Prevention measures are best defense against stroke

Special to the Herald-LeaderOctober 31, 2011 

Prevention is crucial in reducing the risk and occurrence of stroke.

Know your family history regarding stroke and heart disease, treat high blood pressure, stop smoking and keep your "bad" cholesterol levels under control.

Stroke is a leading cause of illness and the second most common cause of death worldwide.

The only widely approved drug treatment for acute stroke is tissue plasminogen activator.

Many patients are ineligible for the treatment — usually because they don't arrive at an emergency room within the required 4.5 hours from the onset of stroke symptoms.

Smoking, hypertension (blood pressure higher than 120/80) and high cholesterol levels increase the risk of stroke.

Blood cholesterol levels are comprised of unhealthy low-density lipoproteins (LDL-C) and healthy high-density lipoproteins (HDL-C). Total cholesterol level is important. However, it is the relative concentrations of HDL-C and LDL-C that more accurately reflect the risk of atherosclerosis, a buildup of fats in and on artery walls often called plaque. In general, lower levels of LDL-C help reduce stroke risk.

To lower LDL-C, reduce the amount of saturated fat and cholesterol you eat, lose weight and increase physical activity. If these changes are not sufficiently effective, medicines called statins might be necessary.

Many strokes are caused by the rupture of plaques within the carotid artery, which block blood flow to the brain. Plaques that rupture are soft, inflamed and unstable. Rupture risk is especially high when an unstable plaque is exposed to high pressures due to untreated hypertension, or high blood pressure. The goal of the statins is to lower LDL-C concentrations and stabilize plaque.

Statin therapy also is associated with a reduction in stroke occurrence, even in individuals without high cholesterol but with other genetic risk factors. Statin therapy should be considered for all patients with any risk factors. Ideally, use would result in a 50 percent reduction in LDL-C levels.

Dr. William Brooks is a neuro surgeon with Neurosurgical Associates and is the medical director of the Stroke Center at Central Baptist Hospital.

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