Preventing Strokes: A Doctor's Role And Responsibility

Strokes are a serious medical condition that can cause permanent brain damage or even death. They occur when there is an interruption in the blood flow to the brain, and they can happen to anyone, at any age. However, the good news is that up to 80% of strokes can be prevented through a combination of healthy lifestyle choices and working with doctors to control risk factors. While some risk factors, such as age, gender, and family history, are beyond our control, there are several modifiable risk factors that can significantly reduce the chances of having a stroke. These include maintaining a healthy weight, managing cholesterol and blood pressure, quitting smoking, and engaging in regular physical activity. Knowing the warning signs of a stroke, such as sudden numbness or weakness on one side of the body, is also crucial for prompt medical attention and treatment.

Lower blood pressure

Lowering blood pressure is a crucial step in preventing strokes, as high blood pressure is the biggest contributor to stroke risk. Here are some ways to lower blood pressure and prevent strokes:

Lifestyle Changes

• Maintain a healthy weight– Obesity is a significant risk factor for strokes and is linked to high blood pressure. Losing weight can help lower blood pressure and reduce stroke risk. Aim for a Body Mass Index (BMI) of 25 or less, but work with your doctor to set a realistic personal weight loss goal.
• Exercise regularly– Regular physical activity can help lower blood pressure and reduce stroke risk. Aim for at least 30 minutes of moderate-intensity exercise, five days a week. Walking, golfing, and playing tennis are great options.
• Healthy diet– Adopt a heart-healthy diet, such as the Mediterranean diet or the DASH (Dietary Approaches to Stop Hypertension) diet. Reduce your sodium intake to no more than 1,500 milligrams per day and limit high-cholesterol foods. Increase your fruit and vegetable intake to 4-5 cups per day and include fish, whole grains, and low-fat dairy.
• Limit alcohol intake– Drinking alcohol can increase blood pressure. If you choose to drink, do so in moderation. Limit yourself to one drink per day for women and up to two drinks per day for men.
• Quit smoking– Smoking cigarettes increases stroke risk by damaging the brain and blood vessels. Quitting smoking is one of the most effective ways to reduce stroke risk.

Medical Treatments

• Blood pressure medications– If lifestyle changes alone are not sufficient, your doctor may prescribe blood pressure medications to help lower your blood pressure and reduce the stress on your blood vessels.
• Blood thinners– Taking a blood-thinning medication, such as aspirin, can help prevent blood clots from forming, reducing the risk of stroke. However, consult your doctor before taking any medication.

Stop smoking

Stopping smoking is one of the most effective ways to reduce your risk of stroke. Cigarette smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke. It is linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans.

Quitting smoking is challenging, and most smokers require multiple attempts to stop for good. However, doctors can play a crucial role in supporting their patients' smoking cessation journey. Here are some strategies that doctors can employ to help their patients quit smoking:

Brief Advice and Intervention:

Even a few minutes of conversation about smoking during a consultation can make a significant difference. Doctors should take the opportunity to talk to their patients about the dangers of smoking, provide advice on quitting, and offer supportive resources. This simple intervention can increase quitting rates by 1-3%.

Patient-Centred Approach:

Doctors should adopt a non-judgmental and empathetic approach, understanding that quitting smoking is a process and treating it as they would any other addiction. They should tailor their advice to the individual patient, considering their unique circumstances, motivations, and challenges. This approach helps build trust and encourages patients to be honest about their smoking habits.

Provide Resources and Referrals:

Doctors can provide patients with resources such as leaflets, nicotine replacement therapies (gums, patches), or even samples of nicotine gum. They can also refer patients to community-based programs, intervention specialists, or telephone quit lines that offer ongoing counselling and personalized cessation plans. These additional supports can increase the likelihood of successful smoking cessation.

