From genes and gender to age and fitness, whether you smoke or drink, or have other medical conditions, there are many factors which can increase your risk of stroke. Victoria Lambert suggests ways of minimising the risk
CHECK BLOOD PRESSURE
The most important risk factor of stroke is whether you have high blood pressure as it can damage or narrow the arteries. So says Professor Tony Rudd, national clinical director for stroke, based at Guy’s and St Thomas’ NHS Foundation Trust. “If everyone had well-controlled blood pressure – below 130mmol/80mmol – it would prevent 60 per cent of strokes,” he says. High blood pressure is a common problem, affecting about ten million people in the UK. It often has no symptoms; having it measured is the only way to tell if your blood pressure is high, and putting a strain on your arteries and heart. This makes it more likely that you will suffer a stroke or other health problems, such as a heart attack or kidney disease. Blood pressure varies throughout the day, going down if you are asleep or sitting quietly and going up if you are rushing about or stressed. The NHS recommends that all adults should have their blood pressure checked at least every five years. If you haven’t had yours measured or don’t know what your reading is, ask your GP to check it.
TAKE YOUR PULSE
An erratic pulse could be a symptom of atrial fibrillation (AF) a type of irregular heart beat which affects about 750,000 people in the UK. An estimated 15 per cent of all strokes occur in someone with untreated AF. “Having AF means that your heart may not be pumping as well as it should. As a result, blood clots are more likely to form in your heart, increasing your risk of having a stroke,” says neuroscientist Shamim Quadir, research communications manager at the Stroke Association. Symptoms of AF include palpitations, breathlessness, chest pain, fatigue or you may have no symptoms except an irregular pulse over one minute. If concerned, check with your GP. Treatments for AF include medication such as beta blockers which can restore a normal heart rhythm or control the rate at which the heart beats. Other interventions include cardioversion, a controlled electric shock to restore a normal rhythm, or catheter ablation where thin, soft wires are guided through a vein into your heart to record and restore correct electrical activity. Some patients with AF may be prescribed anticoagulants as these can prevent blood clots.
EAT FIVE A DAY
Eating foods that contain vitamin C may reduce the risk of the most common type of haemorrhagic stroke, according to a new study by Dr Stéphane Vannier, of Pontchaillou University Hospital in Rennes, France. Vitamin C is found in fruits and vegetables such as oranges, papaya, peppers, broccoli and strawberries. “It’s important to eat healthily as high amounts of fruit and veg reduce your risk of stroke by 30 per cent,” adds Dr Quadir. “Eating your five a day and having plenty of fibre can reduce stroke risk. But high-fat foods can raise cholesterol and a lot of salt in food can cause high blood pressure, the biggest risk factor for stroke.” The Stroke Association suggests limiting salt to a teaspoon (6g) a day. This includes hidden salt found in some ready-made and processed foods. Most pre-packed foods have a nutrition label on the packaging, which lists amounts of fat, saturated fat, salt or sugar. Watch out for foods which are high in total fat (more than 17.5g of fat per 100g), have more than 5g of saturated fat per 100g, more than 22.5g of total sugars per 100g and more than 1.5g of salt per 100g (or 0.6g sodium).
GET ENOUGH SLEEP
Insomnia may significantly increase your risk of stroke and subsequent stroke hospitalisations, according to the American Heart Association journal Stroke. The risk was highest – up to eight times – among insomniacs aged 18 to 34 years old in a study by Professor Ya-Wen Hsu of the Department of Medical Research at Chi-Mei Medical Center in Taiwan. The risk also seems far greater when insomnia occurs as a young adult compared to those who are older. Research by Dr Chien-Yi Hsu, a cardiologist at Taipei Veterans General Hospital, also in Taiwan, shows that people with insomnia are twice as likely to have heart attacks or strokes as those without the sleep disorder. “Doctors should pay more attention to their patient’s insomnia symptoms, and consider using different methods to improve sleep, including medical, psychological or behavioural therapy, which might improve subject quality of life and reduce the risk of cardiovascular disease,” he says. The link between insomnia and stroke is not yet fully understood, but 90 per cent of people with insomnia have another health condition so further research is required.
