Dr. M. P. Ravindra Nathan with Peter Sleight, M.D.

ARE YOU STROKE SMART? � PART IV

WHAT YOU NEED TO KNOW FOR PREVENTION - I

By M. P. RAVINDRA NATHAN, MD, FACC, FAHA                        

Stroke is a devastating disorder with potential for crippling damage and life long disability; hence, prevention is the best strategy. A recently published large case-control study  called �INTERSTROKE,� presented at the World Congress of Cardiology in June 2010 has shown clearly that 10 stroke factors are responsible for almost 90 percent of all cases of stroke.

A total of 3,000 first-time acute-stroke cases and 3,000 controls from 22 countries were analyzed in the landmark research. About 81 percent of the cases were from Southeast Asia, India or Africa. Interestingly, all these causative risk factors are modifiable with appropriate management.  Hypertension or high blood pressure (BP), these researchers felt, is the most important risk factor for all stroke subtypes and is a particularly dangerous risk factor for hemorrhage in the brain.

These are the predisposing diseases or entities that need to be addressed if you want to prevent a stroke:

1.    Hypertension: The ideal BP of a person is about 120 mm of Hg systolic and 80 mm of Hg diastolic, or less. BP above 140 systolic and 90 diastolic is considered hypertension and 120 -139 systolic and 80 and 89 diastolic indicate pre-hypertension. For diabetics, a systolic BP lower than 120 may be desirable. Systolic hypertension is the one to be more concerned as you get older. Even people with pre-hypertension  and mild hypertension are at higher risk of developing strokes and heart disease; hence, don�t take it lightly.

2.    Smoking: Needless to say it is one of the scourges of modern world. Tobacco abuse is one major risk factor for atherosclerosis of arteries leading to strokes and heart attacks. We have already covered this area in detail in this publication earlier. 

3.    Diabetes Mellitus: This has reached an epidemic status all over the world; the incidence has especially increased among South Asians. Progressive vascular disease is quite common in inadequately controlled diabetic patients. You have seen many of them developing �claudication� in the legs (pain in calf muscles on exercise) from occlusion of peripheral arteries. The same process takes place in your brain too. So, control the diabetes properly; aim for a fasting blood sugar between 80 -120 or Hb A1 C (a specific parameter of long range control) of 6.5 or less. 

4.    Dietary factors: So much has already been written about diet, obesity and cardiovascular risk. Obesity has reached pandemic proportions and America leads the way. �Eat less, live longer� is an often-quoted statement and should be your mantra too. Research links fewer calories to better aging and yet discussion of diet with patients can be challenging. An unhealthy cardiovascular diet has been linked to an increased risk for all causes of stroke including ischemic stroke and intracerebral hemorrhagic stroke. What is good for the heart is good for the brain as well. Stick with a low fat, low to medium carb with plenty of good protein diet and nutritional supplements as needed. It is a lifelong process and total commitment is needed.

5.    Cardiac causes: The most important one is an erratic rhythm called Atrial Fibrillation, especially common in older people. Clots are liable to be formed inside the cardiac chambers and pieces of these clots can be broken off and land in the brain (called cerebral embolism.) Other diseases such as valvular heart disease, prosthetic valves, septal defect (hole in the heart) � all these can increase the risk of embolic strokes. Usually, the therapy is to use blood thinning agents like warfarin, aspirin, clopidogrel, etc., often in combination.

6. Bulging bellies: They have earned the nick name �killer bellies� for a good reason. Because big bellies can be deadly for older people, even for those who aren�t overweight or obese by other measures. In other words, the ones who sport a paunch or beer belly � scientifically known as central, apple shaped or abdominal obesity, more common in men than women (who have pear shaped obesity with bigger buttocks) are at greater risk of strokes and heart attacks. A new study just published in Archives of Internal Medicine suggests, �men and women who have the biggest waist lines have twice the risk of dying during over a decade compared with those with the smallest tummies.�

To be concluded in next issue

Dr. M.P. Ravindra Nathan is a Brooksville cardiologist and director of the Hernando Heart Clinic.