Risk Factors for Stroke Do you have them?

[Lee Kirksey, MD]

Stroke Risk Factors

Some stroke risk factors are hereditary.  Others are a function of natural processes.  Still others result from a person's lifestyle.  You can't change factors related to heredity or natural processes, but those resulting from lifestyle or environment can be modified with the help of a healthcare professional. Fortunately, most risk factors are under our control

What risk factors for stroke can't be changed?

Age - The chance of having a stroke more than doubles for each decade of life after age 55.  While stroke is common among the elderly, a lot of people under 65 also have strokes.

Heredity (family history) and race - Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke.  African Americans have a much higher risk of death from a stroke than Caucasians do.  This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.

Sex (gender) - Stroke is more common in men than in women.  In most age groups, more men than women will have a stroke in a given year.  However, more than half of total stroke deaths occur in women.  At all ages, more women than men die of stroke.  Use of birth control pills and pregnancy pose special stroke risks for women.

Prior stroke, TIA or heart attack - The risk of stroke for someone who has already had one is many times that of a person who has not.  Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke.  A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't.  Recognizing and treating TIAs can reduce your risk of a major stroke. If you've had a heart attack, you're at higher risk of having a stroke, too.  

What stroke risk factors can be changed, treated or controlled?

High blood pressure - High blood pressure is the most important controllable risk factor for stroke.  Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.

Cigarette smoking - In recent years, studies have shown cigarette smoking to be an important risk factor for stroke.  The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways.  The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.

Diabetes mellitus - Diabetes is an independent risk factor for stroke.  Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight.  This increases their risk even more.  While diabetes is treatable, the presence of the disease still increases your risk of stroke.

Carotid or other artery disease - The carotid arteries in your neck supply blood to your brain.  A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot.  Carotid artery disease is also called carotid artery stenosis.   Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It's caused by fatty buildups of plaque in artery walls.  People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.

Atrial fibrillation - This heart rhythm disorder raises the risk for stroke.  The heart's upper chambers quiver instead of beating effectively, which can let the blood pool and clot.  If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.

Other heart disease - People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally.  Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.

Sickle cell disease (also called sickle cell anemia) - This is a genetic disorder that mainly affects African-American and Hispanic children.  "Sickled" red blood cells are less able to carry oxygen to the body's tissues and organs.  They also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
High blood cholesterol - People with high blood cholesterol have an increased risk for stroke.  Also, it appears that low HDL (“good”) cholesterol  is a risk factor for stroke in men, but more data are needed to verify its effect in women.

Poor diet - Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels.   Diets high in sodium (salt) can contribute to increased blood pressure.  Diets with excess calories can contribute to obesity.  Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.

Physical inactivity and obesity - Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke.  So go on a brisk walk, take the stairs, and do whatever you can to make your life more active.  Try to get a total of at least 30 minutes of activity on most or all days.
What are other, less well-documented risk factors?

Geographic location - Strokes are more common in the southeastern United States than in other areas.  These are the so-called "stroke belt" states.

Socioeconomic factors - There's some evidence that strokes are more common among low-income people than among more affluent people.

Alcohol abuse - Alcohol abuse can lead to multiple medical complications, including stroke.  For those who consume alcohol, a recommendation of no more than two drinks per day for men and no more than one drink per day for nonpregnant women best reflects the state of the science for alcohol and stroke risk.
Drug abuse - Drug addiction is often a chronic relapsing disorder associated with a number of societal and health-related problems.  Drugs of abuse, including cocaine, amphetamines and heroin, have been associated with an increased risk of stroke.

[Suzie9]

Maybe you could help me.I had a couple of MRI scans which showed up areas of high attenuation consistant with demyelination on the brain and spine.The only symptom i have is Pareasthesia  around the spine and i'm not sure if this is related.

M.S,Devic's and Clinically isolated syndrome are what my neurologist is testing me for but i was curious to know if it was possible that drug use could have caused these areas that showed up on my scan.

I am not a user at the moment and have never been a regular user but once after taking Ecstasy [1 pill] i collapsed for around 10 minutes.I didn't have any neurolgical symptoms after this,but could this have caused any damage on my brain and spine?I took less than half a pill at a later date and passed out for a short time.I haven't taken it since.I was drinking alcohol on both occassions.

I have also taken Cocaine on several occasions but i have never had a bad experience with this.

I would appreciate any help and advice.

Suzie.

[Lee Kirksey, MD]

Hello
Its possible, but unlikely. It is conceivable that low blood pressure caused you to "pass out" and low blood pressure could injure the spinal cord. Good luck

[Suzie9]

Thank you for your message back.

You said low blood pressure could injure the spinal cord but could it account for the "blob" as my neurolgist called it,on my brain?

Suzie.

