The consequences of stroke—also called brain attack—can be devastating: cognitive impairment, paralysis, even death. A stroke can occur as the result of bleeding in the brain (hemorrhagic stroke) or blocked blood flow to the brain (ischemic stroke). The longer the blood supply is blocked, the more brain cells are destroyed—and the greater the physical and cognitive damage. (See “Hitting the Books,” page 16, for novelist Esmeralda Santiago's story of stroke recovery.)
Each year, about 795,000 people in the United States have a stroke. It's our nation's number four killer and a leading cause of long-term disability. Yet most of the public is woefully ignorant about the risk factors for stroke, according to Louis R. Caplan, MD, Fellow of the American Academy of Neurology (AAN), neurologist at Beth Israel Deaconess Medical Center in Boston, MA, professor of neurology at Harvard Medical School, and author of Navigating the Complexities of Stroke from Neurology Now™ Books (available in bookstores and from Internet retailers including Oxford University Press at bit.ly/157OuTP and from the AAN Store at aan.com/view/PatientBookSeries).
“The medical profession and the media have been relatively successful in educating the public about heart attacks, cancer, and HIV, but stroke has received much less attention,” Dr. Caplan says. What's more, 80 percent of all strokes are preventable, according to the American Stroke Association (ASA).
To help combat these alarming statistics, the ASA and the American Heart Association (AHA) joined forces to create Life's Simple Seven. This quick risk-assessment and prevention tool focuses on seven ways to prevent stroke: getting active, eating better, losing weight, managing blood pressure, controlling cholesterol, reducing blood sugar, and not smoking. Go to mylifecheck.heart.org, plug in a few numbers along with certain lifestyle habits, and voila, you can calculate your risk.
In a nationwide study of more than 20,000 adults published in the medical journal Circulation, people who met just one of the prevention criteria identified by Life's Simple Seven had a 25 percent reduction in stroke risk.
HOW TO FOLLOW THE SIMPLE SEVEN
Life's Simple Seven reaffirms the accepted wisdom that what's good for the heart is good for the brain. What are the strategies?
Get active. Not only does exercise help you lose (or maintain) weight, it also lowers blood pressure, increases high-density lipoprotein (HDL, the good cholesterol), and helps keep blood sugar levels in check.
“Just 30 minutes of moderate activity, five days a week, can dramatically lower your risk of heart disease, stroke, and diabetes,” says Robert Sacco, MD, vice president of the American Academy of Neurology, former president of the AHA, and chair of neurology at the University of Miami School of Medicine in Florida. Researchers from Columbia University Medical Center and the University of Miami found that men who participated in moderate to high intensity activities (such as tennis, swimming, and running) were 63 percent less likely to have a stroke than those who were mostly sedentary.
Simple tip: Go for a walk. You don't have to be a triathlete to benefit from exercise. Even a moderate amount of exercise can provide a huge health benefit.
Eat better. Think of your body as an engine. The higher-octane fuel you put into it, the better it runs. That's why the AHA calls for Americans to fill half their plates with fruits and vegetables (more than 4.5 cups/day), fuel up on fiber-rich whole grains (more than 3 one-ounce servings/day) and increase fish intake (2 or more 3.5 ounce servings/week). Then, ditch sodium and added sugars. Eat this way and you'll be close to a Mediterranean-style diet, which many experts believe is the best dietary defense against a brain attack. Research shows eating this way lowers blood pressure, reduces inflammation, and protects the heart.
Simple tip: Load up on fruits and veggies. Experts claim eating eight to 10 fruits and vegetables a day as part of a low-fat diet can lower blood pressure almost as much as most blood-pressure medications.
Lose weight. One of the most important steps you can take to stave off stroke and add years to your life is to keep excess pounds at bay. “Heavier people are more likely to have high blood pressure, diabetes, and elevated cholesterol levels,” says Dr. Caplan—all of which increase the risk of stroke. A study of more than 20,000 male health professionals found the risk of stroke was 30 percent higher in those who were overweight and twice as high in those who were obese as in normal-weight men. (Where the weight accumulates is important as well: belly fat has a metabolic effect that's detrimental to blood vessels.)
Simple tip: Track what you eat for a few days to pinpoint problem habits. Then, focus on burning more calories than you take in.
Manage blood pressure. According to a study published in the journal Stroke, people who had ideal blood pressure levels had a 60 percent lower risk of future stroke. Unfortunately, one in three Americans have hypertension, meaning their blood pressure is above 120/80 millimeters of mercury per deciliter of blood. When blood pressure runs high, blood courses through your body with too much force, stretching out the arteries and creating microscopic tears. The scar tissue that forms to heal those tears traps plaque—resulting in blockages, blood clots, and hardened arteries, all of which can deprive the brain of needed blood. Dubbed the “silent killer,” hypertension has no symptoms, yet it can devastate lives by causing heart disease and stroke.
