Surprising overlooked stroke risks

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Stroke is the second most common reason of brain damage (after Alzheimer’s disease) and the third most common reason of death (right after heart attack and cancer).

Most of us know that risk of stroke can be reduced by controlling high blood pressure and cholesterol, eating a well-balanced diet and exercising on a regular basis. But it is what you may not know about this disabling disorder that could save your life.

Often overlooked stroke risks…


Until just recently, blood pressure less than 140/90 was considered normal. However, studies now indicate that a reading of 120/80 or higher raises the risk for stroke and should be treated with a combination of exercise, diet and medication, if needed.

What you may not know: Although diuretics, beta blockers and ACE inhibitors have long been utilized to lower blood pressure, recent research reveals that a newer class of antihypertensive medication, called angiotensin II receptor blockers (ARBs), may provide unique protection against stroke.

Recent study: An ARB known as losartan (Cozaar) reduced stroke risk by an additional 25% over the beta blocker atenolol (Tenormin). Several large trials are under way to further study ARBs. If the results are as promising as this preliminary one, ARBs could become the antihypertensive medication of choice for preventing stroke.

Bonus: ARBs cause fewer side effects than other blood pressure medications.

Self-defense: If you take blood pressure lowering medication, ask your physician if an ARB would be appropriate for you.

 Atrial fibrillation

This heart rhythm disturbance affects two million Americans. With atrial fibrillation (AF), the upper chambers of the heart quiver rapidly or irregularly and fail to pump efficiently.

What you may not know: Each year, up to 70,000 strokes are caused by AF. During AF, some patients experience a racing heart, palpitations or a fluttering in their chest, dizziness and/or shortness of breath. For other patients, the first symptom of AF may be a stroke.

Self-defense: To determine if you may have AF, put your index finger on your wrist and check your pulse for an irregular or random rhythm. AF can be confirmed with a routine electrocardiogram (EKG).

If you are diagnosed with AF, your doctor may prescribe an antiarrhythmic medication, such as digoxin (Lanoxin) or amiodarone (Cordarone), or a type of electric shock, known as cardio version, to correct the arrhythmia.

However, the recurrence rate for AF is high with these therapies. It is usually preferable to choose a treatment that prevents blood clots, rather than focusing on the heart rhythm disturbance. Lifetime use of anticoagulants can reduce stroke risk in AF patients by 68%

The most frequently prescribed anticoagulant, warfarin (Coumadin), is extremely effective at preventing clots and reducing stroke risk in people with AF. Unfortunately, it has a narrow “therapeutic index” slightly too much in your system can cause bleeding, slightly too little will permit stroke. Warfarin also interacts with other drugs, supplements and even foods.

Example: Vitamin K, which is found in the leafy greens and margarine, counteracts the effects of warfarin.

Because warfarin interferes with so many common substances, people taking it need to undergo monthly blood tests and physicians must adjust the dosage frequently. As a result, less than half of AF patients who should take Coumadin actually do.

The anticoagulant called ximelagatran (Exanta) looked promising as a way to revolutionize stroke and blood clot prevention. However, it was recently withdrawn from the market due to reports of serious liver problems in a clinical trial.

Leg pain

Just as atherosclerosis can narrow blood vessels to the heart and brain, it also can block arteries in the extremities, causing peripheral artery disease (PAD). Leg pain especially in the calves is the chief symptom. Known as intermittent claudication, the pain typically begins with walking and ends when you stop. PAD affects up to 20% of Americans who are age 65 or older.

What you may not know: If you have PAD, you also may have atherosclerosis elsewhere in the body, such as the heart or the brain. This puts you at increased risk for stroke. What’s more, you also can have “silent,” or asymptomatic, PAD. Risk factors for PAD are the same as those for cardiovascular disease high blood pressure, high cholesterol, diabetes, smoking, age, etc.

Self-defense: PAD is easily and painlessly diagnosed with an ankle brachial index test, which measures the ratio of blood pressure in the arm and ankle.

If you’re diagnosed with PAD, your physician might prescribe an antiplatelet medication, such as aspirin or clopidogrel (Plavix). Moderate exercise to reduce leg pain and blood pressure or cholesterol-lowering medications also may be recommended.

Sleep apnea

This disorder occurs when breathing is temporarily interrupted during sleep. An estimated 24% of men and 9% of women suffer from significant sleep apnea.

What you may not know: People with sleep apnea are three to six times more likely to suffer a stroke. Their blood pressure increases dramatically during the night, which can raise the risk for atherosclerotic blockages of the carotid or neck arteries, and this is a chief cause of stroke.

In one recent study involving men ages 45 to 77, more than 21% of patients with sleep apnea had calcified plaques, which block blood flow, in their carotid arteries. Only 2.5% of the healthy control patients had calcified plaques.

Self-defense: Obesity is the leading risk factor for sleep apnea and loud snoring and excessive daytime sleepiness are telltale signs. If you suspect you may have sleep apnea, consult your physician about diagnosis and the best treatment options.

Caution: It’s important for AF patients who have symptoms of sleep apnea to undergo sleep apnea screening. Mayo Clinic researchers’ recently reported that AF is twice as likely to recur in patients with untreated sleep apnea.

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