DIET:
A
diet high in saturated fat can raise blood cholesterol levels. High sodium (salt) intake is also related to
high blood pressure. High cholesterol and high blood pressure contribute to
development of atherosclerosis and so increases the risk of stroke. In addition,
high sodium may also have a direct
effect on stroke risk. A recent meta-analysis found a direct
relationship between high sodium intake and stroke and heart disease,
suggesting that salt intake in adults could be as high as 10g per day and by
reducing to the WHO recommendations of 5g per day, the risk of stroke could be
reduced by 23%.
HIGH BLOOD PRESSURE:
High
blood pressure is the most important risk factor for stroke as it weakens the
artery wall. People with hypertension are four times more likely to have a
stroke than those with normal blood pressure.
SMOKING:
In
the UK, 22% of men and 19% of women smoke cigarettes it is estimated that
nearly one in five deaths in England for adults aged 35 and over is attributed
to smoking. Risk of stroke in tobacco smokers is approximately two to four
times the risk in non-smokers. Five years after stopping smoking, the risk of
stroke is reduced to that of non-smokers, regardless of age at starting to
smoke and the number of cigarettes smoked per day.
DIABETES:
People
with diabetes are two to four times more likely to have a stroke compared to
those without the condition.
ATRIAL FIBRILLATION:
This
is a type of irregular heart rhythm and represents an important risk factor for
stroke, found in 15% of all stroke patients, because the heart does not beat
properly , there is a risk of blood clots forming in a chamber of the heart,
which may subsequently break up. Fragments of that may then lodge in the brain,
causing stroke. Not only does atrial fibrillation increases the risk of stroke,
it is also apparent that stroke in patient with AF are more severe than those
in patients with a normal heart rhythm. They are more likely to be severe or
fatal, have higher 30 day and one year mortality and have higher stroke
recurrence rates at one year (23% vs 8%). The overall prevalence of AF in
adults over 65 is 4>7%, rising to 10% in men 75 and over.
SLEEP APNOEA:
The
cessation of breathing during sleep, or sleep apnoea, may cause high blood
pressure, which may lead to a stroke or heart attack. Diagnosing sleep apnoea
early may be an important stroke prevention tool.
STROKE PREVENTION
The
risk factors listed above include some conditions that can be changed by
lifestyle modification or medical treatment and some such as hereditary factors
that cannot be changed. However, there are many positive steps that can reduce
risk of stroke.
1. Given
its importance as a risk factor, controlling high blood pressure is crucial. In
general, blood pressure should be below 120/80. Methods for controlling this
include a low-sodium diet, weight control and /or medication.
2. Monitoring
risk factors such as elevated blood cholesterol and controlling them via diet
and lifestyle modifications or medical treatment, where appropriate.
3. Prescribing
anti-clotting and antiplatelet drugs to thin the blood and lower the risk of
blood clots forming.
4. Stopping
smoking.
5. Dietary
improvements including avoiding excess fat, particularly saturated fat,
avoiding excess sodium and avoiding alcohol intake.
6. Maintain
a healthy weight
7. Exercise
regularly – the recommendation is at least 20–30 minutes of aerobic exercise
and maintain an improved level of fitness.
8. In
patients with diabetes, it is important to maintain good control blood sugar
levels, as this group of patients is at particular risk of cardiovascular
disease.
9. Treat
for sleep apnoea – advice on diet (losing weight) and alcohol, special pillows
or devises to avoid sleeping on back etc.
10.
Treat for atrial fibrillation if
necessary.
USING EPIDEMIOLOGICAL DATA IN
PREVENTION
Ultimately,
effective prevention of stroke is fundamentally dependent upon the availability
of high quality data from epidemiological and intervention studies, informing
both the development of health policy and better clinical decisions. It is
important to know not only who experiences stroke but also what impact it has
on those who survive.
The
development of stroke registries has also led to the accumulation of a wealth
of data on the descriptive epidemiology of stroke. For example, the south
London stroke register holds data on a multi-ethnic population of almost 250,
000 stroke patients. Patients are notified to the register from a variety of
sources, including accident and emergency records, hospital wards, brain
imaging requests and death certificates. Patients are followed up 3 months
after their stroke by a register team field worker and then yearly by postal
questionnaire. A huge range of information is collected on each patient
including socio-demographic characteristics, risk factor history, disability
and quality of life assessment, providing a valuable resource about both the
natural course of stroke and its impact.
However,
the same issues apply to strike data as any large dataset. For the data to be
useful, every effort must be made to ensure that it is complete, and the method
of data collected does not inadvertently exclude any important groups. For
example, the south London register receives strike notifications from a wide
range of sources. This is crucial to ensure that all patients who experience a
stroke are captured and there is complete coverage of the stroke population,
including those who have died before reaching the hospital. The accuracy of the
data is also important and staff training may be required to ensure that
rigorous methods of data collection and recording are used, in order to
facilitate accurate comparisons between patients.
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