Print Eric Van De Graaff, M.D.

Lists are big.  I love them and so do most people.  For me they do three things.  They give me a pithy, terse overview of a particular subject without the need to delve into it too far.  They validate (or repudiate, as the case may be) my own frame of reference on a subject.  And they spark discussion and controversy.  Although I have no authoritative source on the subject, I believe top ten lists must have originated with the FBI (“most wanted”), or Casey Kasem, or even the Moses’ original “top ten.”  A few years back the American Film Institute generated some controversy by creating lists of the 100 best films of the last 100 years and followed up with other “100 best” lists in sub-genres.  These lists became a rousing success despite (or perhaps because of) initial outrage.  Some people hate these types of rankings—I love them, even if I can’t see why Citizen Kane is the best film ever made.

Well, my lists are unfortunately not quite so fascinating but I’ll give it a shot.  Next week I am scheduled to give a lecture on stroke prevention. For this blog entry I’ll produce my list of the 10 best things you can do to prevent a stroke.

A little background first.  A stroke (synonym: cerebrovascular accident, CVA) occurs when part of the brain is starved of oxygen long enough to do permanent damage.  Many things can interrupt blood flow to the brain.   A vessel with a weakened wall (aneurysm) can rupture and cause bleeding and pressure on a portion of the brain tissue and lead to a hemorrhagic stroke.  A clot can become lodged in one of the vessels—arising from the heart or other vessels in the chest, neck and head—and cut off downstream flow to the area of the brain normally supplied by that vessel.  This last mechanism is the most common scenario and generally results in the classic symptoms of numbness, paralysis, slurring of speech, and weakness.

So here goes.  The ten things you can do to avoid a stroke:

  1. Know and treat your blood pressure. We have plenty of studies showing that most Americans don’t know what their usual blood pressure is, and most who have high blood pressure are not adequately treated.  Check your pressure periodically and seek treatment advice if your numbers are consistently above 130 over 80.
  2. Don’t smoke, and if you do, quit. Tobacco use (even light, occasional use) increases the risk of stroke.  On the other hand, quitting produces a rapid drop in risk, as was reported in a study from the Journal of the American Medical Association.
  3. Get thin. I know, this is easier said than done.  Obesity itself serves as a risk factor for stroke and can also lead to metabolic syndrome, a disorder that involves diabetes, cholesterol abnormalities, and high blood pressure.
  4. Limit alcohol intake.
  5. Seek treatment if you have atrial fibrillation. This irregular rhythm arising in the upper chambers of the heart is generally associated with more advanced age and can dramatically increase your risk of stroke if left untreated.  Anticoagulation with warfarin (Coumadin) is the current treatment of choice (please see my previous post about this medication).
  6. Be aggressive with cholesterol treatment. Curiously, high cholesterol has not been clearly established as a risk factor for stroke (as it is with heart attacks), but treatment with statin medications (Zocor, Lipitor, Crestor, etc.) decreases stroke risk rather dramatically.
  7. Exercise on a regular basis. I know, I know.  I have to add this—I’m a cardiologist, after all.
  8. See your doctor regularly if you have any form of vascular disease. Blockage in any vessel of the body (such as coronary artery disease in the heart) implies that the chance is much higher that blockages exist elsewhere, such as in the carotid arteries of the neck.
  9. Know the symptoms of stroke and seek care immediately. If we catch this very early we can provide aggressive treatment that may result in full resolution of symptoms.  The American Heart Association has a useful page on this subject.
  10. Keep reading my blog. Actually, this doesn’t really reduce your risk of stroke, but I couldn’t come up with a tenth item and I wanted and opportunity to insert a shameless plug.


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6 Responses to 10 Ways to Prevent a Stroke

  1. Arie says:

    How dare you question the greatness of Citizen Kane?

    I was glad to see that I do over half of the things you listed (even if I had to count reading the blog as one of them).

    Now I’m going to reveal my ignorance, but when you say keep your blood pressure below 130 over 80 what exactly do you mean? Should both the upper number and the lower number be below their thresholds and what if one or the other isn’t?

  2. Dr. Van De Graaff says:

    Arie,

    You are right in your interpretation about my comments on blood pressure. The top number is the systolic measurement. The term “systole” refers to the contraction of the ventricle and implies the pressure generated in the large vessels during contraction. The lower number–the diastolic–is what is measured between heart beats.

    The history of the science of blood pressure is interesting and has evolved over the last 50 years (it would be a great subject to write about). It used to be thought that the diastolic number was most important and that the top number was irrelevant. Now we know that there is a rather dramatic difference in survival between people with a top number above 130 and those below. This difference is magnified in individuals with other risk factors for vascular disease, such as diabetes.

    As to your opinion on Citizen Kane, you have to understand that the AFI put together their rankings prior to the release of such greats as “Transformers,” “Alvin and the Chipmunks,” and the third “X-men” movie.

    Thanks for your comments.

  3. Billy says:

    Thanks for sharing at the Heart Healthy Cooking Class this past Wednesday. I have a much better understanding of different types of strokes. The food was pretty good as well.

    On my way my way home from work NPR’s Terry Gross interviewed Jill Bolte Taylor,a neurological researcher, who had a stroke about 8/9 yrs ago. In the interview she was able to articulate her experience with stroke and describe her recovery. The link to the interview and the title of the book has been copied below.

    http://tinyurl.com/qpd2t9
    “My Stroke of Insight: A Brain Scientist’s Personal Journey”
    Jill Bolte Taylor

    Citizen Kane, the only thing I got out of it was a lot of sleep during Film Appreciation class as an undergraduate.

    Hope to see you at another Heart Healthy Cooking Class.

  4. Joyce Hoffman says:

    I started a blog in August, 2010, to give patients and caregivers the confidence to stand up for themselves, despite the indifference and negativity that confronted me daily.
    Using only one hand to type since my right, dominant hand was paralyzed from the stroke, I go through my story, beginning with the signs before I had the stroke and ending, in the future, when I came to grips with the stroke. It is important to make any person both heed the warning signs and, at the same time, come to realize the necessity of accepting the stroke and going on with your life. http://stroketales.blogspot.com

  5. B.B. Imokhai says:

    Thanks for your useful tips. We need the grace of God observe the tips though. My slogan is ‘health is wealth’.

  6. B.B. Imokhai says:

    Many thanks for the health tips.

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