blood clotting, needs to be carefully controlled. For these reasons, some people refuse to take it.

The updated guidelines include three additional drugs—apixaban (Eliquis), rivaroxaban (Xarelto) and dabigatran (Pradaxa). They work as well as warfarin, without the need for dietary changes or frequent blood tests. However, they’re more expensive than warfarin and have their own limitations (they can’t be used by some patients with kidney disease, for example). Bleeding is still a risk with new anticoagulants.

Bottom line: Don’t let your concerns about side effects stop you from taking one of these drugs if you need it. Any anticoagulant can potentially cause bleeding, but the stroke-prevention benefit far outweighs the risks. 

STEP 4: Go Mediterranean! For years, “DASH”—short for “Dietary Approaches to Stop Hypertension”—has been the go-to diet for lowering blood pressure and reducing stroke risk. For the first time, the new guidelines encourage patients to consider a Mediterranean diet, which includes plenty of fish, fresh fruits, vegetables and nuts, along with olive oil and the occasional (optional) glass of wine.

Game-changing research: An influential Spanish study, known as PREDIMED, randomly assigned participants into dietary groups that included people who followed a low-fat diet…and others who followed a modified Mediterranean diet that emphasized an increased intake of walnuts, almonds and hazelnuts.

Results: The Mediterranean group had a lower stroke risk than the low-fat diet group. Based on these findings, the new guidelines advise patients to consider the Mediterranean diet, including a daily one-ounce serving of walnuts, hazelnuts or other unsalted nuts.

STEP 5: Take migraines seriously. For reasons that aren’t clear, women age 49 and under who suffer migraine-with-aura (a migraine accompanied by visual disturbances such as flashing lights and blind spots) are more than twice as likely to have a stroke (during the headache or at any time) as those without such migraines. For those who also smoke and take oral contraceptives, the risk is 10 times higher.

It’s not known whether migraine medication will help prevent stroke in these women. What does matter: Giving up smoking is critical. Migraineurs–with-aura who smoke and take birth control pills may also want to talk to their doctors about other forms of contraception. In men, migraine-with-aura does not significantly affect stroke risk.

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Source: Victor C. Urrutia, MD, an associate professor in the department of neurology at The Johns Hopkins University School of Medicine and director of the Comprehensive Stroke Center/Stroke Prevention Clinic at The Johns Hopkins Hospital, both in Baltimore. Date: June 1, 2016 Publication: Bottom Line Health
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