Medications:

There are two types of anti-smoking medications: controllers and relievers. Controllers, such as varenicline tartrate (Chantix) or bupropion (Zyban), prevent cravings and reduce the compulsion to smoke. On the other hand, relievers, like nicotine patches, gum, lozenges, inhalers, or nasal sprays, help fight immediate urges by delivering nicotine through less harmful methods than smoking. Doctors should work with their patients to find the right combination of medicines or therapies to support their journey.

Encourage and Motivate:

Doctors should provide ongoing encouragement and motivation to their patients, even in the face of relapses. They should reassure patients that relapses are a normal part of the process and help them get back on track. It is essential to understand the patient's reasons for smoking and address those underlying causes.

Quitting smoking is a challenging but rewarding journey. Doctors play a pivotal role in supporting their patients through this process, and by employing these strategies, they can help reduce the risk of stroke and improve their patients' overall health and well-being.

Manage cholesterol

Cholesterol is a fatty substance, called a lipid, that is found naturally in the blood. While it is an important substance in our bodies, playing a role in our digestive and hormonal systems, high cholesterol is very common and harmful. If there is too much cholesterol in your blood, it can damage your blood vessels, which may cause heart disease and stroke.

High cholesterol can lead to a build-up of fatty deposits in your arteries, which can become narrow and stiff. This process is called atherosclerosis. The damage to the artery wall can lead to a clot forming, which may travel to the brain and cause a stroke.

There are two types of cholesterol:

• 'Good' cholesterol (HDL): This takes cholesterol away from cells and back to the liver, where it is destroyed. You should aim to increase your levels of HDL.
• 'Bad' cholesterol (non-HDL or LDL): This moves cholesterol to where it is needed in your cells. However, if there is too much non-HDL cholesterol in your blood, it can end up as fatty deposits in your arteries, increasing your risk of stroke.

High cholesterol is often caused by eating too much saturated fat and not enough unsaturated fats. Other causes include drinking too much alcohol, as well as factors such as age, gender, general health, and family history.

• Medication: Statins are the main type of medication used to reduce the risk of stroke and heart attack. If you have had a stroke caused by a blood clot, your doctor may prescribe statins to help prevent another one. If you cannot take statins, there are other types of drugs available, such as selective cholesterol absorption inhibitors like ezetimibe.
• Dietary changes: Cut down on foods high in saturated fat, such as full-fat dairy, fatty meat, cakes, pastries, and biscuits. Reduce your consumption of coconut oil, palm oil, and ghee. Instead, eat more foods high in soluble fibre, such as oats, beans, peas, pulses, nuts, fruits, and vegetables. Aim for two servings of oily fish, such as salmon, mackerel, sardines, trout, or fresh tuna, each week.
• Exercise: Physical activity can help lower your cholesterol levels. Aim for at least 30 minutes of exercise per day, or 2 hours and 30 minutes of moderate-intensity aerobic activity per week.
• Weight management: Being overweight or obese increases your risk of high cholesterol. Losing weight can help lower your cholesterol and reduce your risk of stroke.
• Limit alcohol intake: Drinking too much alcohol can raise your blood pressure and cholesterol levels. Men should have no more than two drinks per day, and women should have no more than one.
• Stop smoking: Cigarette smoking increases your risk of stroke and can lead to the buildup of fatty substances in the arteries. Quitting smoking is one of the most powerful lifestyle changes you can make to reduce your risk.

It is important to work closely with your doctor to manage your cholesterol and reduce your risk of stroke. They can recommend specific lifestyle changes, medications, and treatments based on your individual needs and health status.

Limit alcohol consumption

Alcohol consumption is a significant factor in stroke prevention, and limiting alcohol intake is crucial for maintaining a healthy brain. Excessive alcohol consumption increases the risk of all major types of strokes, while light to moderate drinking is associated with a reduced risk of ischemic stroke. This relationship between alcohol and stroke risk is important to understand to make informed decisions about alcohol consumption.

