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Every 40 seconds, someone in the US has a stroke. Every 4 minutes, someone dies from this condition.

That’s not all. Here are the other stroke statistics from the Centers for Disease Control and Prevention (CDC, 2020):

  • In 2018, 1 in 6 deaths from cardiovascular disease was because of stroke.
  • Over 795,000 people in the US have a stroke every year. 610,000 of these are first-time strokes. The remaining—185,000—are repeat strokes.
  • 87% of strokes are ischemic strokes. Here, blood flow to the brain is blocked, and blood supply is lost. (The other type of stroke is hemorrhagic stroke.)
  • Stroke is costly. In 2014-2015, stroke-related costs reached $46 billion per year. This amount includes the cost of healthcare services, medicines, and missed days of work because of stroke.
  • Stroke is the leading cause of serious long-term disability. More than half of stroke survivors 65 years old and above have reduced mobility.

While the above facts are worrying, there’s good news—we can prevent stroke!

In this post, we’ll discuss stroke risks and how to manage them, as well as a related condition called atrial fibrillation.

 

Stroke and stroke risk factors

A stroke is when the brain loses its blood supply. 

Aging, family history, and genetics—these are a few factors that make a person susceptible to having a stroke. While these 3 factors can’t be stopped or reversed, there are several other risk factors that are controllable. 

For a start, here’s a good list from the INTERSTROKE study (O’Donnell, 2010):

  1. History of hypertension or high blood pressure
  2. Smoking
  3. Waist-to-hip ratio
  4. Diet
  5. Physical inactivity
  6. Diabetes
  7. Alcohol intake
  8. Psychosocial stress
  9. Cardiac causes
  10. The ratio of apolipoprotein B to A1

How to Prevent Stroke

Knowing the controllable risk factors is the first step to stroke prevention. Acting to control them is the next big step.

Harvard Health Publishing provides an easy-to-understand list of things we can do to prevent stroke. I add a 7th—manage atrial fib—which should be useful for people diagnosed with atrial fib and those who may not know they have it.  

1. Lower blood pressure. 

High blood pressure or hypertension remains the biggest contributor to the risk of stroke in both men and women. It can double or quadruple stroke risk.

We were unaware of how many people do have high blood pressure in the old days, as we didn’t check for high blood pressure that much back then.

When lots of people start having heart attacks and strokes, we notice that these people are likely to be hypertensive too. We then realized that high blood pressure is indeed a big risk factor. That’s why we started monitoring it. 

Is hypertension a bigger risk than atrial fib?

No. A lot more people have high blood pressure problems than there are people with atrial fib.

Just look at me. I do have high blood pressure problems. I treat and control it. But since I have atrial fib, atrial fib is a much bigger stroke risk factor for me than my hypertension. 

2. Lose weight. 

Obesity and its linked complications raise the odds of having a stroke.

If you’re overweight, losing as little as 10 pounds can already have an enormous impact on your stroke risk. Not only that. Losing weight also has an enormous impact on prediabetes, diabetes, and heart attack risk.

3. Exercise more.

Exercise can lower blood pressure and help people lose weight.

Amazingly, exercise also stands on its own as an independent stroke reducer. In one study, stroke risk is reduced by 11% in moderately active people, and by up to 19% in very physically active ones (Diep, 2010). 

There are debates, though, whether the difficulty and duration of the exercise are important. One study showed that every little activity counts, whether it’s just a leisure activity, walking, or a physically demanding task (SAFE, 2020). 

On the other hand, another study stated that 30 minutes of moderate-intensity exercise is more beneficial to stroke survivors than doing an entire hour of lower-intensity exercise (Rimmer, 2009). This is one “soft” indicator that moderate to intense activity is a bigger deal for stroke prevention. 

So, is a more strenuous exercise better? The answer is that we don’t know for sure. 

For an additional perspective, I made this video where I covered an article from Mayo Clinic. 

 

One thing this article hinges on is on how important mitochondrial mass is in our muscle tissues. I think most of us would agree and say, “That’s probably the case.” 

The bottom line here is that you can increase mitochondrial mass mostly with high-intensity interval training, followed by resistance training as a moderate second, and then by aerobic training or mild activity as a distant third. 

4. Keep your blood sugar under control.

Having high blood sugar damages blood vessels. This leads to the formation of soft plaque, which could form a blood clot. 

5. If you drink, do it in moderation. 

Studies show that with 1 drink per day, the risk is lower. But once you get to 2 drinks, the risk goes up sharply. 

