May 4, 2006 -- Today, tomorrow, and every day this year, roughly 1,900 strokes will be suffered by people in the U.S.
After heart disease and cancer, strokes are responsible for more American deaths than any other medical condition, but experts say much could be done to change this.
Guidelines released today by the American StrokeAssociation highlight some well-established and less well-known risk factors for stroke, as well as measures people can take to lower their risk.
"We are making some progress, but we still have a big mountain to climb," says Larry B. Goldstein, MD, who led the guidelines committee. "People are more aware of stroke than they used to be. But far too many people ignore or don't recognize the symptoms of stroke and delay seeking treatment."
Who Is at Risk
Low birth weight was recognized for the first time as a possible risk factor for stroke, based on recent studies suggesting a doubling of risk among adults who weighed less than 5.5 pounds at birth compared with those who weighed 8.8 pounds or more. The reason for this is unclear, and this association does not mean that low birth weight causes stroke.
Other well established, nonmodifiable stroke risk factors include age, sex, race or ethnic background, and family history. Elderly people, men, blacks, and people with a family history of stroke tend to have a higher than average risk.
The guidelines call for very aggressive stroke screening and prevention efforts for children and adults with sickle cell disease. About 10% of children with sickle cell will have had a stroke by the time they reach adulthood.
The committee report also called on doctors to assess their patients' stroke risk using established tools.
Patients who know they are at risk for having a stroke tend to be more motivated to make lifestyle changes and take their medication than patients who are simply told they have cardiovascular disease, Goldstein says.
"We know that people greatly fear the consequences of stroke, such as being unable to talk and understand, being unable to care for yourself, and being unable move one side of your body," he tells WebMD.
Lowering Stroke Risk
The new report reiterated some well-known steps that people can take to lower their stroke risk, including:
- Knowing your blood pressure and keeping high blood pressure under control
- Not smoking and avoiding exposure to secondhand smoke
- Getting regular physical exercise
- Aggressively treating disorders that increase stroke risk, such as diabetes, irregular heartbeat, carotid artery disease, and heart failure
- Treating diabetes patients with statins to lower "bad" cholesterol
- Increasing potassium in the diet to at least 4.7 grams a day and reducing sodium intake to 2.3 grams or less to help lower blood pressure in people with hypertension
- A referral to be considered for genetic counseling for people with rare genetic causes of stroke
More Who Might Be at Risk
Sleep-disordered breathing, such as in sleep apnea, also appears to increase stroke risk. This suspected link led to the recommendation that people with excessive daytime sleepiness and who may snore loudly each night be evaluated for the condition and get treatment if they have it.
"We know that treating sleepapnea is associated with a reduction of blood pressure," Goldstein says. "And although we don't have direct evidence that (treatment) will reduce stroke risk, the feeling is that it will. But that is not yet supported by randomized trials."
Other prevention efforts that may reduce stroke risk include:
- Limiting alcohol consumption to no more than two drinks a day if you are a man and one drink a day if you are a woman. Avoiding illicit drug use.
- Taking low-dose aspirin if you are a woman at high risk for stroke. Aspirin has been shown to reduce heart attack risk in men, but the stroke data are less conclusive. No one should take aspirin for prevention without first discussing it with their doctor, however.
- Postmenopausal hormone therapy should not be used for prevention of stroke.
The Importance of Quick Action
If you think you are having a stroke or someone around you is, call 911 immediately, not your doctor, Goldstein says.
Time is critical, and the quicker a stroke victim gets to a hospital the better his or her chances of surviving and recovering.
Clot-busting drugs used to treat ischemic stroke (stroke from a blood clot) can only work if they are given within three hours of the onset of symptoms.
"If someone is having a stroke there is nothing that can be done in their doctor's office and there is nothing that patients can do at home," Goldstein says.
Symptoms of stroke can include, but are not limited to:
- A sudden, severe headache.
- Sudden vision disturbance or vision loss.
- Trouble speaking or understanding.
- Weakness or numbness of the body, especially on one side of the body.
"Even within that three-hour time frame, the quicker someone gets treatment the better," Goldstein says. "The brain likes blood and oxygen, and the longer it goes without them the lower the chances that they will fully recover."