Prevention methods for stroke - Diabetic Stroke Preven...

Prevention methods for stroke

Prevention methods for stroke
Nikheel Kolatkar, M.D.
Your Total Health

People can take many actions to reduce their risk of suffering a stroke. Many of these lifestyle modifications are similar to those recommended for preventing and controlling diabetes, diabetic angiopathy and heart conditions. Control of risk factors can reduce the incidence of stroke by 50 percent and the mortality by 30 percent, according to the American Association of Diabetes Educators. These steps include:

Controlling glucose (blood sugar). Elevated glucose (hyperglycemia) can damage the arteries and promote atherosclerosis (a condition characterized by excess plaque on the inner arterial walls). Diabetic individuals can reduce their risk of stroke through regular glucose monitoring and glycohemoglobin tests.

Controlling high blood pressure. Blood pressure abnormalities are a chief contributor to strokes and should be continually monitored and controlled. This is especially important for individuals with diabetes. Diabetic patients are generally advised to keep blood pressure below 130/80 mmHg. Blood pressure that cannot be controlled through exercise and diet may require antihypertensive medication.

Controlling cholesterol and triglycerides. Unhealthy levels of blood lipids, such as high LDL “bad” cholesterol or low HDL “good” cholesterol, can lead to atherosclerosis and stroke. People with hyperlipidemia should have a cholesterol test annually or as recommended by their physician. Certain patients may require cholesterol-reducing drugs, which lower levels of harmful cholesterol in the body.

Achieving and maintaining an ideal weight.

Exercising regularly. Experts recommend that all individuals – especially those with type 2 diabetes – get regular exercise. A general recommendation is a minimum of 30 minutes a day on most days of the week. Patients should consult their physician before starting an exercise program.

Eating a heart-healthy diet. Findings from numerous studies illustrate that a heart-healthy diet can decrease the risk of stroke. For instance, women who ate fish - which is rich in omega-3 fatty acids - in excess of five times a week demonstrated a significantly lower risk of stroke than those who consumed fish less than once a month.

Quitting smoking or not starting to smoke. Smoking contributes to atherosclerosis, high blood pressure, stroke and heart conditions. Recent research even shows that women who smoke during pregnancy raise their children’s risk of atherosclerosis and cardiovascular diseases in adulthood.

Managing stress. Stress and anger have been linked to stroke as well as heart disease.

Limiting consumption of alcohol to about one glass of wine or beer a day, if approved by a physician. Some evidence suggests that modest consumption of alcohol can reduce the risk of stroke and heart disease, but heavy use can impair control of diabetes and can cause or worsen many other health problems.

Getting regular dental care and performing good dental hygiene. Increasing numbers of studies are linking periodontal disease to vascular diseases.
Patients are also advised to seek treatment for sleep apnea (a condition in which an individual’s breathing stops and starts many times during sleep), depression, drug abuse or any other risk factors.

The physician may recommend taking aspirin or other antiplatelets or anticoagulants to help prevent the formation of blood clots. Diabetes patients may be underusing aspirin therapy to guard against stroke and heart disease, according to the American College of Preventive Medicine. However, people are advised not to begin aspirin therapy without their physician’s approval. Aspirin may increase the risk of hemorrhagic stroke, especially in women, and it can be dangerous to some individuals, such as those with diabetic nephropathy, other kidney diseases, liver disease or gastrointestinal problems.

Other antiplatelets and anticoagulants also increase the risk of hemorrhagic stroke, especially in people over age 80. Patients taking anticoagulants may be monitored with a blood test called INR (international normalized ratio).

Some blood tests can help predict the risk of stroke in certain patients. The U.S. Food and Drug Administration (FDA) has approved the PLAC test for this purpose. Another test that detects inflammation and may suggest who is at risk of stroke is the c-reactive protein test. However, this is not recommended for routine use.

Some high-risk patients, such as those who have already had a stroke, may benefit from carotid artery stenting. The FDA has approved carotid artery stents for use in certain patients. These tiny mesh tubes have proven to be as effective as surgery in preventing stroke for certain individuals. Carotid artery stents crush plaque against the arterial wall and hold it in place, thereby preventing pieces of plaque from breaking off and traveling in the bloodstream, resulting in stroke.

Alternatively, carotid endarterectomy surgery has proven to be an effective means of stroke prevention for many patients who have already had a stroke or transient ischemic attack (mini-stroke) as well as those with significant carotid artery blockages (80 percent blockage or greater). This procedure involves the removal of accumulated fat along the walls of the carotid arteries, which supply blood to the brain. While the patient is under general anesthesia, the plaque and the inner lining of the artery are removed.

A cerebral aneurysm (a bulging formation on the arterial wall) that has yet to rupture may be diagnosed early, especially if it produces warning signs that prompt the patient to seek treatment. Surgery may be recommended to repair the aneurysm and prevent a hemorrhagic stroke. This surgery, which involves snipping off the aneurysm before it can rupture, is sometimes called “clipping.”

Another practice that is gaining attention is called the detachable coil technique. This minimally invasive procedure involves implanting a small coil into the bulge in the arterial wall. The coil provokes an immune response from the body, which, in turn, produces a blood clot inside the aneurysm that strengthens the walls or the artery and reduces the risk of a rupture.