A worldwide problem
By Allan R. Handysides and Peter N. Landless
My mother has had two episodes that the doctor says were ministrokes, or transient ischemic attacks. We are worried that she might have a major stroke. Is there anything we can do that will protect her?
Stroke is a major cause of death worldwide and a leading cause of incapacity in its victims. When stroke and transient ischemic attacks (TIAs) are lumped together, they may exceed the rate of coronary vascular effects.
An ischemic stroke occurs when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes brain cells begin to die. A stroke or TIA (in which the blockage is temporary) has a 12.8 percent risk of recurring within a week. Some have estimated up to 80 percent of stroke recurrences could be avoided if patients were managed appropriately.
Not all strokes occur for the same reason. A clot or a plaque blockage in the blood vessels is most often the cause of the interruption in blood flow. About 15 percent of ischemic strokes, however, are the result of a blood-vessel rupture in the brain, with about 5 percent (1 in 20) related to bleeding around the brain.
To identify the cause of the TIA, or ministroke, doctors need to determine:
2. Is it related to large artery disease, such as carotids?
3. Is there small artery disease, as with diabetes?
4. Is this related to other problems, such as clotting disorder, drugs, or mechanical problems?
In order to get this information, most patients will undergo magnetic resonance imaging (MRI) investigation, which is more sensitive than computed tomography (CT) for defining strokes. Other forms of imaging will permit diagnosis of blood-vessel damage. Even with this testing, however, doctors are sometimes unable to determine the cause of strokes.
For your mom, and all such patients, aggressive risk-factor management and lifestyle modification are essential. Regular exercise, abstinence from smoking, and weight control are critical.
The following 10 factors have been identified as playing a role in 90 percent of stroke risk factors:
4. poor diet
5. lack of exercise
7. alcohol consumption
8. stress and depression
9. cardiac irregularities
10. genetically determined abnormal cholesterol levels
In addition to lifestyle changes, solid evidence supports the lowering of blood pressure, the lowering of cholesterol, and medications to lower platelet adhesiveness. Data is not available to define an optimal blood pressure, but absolute lowering of systolic pressure has shown improved outcomes. A 28 percent lower risk of stroke over four years was seen in those taking an angiotensin-converting enzyme (ACE) inhibitor to lower blood pressure. Whether the specific medication or the lowered blood pressure is most responsible is debatable, but most of the evidence supports it is the lowered blood pressure.
Lowering cholesterol with a statin has shown a 25 percent reduction in the risk of stroke, with the greatest effects being seen in persons whose cholesterols were lowered the most significantly.
Aspirin in very low doses (80 milligrams per day) seems as effective as high doses when taken regularly, and although other antiplatelet drugs have slightly better effects, their side effects offset these benefits.
Careful evaluation of your mom is required, followed by lifestyle change. If her blood pressure is elevated, it must be normalized. Cholesterol levels, too, need to be brought to normal. Antiplatelet treatment is of lesser benefit, but may be recommended.
Exercise along with a low-fat vegetarian diet that includes whole, unprocessed foods and lots of fresh fruits and vegetables offer the best chance of a longer life. The implementation of such a lifestyle also permits the celebration of God’s goodness in giving us life and health as His gracious gifts.
Allan R. Handysides, a board-certified gynecologist,
is director of the General Conference Health Ministries Department.
Peter N. Landless, a board-certified nuclear cardiologist,
is an associate director of the General Conference Health Ministries Department.