Firstly, it is essential to understand what constitutes excessive and moderate alcohol consumption. Excessive alcohol consumption is generally defined as consuming more than two drinks per day. On the other hand, moderate consumption is considered to be less than one drink per day or one to two drinks per day, depending on the source. Consuming five or more drinks per day is considered high-risk behaviour and significantly increases the likelihood of both ischemic and hemorrhagic strokes.

Excessive alcohol consumption contributes to the development of hypertension, which is a leading cause of strokes. Additionally, alcohol can lead to specific heart problems, such as atrial fibrillation and cardiomyopathy, which are also risk factors for strokes. Therefore, limiting alcohol intake can help reduce these associated risks and lower the overall chances of experiencing a stroke.

Interestingly, moderate alcohol consumption may offer some protection against ischemic strokes. This protective effect is attributed to the inhibition of coagulation, preventing blood clots that can cause this type of stroke. Additionally, alcohol raises high-density lipoprotein (HDL) or "good" cholesterol, which is associated with a reduced risk of stroke. However, it is crucial to emphasise that excessive alcohol consumption can outweigh these potential benefits and lead to an increased risk of stroke.

In conclusion, limiting alcohol consumption is an essential aspect of stroke prevention. While moderate drinking may offer some protection against ischemic strokes, excessive alcohol intake significantly increases the risk of all major types of strokes. Therefore, it is recommended to limit alcohol consumption to one or two drinks per day to maintain a healthy balance and lower the chances of experiencing a stroke.

Maintain a healthy weight

Maintaining a healthy weight is crucial in stroke prevention. Being overweight or obese increases your risk of high blood pressure, heart disease, and type 2 diabetes, all of which are risk factors for strokes. Additionally, carrying extra weight around your waist can further increase your likelihood of experiencing these health issues.

• Small, steady weight loss: Aim for a consistent weight loss of 1/2 to 1 kg (1 to 2 pounds) per week. This is a healthier and more sustainable approach than aiming for a larger, quicker weight drop.
• Eat more fruits and vegetables: Aim to fill half of your plate with fruits and vegetables at every meal and snack. This will help increase your intake of essential nutrients and promote satiety.
• Choose a variety of protein sources: Opt for beans, lentils, nuts, seeds, lower-fat dairy products, lean meats, poultry, and fish to ensure you get enough protein while also benefiting from the other nutrients these foods provide.
• Select a range of healthy foods: Include colourful peppers, dark green leafy vegetables, whole grains, legumes, tofu, lower-fat milk, lean meat, and nuts (in moderation) in your diet. These foods provide essential nutrients such as fibre, vitamins, iron, and calcium.
• Read nutrition labels: Check the Nutrition Facts table on food labels to assess the amount of calories, saturated fats, sugar, and salt in a product. This will help you make informed choices about what you're eating.
• Avoid highly processed foods: These foods are often high in saturated fat, sugar, and sodium. Examples include processed meats (hot dogs, burgers), fried foods (French fries), frozen meals (pizza), and snack foods (chips, crackers, donuts).
• Drink plenty of water: Water is essential for hydration and can also help you feel fuller for longer, aiding in weight management.
• Choose lower-fat dairy options: Opt for skim or 1% milk to reduce your saturated fat intake.
• Limit sugary and alcoholic drinks: Avoid pop, sugary drinks, fruit juice, and excessive alcohol consumption. These beverages are high in calories and sugar, which can contribute to weight gain.
• Practice portion control: Keep portion sizes reasonable and avoid supersized portions and second helpings. Use smaller plates, bowls, and cups to help with this.
• Follow a balanced meal schedule: Eat three meals and two healthy snacks at regularly spaced intervals throughout the day. Ensure you eat breakfast, as this is linked to maintaining a healthy weight.
• Eat mindfully: Savour the flavours and textures of your food, and make mealtime a social activity. This can help prevent unconscious eating and bingeing.
• Increase your physical activity: Aim for at least 30 minutes of moderate-intensity activity, such as a brisk walk, most days of the week. This will help you lose weight and maintain a healthy weight over the long term.

Frequently asked questions