Who is at risk? Stroke: Who is at Risk?

Stroke is particular devastating at onset and its final outcome can equally be socially reprehensive. Stroke is medically referred to as cerebrovascular ‘accident’, because of the sudden way it occurs; it affects more than a million (on a worldwide basis) people every year, and the incidence appears to be increasing. The rate of death from stroke, however, appears to be decreasing in more developed nations and in places where appropriate hospital care and early intervention are available. In general, people with stroke are likely to have more than one risk factor. The various risk factors are outlined below: Age and Gender Older Adults: People most at risk for stroke are older adults, particularly those with high blood pressure, who are sedentary, overweight, smoke, or have diabetes. Younger Adults: Younger people are not immune; about 28% of stroke victims are under 65. Stroke in younger people affect men and women equally. High Blood Pressure (Hypertension) High blood pressure or hypertension contributes to 70% of all stroke. In fact, researchers have estimated that almost half of stroke could be averted by controlling blood pressure. Smoking People who smoke a pack (i.e. 20 sticks of cigarette) or more a day have almost two and a half times the risk for stroke as nonsmokers. Quitting significantly reduces the risk. It’s been shown from research studies that former smokers had the same risk as people who had never smoked. Diabetes and Insulin Resistance Diabetes is a strong risk factor for ischemic stroke, perhaps because of accompanying risk factors, such as obesity and high blood pressure.

Studies have also implicated insulin resistance, which usually occurs in people with non-insulin dependent diabetes (these are individuals who control their blood sugar with oral hypoglycemic drugs) as an independent factor in the develop- ment of atherosclerosis and stroke.

In this condition, insulin levels are normal to high, but the body is unable to use the insulin normally to metabolize blood sugar. The body compensates by raising the level of insulin (hyperinsulinemia), which can, in turn, increase the risk for blood clots and reduce HDL levels (the beneficial form of cholesterol). Obesity and Sedentary Lifestyles Obesity is associated with stroke, most likely because being overweight reflects the presence of other risk factors, including insulin resistance and diabetes, high blood pressure, and unhealthy cholesterol levels.

Weight that is centered around the abdomen (the so-called apple shape) has a greater association with stroke, as it does for heart disease, than weight distributed around hips (pear-shape). Homocysteine and Vitamin B Deficiencies Abnormally high blood levels of the amino acid homocysteine, which occur with deficiencies of vitamin B6, B12, and folic acid, are strongly linked to an increased risk of coronary artery disease and stroke. Some experts believe that homocysteine is a major risk factor for stroke, second only to high blood pressure. Homocysteine appears to be toxic to the cells lining arteries and contribute to blood clotting. Alcohol Heavy alcohol use, particularly a recent history of drinking, is associated with a higher risk of both ischemic and hemorrhagic stroke.

Studies have indicated, however, that mild to moderate alcohol use (one to seven drinks a week) is associated with a significantly lower risk for ischemic stroke. Drug Abuse Drug abuse, particularly with cocaine and increasingly methamphetamine (an amphetamine), is a major factor in the incidence of stroke in young adults. Steroids used for body building also increase the risk. Genetic and Inborn Factors Genetics may be responsible for many of the causes of stroke. Studies indicate that a family history of stroke, particularly in one’s father, is a strong risk factor for stroke. Heart Disease and its Treatments Heart disease and stroke are closely tied for many reasons: They often have common risk factors, including high blood pressure and diabetes. The risk of stroke is increased during surgical procedures involving the coronary arteries, including coronary bypass operations, angioplasty, and coronary atherectomy. Thrombolytic (clot-busting) and other anti-clotting drugs used for treatment of heart attacks also slightly increase the risk for hemorrhagic stroke. A heart attack itself increases the risk for a stroke; the danger is highest in the first few days after an attack but it is still not very great. Those at higher risk are older people and patients who

also have congestive heart failure. Stress In some people, prolonged or frequent mental stress causes an exaggerated increase in blood pressure; over time, this effect has been linked to thickening of the carotid arteries – the vessels that takes blood from the heart to the neck and brain, this thicken can contribute to stroke occurring. Migraine and Associated Risk Factors Studies have found that migraine or severe headache is a risk factor for stroke in both men and women, especially before age 50. In fact, migraine is associated with about 19% of all strokes. However, it should be pointed out that many people have migraines, and their risk is still low, 2.7% for women and 4.6% for men, according to one study. Infections Reports have indicated for some time that certain bacteria and viruses may play a role in atherosclerosis and heart disease, generally by provoking an inflammatory response in the arteries. These two conditions are known culprits which can lead to stroke in the last analysis. Pregnancy This carries a very small risk for stroke, mostly in women with pregnancy related high blood pressure and in those with cesarean delivery. Medications Over-the-counter decongestants (these are the common anti-catarrh drugs) contain ingredients that increase the risk of stroke, particularly in people with other risk factors. Height Shorter people have a higher risk than taller individuals. Lifestyle changes By and large, these risk factors are cumulative in a number of cases, In other words, those having more than one risk factor are more likely to develop stroke than those with isolated risk.

Ultimately, the public health message-in-chief is the need to indulge in changing those stoke-related risk factors enumerated above, particularly the modifiable ones.