I would tell you, with any addictive substance (like alcohol), if you take it every day, you would greatly increase your risk of addiction.

I know many people would say, “Well, you should have a glass of red wine each day for your heart.” While wine may help with some of these risk factors (like LDL and HDL), overall, things should be in balance. 

6. Quit smoking.

You may already know this, but smoking does bring a lot of bad things to you.

It speeds up clot formation. It thickens the blood. Moreover, it increases plaque buildup. 

7. Manage atrial fib.

Have you ever had this little flutter in your chest quite often? That may be nothing, but sometimes, that’s an atrial fib. 

Atrial fib (also known as AF, AFib, or atrial fibrillation) is the most common abnormal heart rhythm. It can increase stroke risk by 5 to 8 times. That’s why I added atrial fib management as it’s a big part of stroke prevention.

Unfortunately, 10-20% of people with atrial fib are uncertain if they did have a stroke. One reason they are uncertain is that they don’t have those usual stroke symptoms. 

I suspected that I had atrial fib because I had that little fluttering thing. I woke up one morning, and I felt this sensation of a trout flipping around in my chest. I expected it to go away, but it didn’t. I’m also aware that I have 4q25, the atrial fib gene.  

Thanks to a wearable technology called iKardia, I was able to diagnose my atrial fib. This device has a little electrode that everyone can use to find out if they do have atrial fib. I plugged it in, I used it, and sure enough, I found out I have atrial fib.

 

Atrial fib treatment

If you know you have it, how do we treat atrial fib then?

There are several ways to do this. There are medicines for atrial fib, with different effects like restoring the heart’s normal rhythm beat rate, or preventing blood clotting (e.g., warfarin and aspirin). There’s also a procedure called catheter ablation where diseased areas of the heart are destroyed (NHS, 2018).

A cardiologist friend of mine strongly suggested that I get an ablation. He was very proud of his results. He said almost a third of his patients never need a new ablation. 

But can atrial fibrillation ablation really reduce the risk of stroke?

While ablation is considered to be “a cure” for atrial fib, you should know that atrial fib has this nasty habit of coming back. That’s the reason I decided not to get an ablation. 

I did several other things, though. I improved my sleep. I further lost weight. I increased my exercise. In the end, there are lots of things in terms of lifestyle that are more effective than ablation, medications, or even surgery.

My name is Ford Brewer. My team and I work to prevent heart attack, stroke, cancer, and dementia. Our goal is to help you understand how to prevent major killers and disablers. Most of them are driven by the process of cardiovascular inflammation. If you want to know more about the science of preventive medicine or you have questions about certain aspects of your health, check out our webinar programs and online courses

References

Centers for Disease Control and Prevention (CDC). Stroke Facts. CDC website. https://www.cdc.gov/stroke/facts.htm. Page last reviewed September 8, 2020. Accessed October 14, 2020. 

Diep L, Kwagyan J, Kurantsin-Mills J, Weir R, Jayam-Trouth A. Association of physical activity level and stroke outcomes in men and women: a meta-analysis. J Womens Health (Larchmt). 2010 Oct;19(10):1815-22. doi: 10.1089/jwh.2009.1708. 

Harvard Health Publishing. 7 things you can do to prevent a stroke. Harvard Health Publishing website. https://www.health.harvard.edu/womens-health/8-things-you-can-do-to-prevent-a-stroke. Updated June 26, 2020. Accessed August 25, 2020. 

National Health Service (NHS). Atrial fibrillation: Treatment. NHS website.  https://www.nhs.uk/conditions/atrial-fibrillation/treatment. Page last reviewed April 24, 2018. Accessed October 14, 2020.

O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010 Jul 10;376(9735):112-23. doi: 10.1016/S0140-6736(10)60834-3.

PrevMed. Prediabetes: A Risk for Heart Attack & Stroke? PrevMed website. https://prevmedhealth.com/prediabetes-a-risk-for-heart-attack-stroke. Accessed October 14, 2020. 

Rimmer JH, Rauworth AE, Wang EC, Nicola TL, Hill B. A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors. Arch Phys Med Rehabil. 2009 Mar;90(3):407-12. doi: 10.1016/j.apmr.2008.07.032. 

Stroke Alliance for Europe (SAFE). 8 Facts on Exercise and Stroke Risk. SAFE website. https://strokeprevention.info/risk-factor-psysical-inactivity/8-facts-on-exercise-and-stroke-risk. Accessed August 25, 2020.

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