AVOID DIET DRINKS
Healthy postmenopausal women who drink two or more diet drinks a day may be more likely to have a stroke, heart attack or other cardiovascular problems, according to research presented earlier this year at the American College of Cardiology’s 63rd Annual Scientific Session. In fact, compared to women who never or only rarely consume diet drinks, those who consumed two or more a day were 30 per cent more likely to suffer a cardiovascular event and 50 per cent more likely to die from related disease. While scientists don’t yet understand why this is, the Stroke Association’s Dr Quadir highlights that obesity is a significant symptom for stroke as excessive weight strains the cardiovascular system, forcing the heart to work too hard. “Even making small changes to your eating habits can make a difference to your overall health, particularly if you have been told that you are at risk of having a stroke or mini stroke,” he says. The Stroke Association recommends you use smaller plates and bowls to stay in control of your portion sizes. Switch white pasta and white bread for brown versions, and grill food rather than fry. When ordering a takeaway, swap creamy sauces for less fatty tomato-based sauces.
Smoking doubles the risk of stroke as it narrows the arteries, while high alcohol intake is potentially dangerous because it exacerbates obesity and high blood pressure. Family history matters too. “We’re not sure to what extent stroke is genetic,” says Dr Quadir. “Some stroke risk is hereditary while many strokes are caused by lifestyle factors, such as smoking – factors or habits that can run in the family too. But it is certainly true that if a close relative has a stroke your risk is likely to be higher.” And heritage is a factor. Although it is not understood why, people of South Asian, black African and Caribbean origin in the UK are more at risk of stroke than the rest of the population. According to new consensus recommendations in the British Medical Journal on how best to stave off a worldwide epidemic of cardiovascular disease, understanding the true age of your heart is key to curbing the lifetime risk of developing – and dying from – stroke and heart disease. You can do this using a new method of risk assessment, the JBS3 risk calculator (http://www.jbs3risk.com/pages/risk_calculator.htm) which builds a whole-risk picture taking into account age, lifestyle, weight and blood pressure.
Moderate exercise such as brisk walking may cut stroke risk in women by 20 per cent, says Professor Sophia Wang of the Department of Population Sciences at the City of Hope Beckman Research Institute in Duarte, California, who presented research to the American Stroke Association meeting in February. She found that moderate exercise also helps offset some of the increased stroke risk in women taking postmenopausal hormone therapy. “I was surprised that moderate physical activity was most strongly associated with a reduced risk of stroke,” she says. “More strenuous activity, such as running, didn’t further reduce women’s stroke risk. Moderate activity, such as brisk walking, appeared to be ideal in this scenario.” The Stroke Association concurs. “Regular exercise, such as walking, can dramatically reduce a range of health risks including stroke,” says Dr Quadir. “We recommend 30 minutes’ moderate exercise five times a week to keep your risk of stroke down.” You can choose any form of exercise as long as the activity increases your heart rate, makes you feel warm and a little out of breath. You could join a class or simply make small changes to your lifestyle.
WHAT IS A STROKE?
Our brains need a constant supply of blood, which provides vital nutrients and oxygen to the brain cells. A stroke happens when that supply is cut off, causing cells to be damaged or die. There are two main types of stroke. Ischaemic strokes occur when something, such as a blood clot, air bubble or fat globule, blocks an artery that carries blood to the brain or even inside it. Haemorrhagic strokes happen when a blood vessel bursts and bleeds into the brain due either to a vessel bursting within the brain itself, or a blood vessel on the surface of the brain bleeding into the area between the brain and the skull.
WHAT IS A MINI STROKE?
A transient ischaemic attack or TIA is known as a mini stroke. It is the same as a stroke, except that the symptoms last for a short amount of time and no longer than 24 hours. This is because the blockage in your artery is temporary; it either dissolves on its own or moves, so that the blood supply returns to normal and your symptoms disappear. Although the symptoms may not last long, a TIA is still very serious. It is a sign that there is a problem and you are at risk of going on to have a stroke that could cause you considerable harm. Because of this it is often called a warning stroke.