How To Recognize And Prevent All Different Kinds Of Strokes
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The Silent Stroke
Perhaps the least well-known kind of stroke is the silent stroke that doesn't produce symptoms but can produce damage and eventually disability and inability to function.
Here's the way the newsletter Consumer Reports on Health (May 2007) explains the silent stroke: "While most people think of stroke as an obviously catastrophic event, brain scans have shown that some 10 percent of Americans in their 50s and 40 percent of those in their 80s have had a silent stroke that causes no immediate symptoms. In contrast, just 2 percent of those in their 50s and 15 percent of those in their 80s have had an overt, symptomatic stroke."
The explanation continues: "Silent strokes slowly damage the brain in subtle ways, detectable on a magnetic resonance imaging (MRI) test that can eventually impair physical and mental performance and can even cause dementia. In one 2005 study, researchers found that even people in their 40s and 50s who had such strokes performed worse on a variety of cognitive tests than those without that history."
Silent strokes should not be confused with mini-strokes. The latter is a stroke that produces stroke symptoms that go away in a matter of minutes. However, mini-strokes (also called TIAs, transient ischemic attacks) require immediate medical attention as they are usually followed by a full-blown stroke.
Prevention
The best strategy to use against strokes, mini-, silent, or full-blown, is to prevent them. They are considered among the most devastating of all diseases. Consider the contrast between strokes and heart attacks posed by Consumer Reports on Health in an article entitled "Guarding Against Stroke" (May 2007). Half of all stroke victims suffer substantial and permanent disabilities and only 10 percent fully recover. In contrast, 90 percent of heart-attack survivors "return to work and normal lives. ... Heart attacks are more common [but] strokes are more deadly."
So prevention is the key, especially those who are at high risk such as African-Americans, those with a strong family history of strokes, and those suffering from certain medical conditions such as atrial fibrillation. Here are the key steps to prevent stroke, cataloged by Consumer Reports (the first 13 steps), which I've supplemented with some from other reliable sources.
Stop Smoking: This is a key to preventing almost every disease you can think of. It is certainly one of the most important steps you can take to prevent stroke, heart disease, and cancer.
Lower Your Blood Pressure: This causes 40 percent of all strokes. So try getting your blood pressure down to normal at 120/80. You may need medication, but you should first try diet, exercise, weight loss, and stress control.
Have Heartbeat Checked: The sometimes rapid and irregular heartbeat of atrial fibrillation is a common cause of stroke. So your doctor should check your heart with a stethoscope and feel your pulse for signs of this irregular and rapid heartbeat. Atrial fibrillation doesn't always produce symptoms that are noticed by its victims. So you want to be sure you're checked for it, and then get appropriate treatment if you have it. The standard treatments are drugs, such as Cardizem to control the rapid rate, and aspirin or warfarin (Coumadin) to prevent the blood clots from forming in the heart that may get to the brain and cause a stroke.
Have Your Neck Vessels Checked: About five percent of ischemic strokes (caused by clots) are caused by clogged carotid arteries that supply the brain with blood. A doctor can pick up problems by listening for a noise or bruit. If one is heard, further checks and possible treatment are in order.
Lower Your LDL, Which Is Bad Cholesterol: For some reason, this is important for women but not men in preventing stroke. It is important for both in preventing heart disease. This can often be done by a variety of dietary measures, but sometimes requires medication.
Raise Your HDL, Which Is Good Cholesterol: This is also important for preventing heart attacks. It can be accomplished by aerobic diet, exercise, weight control, and stopping smoking, but sometimes requires medication.
Consider A Statin: Statins such as lovastatin can cut stroke risk by 20 percent. They do so by reducing bad cholesterol, and also by reducing inflammation, which is associated with strokes and heart attacks. Statins may also raise HDL, the good cholesterol.
Control Your Blood Sugar: This helps prevent both strokes and heart attacks.
Ask Your Doctor About Aspirin: Low-dose aspirin helps reduce the risk of future strokes for anyone who has had one or a TIA. However, for preventing strokes among those without a history of a stroke or TIA, aspirin makes sense only for women. But the treatment should be limited to those women at high risk of stroke or heart disease and at normal or low risk for bleeding.
Get Enough Vitamins: The evidence is far from conclusive, but Consumer Reports recommends taking B vitamins, especially folic acid, B12 and B6, to reduce stroke risk.
Seek Help For Severe Snoring: This indicates sleep apnea, which is a risk factor for stroke. There are various ways to try to control it such as sleeping on your side and losing weight. In addition, a sleep specialist can recommend other treatments.
Select Birth Control Pills Wisely: Women older that 35, who smoke or have high blood pressure should avoid birth-control products containing estrogen. They slightly increase stroke risk. There are alternatives, such as progestin-only pills or intrauterine devices (IUDs).
Take Precautions If You Get Migraines: Migraines are associated with a higher risk of stroke. However, there's no evidence that controlling the migraines will then lower the stroke risk. So the information is offered mainly to get those subject to migraines to be especially careful about avoiding stroke risk factors.
Load Up On Potassium-Rich Foods: Bonnie Liebman, a highly regarded nutritionist, says a diet rich in potassium protects against stroke. This is from her column, "Stroke: How to Avoid a Brain Attack" in Nutrition Action Health Letter (March 2007).
Eat Fish Twice A Week: There is evidence this lowers the risk of stroke as well as of other diseases.
Lose Extra Weight: Being overweight substantially increases your risk of stroke.
Eat At Least 8-10 Fruits And Vegetables A Day: This is an important part of the whole-foods, plant-based diet recommended by the book, The China Study (2006) by Campbell and Campbell. That diet lowers the risk of stroke and most other common chronic diseases.
Exercise: This substantially lowers the risk of stroke and other common chronic diseases.
Herb Denenberg, a former Pennsylvania insurance commissioner and professor at the Wharton School, is a longtime Philadelphia journalist and consumer advocate. He is also a member of the National?Academy of Arts and Sciences. His column appears daily in The Bulletin.
Related: How To Recognize And Prevent All Different Kinds Of Strokes
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