[Me967]

What's my risk factor:

Age: 41  Sex: F  Weight 165# @ 5ft 5in.
Heredity (family history) and race--White,  alot of family heart issues with family.
Prior stroke, TIA or heart attack--? On all EKG pictures it shows"?old anterior infarction"?
   I fell down, heart felt fast and hard, my breathing stopped & heart stopped, eyes rolled back, and skin turned bluesh gray.  I was brought back by family member, got real sick and was tired so I just went to bed.  Never got checked, untill 3 yrs later for High BP.

High blood pressure-  Was 165/101 for a couple yrs. before starting meds.  Now 117/78
     on Diazide/ Maxide 50/25 mg, Lopressor 50 mg, and Asprin 81mg.
Cigarette smoking-  Yes ~ 31 yrs.  Trying to quit.  
Diabetes mellitus---No, family members do, mine stays about 101
  high blood Chol.-- was 236 Total, hdl 69 ldl 153 on Lipitor 10mg, now 203 T 56/127
Carotid or other artery disease--- Not that I know of.
Atrial fibrillation---- ? sino-atrial on EKG,  The picture of the EKG is in my pictures on here.  My chest feels funny sometimes like it's sunken in.  I don't like being able to feel my heart beating.  I would greatly apprieate it if you could like at the pictures of the EKGs.
Other heart disease--?,  interatrial septal aneurysm, size 1cm in test results (journal)
Sickle cell disease---No
Poor diet-----No,  eat mainly home canned veggies and fruit, fish and deer meat.  Love salads and fruit to snack on.   Yes,  if I get into chips and dips.  ha ha
Physical inactivity and obesity--165#, not inactive but not overly active.  Get on the treadmill once daily, garden, yard work, ect., Housewife, no job.
Geographic location---Pennsylvania.  Don't understand that one on why?  Socioeconomic factors --Not low income but the bills are there.  ooch. LOL Makes since.
Alcohol abuse-- 2 beers or drinks a night to sleep.
Drug abuse---No

My Dr. told me I was at risk for a heart attack or stroke because of a hs CRP test which has ranged from 6.1- 20 in 2006 and need to keep my heart rate low due to ?ASA.  And always tells my it beats hard?

In Jan.    I had the EKG done when I went in again with back pain that was also in my chest and arm.  She checks my heart, and tells me I'm a ticking time bomb and I  need to quit smoking.  I just wanted help for my back.

In Feb.  I went in with what I thought was actually my heart for the first time (pains were severe the night before, arm felt like cement, heart beat felt fast and hard but actually dropped low).  Since my chest fills empty or sunken somehow.  She told me she done all the test she could in 2006 and that I had to bloom or maybe had the flu comming on?  I felt silly for even going then.  I requested my medical records 2 wks later after stewing on it.  
I have posted them all in my Journal and uploaded the pictures of the EKGs in my pictures.  I was sorta surprised the other day when on here someone said a sino-atrial 2nd degree mobitz ll block was/could be life threatening.  I only found out it was on the EKG by requesting my reports.  If you could look at them and or my test results,  I would greatly apprieciate your opinion.  
Also if you think I should go to another Dr. (new eyes)---How would I do that without upsetting her.  She never mentioned anything on the reports so maybe she was just trying to scare me into not smoking with the hs CRP.  Or what could I ask as far as test for being tired and others mentioned.
Can things change that much within 2 years.  
I thought if they get too bad of going to the ER, but, I don't want to waste their time and feel silly for it.  
Would love to hear from you.  Sorry if I made this long.  Haven't figured out wether the reports are fairly normal or bad.  Thank you;
Amy

[Tizzle]

Dear Dr. Kirksey,
I'm incredibly concerned with my risk factor of obtaining a stroke.  

My mother (48) had a massive stroke unexpectedly in January and passed away.  She was active, fit, and was not sick.  She ate a healthy diet, with an occasional glass of wine.  She did not smoke or do any type of drug.  According to her test results from the hospital, she didn't have high blood pressure or cholesterol.  She had an unusual amount of bacterial infections leading to UTI's and Bladder infections, as well as migraines.  She also had endometriosis (?) since the age of 15, where she's been taking Depo shots to control it.  The only symptoms prior to the stroke was fatigue and the usual migraine she obtained.  I'm confused how she could of had a stroke, and what I need to know to prepare.  My family history has no heart disease or Diabetes, but we do have stomach and prostate cancer.  

As for myself, I'm a 23 year old white female that lives in Southern California.  I don't drink or smoke.  I've been generally healthy most of my life, with a few exceptions.  I do get migraines, and have since I was 13.  I had my nose cauterized when I was 12 to prevent excessive nose bleeds.  I've also had scarlet fever when I was 12.  I had a stomach ulcer (due to stress) when I was 16.  I also have Osgood-Schlatter disease, which has for the most part gone away, except for the slight bumps from the calf bone which lands slightly lower on my knee cap.  I will admit though, that I do have an extreme amount of stress on me (especially recently since my mom's passing and arranging her funeral).

Please let me know what I should do to prevent myself from obtaining a stroke like my mother.
Thank you in advance for your time and aid on this matter!
Tizzle