Simple tip: Toss the salt-shaker. The AHA recommends limiting sodium to 1,500 mg per day to help lower blood pressure and reduce the risk of stroke. The average consumption? A whopping 3,500 mg, according to Dr. Sacco.
Control cholesterol. This waxy substance is used by our bodies to make cell membranes and hormones. Too much bad cholesterol promotes the formation of plaques in the veins and arteries impeding blood flow to your heart, limbs, and brain. “An increase in triglycerides can also promote plaque formation and increase the risk of stroke,” says Dr. Caplan. Lowering low-density lipoprotein (LDL, the bad cholesterol) and triglyceride levels helps ensure your whole body gets adequate blood.
Simple tip: Visit your doctor. If your cholesterol level is over 200 mg/dL, taking a statin can help reduce your risk of stroke.
Reduce blood sugar. Our bodies convert most of the food we eat into blood sugar (glucose) for energy. When your body stops making insulin—a hormone needed to change sugar, starches, and other food into energy—or when insulin stops doing its job, diabetes sets in. While diabetes isn't a death sentence, it greatly increases the risk of heart disease and stroke. In fact, most people with diabetes die of some form of heart or blood vessel disease. Ideal fasting blood sugar for both children and adults is below 100 mg/dL. If your levels are higher than that, work with a healthcare professional to get them in check.
Simple tip: Watch the sugar in foods like candy, soda, and white bread (aim for less than 450 calories per week). Too much sugar in the bloodstream begins to glom onto proteins and make them sticky, like putting cotton candy in your gas tank. Sugar also raises insulin levels, which locks fat cells into place, making it more difficult to lose weight.
Stop smoking. One of the nation's top causes of early death, smoking contributes to plaque buildup in the arteries and reduces HDL levels, which makes the blood more likely to clot and cause problems. The upshot: As soon as you quit, your health improves. According to the ASA, within a few years of quitting, your risks of stroke and heart disease are similar to non-smokers—a 40 percent lower risk compared to smokers.
Simple tip: Get help. Call the National Network of Tobacco Cessation Quitline: 1-800-QUITNOW (1-800-784-8669), visit naquitline.org, or visit WhyQuit (whyquit.com).
While stroke undoubtedly has a strong genetic link, four of the seven Life's Simple Seven criteria are lifestyle related. “If we start by getting our behaviors in check, we may not need medications to control the other three factors (blood pressure, blood glucose, and cholesterol),” says Dr. Sacco.
A study published in 2011 in the New England Journal of Medicine, for example, found that among patients who had a recent heart attack or stroke, aggressive medical management, including regular monitoring of lifestyle factors, was superior to surgical stenting, in which surgeons place a tiny tube into an artery or blood vessel to hold it open.
“[Changing behavior] is sort of a prescription for heart and brain health,” says Dr. Sacco. “It's not easy, but doing something—even one step at a time—could be helpful for heart and brain health.”
Trouble is, for many people, implementing healthy lifestyle changes can seem just as impossible as rewriting your family history. In fact, according to Dr. Caplan, many people don't make important lifestyle changes until after they have a cardiac event or a stroke.
Your best bet, say experts, is to start young before bad habits set in. “Medical risk factors and situations that increase stroke risk begin early in life, long before people are screened,” says Dr. Caplan, who cites autopsy research on teenagers showing atherosclerotic lesions (an early indication of impending heart disease and stroke that increases with time). School education can make a tremendous impact.
In the meantime, if you discover your blood vessels are 10 years older than you are, you might be motivated to take action. Investing in your health, whether by increasing physical activity or eating better, can translate into more successful aging. It may even help you live into your golden years free of cancer, heart disease, stroke, and dementia, to say nothing of its impact on your quality of life. At the end of the day, isn't that what we all want?
Use Your Head: Protect Your Heart
What's good for your heart is good for your head. Taking the following steps to keep your heart healthy may also help reduce your risk of stroke:
- Don't smoke
- Keep your blood pressure and cholesterol levels in check
- Eat a low-fat, healthy diet
- Get plenty of exercise
- Maintain a healthy weight
- Limit alcohol consumption
- Get blood sugar levels (and diabetes, if you have it) under control
FOR MORE INFORMATION
- For a full collection of Neurology Now articles on stroke, go to bit.ly/NN_StrokeCollection
- For articles on stroke from Neurology Today, go to bit.ly/NT_Stroke