The Medical Minute: Prevent a stroke by knowing your risks
Dr. Raymond Reichwein, a neurologist and co-medical director of the Stroke Center, says everyone should request a stroke risk assessment during their annual check-up with their primary care provider. This is especially important as many risk factors may not have any obvious symptoms.
COMMON RISK FACTORS
High blood pressure is the number one, modifiable risk factor for stroke, “but many people are asymptomatic,” said Reichwein, who recommends periodic blood pressure checks in the morning, afternoon and evening as blood pressure can vary throughout the day. If an individual develops pre-hypertension — blood pressure readings above 120/80 and below 140/90 — or high blood pressure, there are many effective, inexpensive medications to manage the condition and lower stroke risk.
High cholesterol and type 2 diabetes are also significant risk factors for stroke and can be managed effectively with medications, Richardson says. But even those who are pre-diabetic — having a higher than normal blood sugar level but not high enough to be type 2 diabetes — have twice the risk of stroke as someone with a normal sugar level.
Other manageable causes of stroke include carotid artery disease and atrial fibrillation (AFib), or irregular heart rhythm. The former, which accounts for approximately 15% of strokes, can be easily assessed during a routine check-up.
“It’s as simple as using a stethoscope to listen for abnormal sounds in the neck that would suggest a blockage,” Reichwein said. If warranted, an ultrasound would follow. A procedure called a carotid endarterectomy can clear the plaque from the blood vessel; occasionally a stent is placed in the artery to reduce subsequent stroke risks.
Up to one-quarter of the population can develop AFib as they get older; a majority of those are asymptomatic. As they age, the condition becomes a stronger risk factor for stroke.
“These can lead to devastating, debilitating strokes in someone who is otherwise a pretty healthy, older individual,” Reichwein said. “The key is to identify it when it’s subclinical. There are devices — Fitbit and Apple Watch — that monitor your heartrate and provide information on whether your data points to AFib.” He cautions anyone who feels abnormal heart palpitations or as if their chest is fluttering to seek medical guidance.
Individuals who snore should take note that obstructive sleep apnea is also a risk factor for stroke. Reichwein advises that people who are overweight, with a bigger neck size, get screened for this disorder.
Finally, there are lifestyle behaviors that can put one at an increased risk of stroke. Smoking, excessive alcohol consumption, obesity, and physical inactivity are all modifiable risk factors.
YOUNG AND AT RISK
While strokes have decreased by 29% in people age 65 and older over the past decade, Penn State Health Stroke Center has seen a dramatic increase in the number of patients ages 25 to 44, according to Richardson. “This population doesn’t even realize they’re at risk,” she said. Read More
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