Crystell Harty
Ischemic stroke, similar to a heart attack, occurs when blood vessels in the brain become blocked. This can be caused by a blood clot or by plaque buildup, which is a sticky, yellow substance made of fatty substances, cholesterol, calcium, and waste products from cells. Ischemic stroke can also be caused by atrial fibrillation, an irregular heart rhythm that causes clots to form in the heart. These clots can then travel to the brain and block blood flow. While the exact association between intracranial atherosclerosis and ischemic stroke is still being researched, it is known that intracranial atherosclerosis is associated with a high risk of stroke recurrence and vascular death.
| Characteristics | Values |
|---|---|
| Ischemic stroke | Similar to a heart attack, except it occurs in the blood vessels of the brain |
| Cause | Clots that block blood flow to the brain's cells |
| Risk factors | Uncontrolled diabetes, excessive alcohol intake, diet high in saturated fat, trans fat, and cholesterol, carotid or coronary artery disease, oral estrogen therapy, gender, race, family history of stroke, a history of migraine headaches, COVID-19 infection, age, sex, family history, indigenous heritage, South Asian and African heritage, personal circumstances |
| Prevention | Making healthy lifestyle choices, having regular medical check-ups, avoiding smoke or smoking, eating healthy foods, exercising more, maintaining a healthy weight, managing stress, and visiting a doctor to discuss lifestyle choices and check for early signs of medical conditions |
What You'll Learn
Atherosclerosis and intracranial atherosclerosis
Atherosclerosis is a form of arteriosclerosis that involves a build-up of fatty substances and cellular waste (plaques) in the arteries. These plaques can either partially or totally block blood vessels, or the plaque can break open and trigger a blood clot that also blocks blood flow. Atherosclerosis can occur anywhere in the body. Intracranial atherosclerosis is the build-up of plaque in the arteries that supply the brain with blood, causing the narrowing and blockage of these vessels.
Intracranial atherosclerosis is one of the leading causes of ischemic stroke. If a vessel becomes completely blocked or severely narrowed, blood flow to the brain can be compromised and a stroke can occur. The risk factors for intracranial atherosclerosis include hypertension, diabetes mellitus, cigarette smoking, and hyperlipidemia. The condition is considered a cause of approximately 8% of all strokes in Western society, but its frequency is much higher in Asian countries.
The intracranial stenosis caused by intracranial atherosclerosis is not a static condition and may progress or regress in a relatively short period of time. Progressive stenosis of intracranial arteries is clearly related to the development of ischemic events. The annual risk of stroke relevant to the stenosed intracranial vessel is approximately 8%.
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Risk factors for ischemic heart disease
Ischemic heart disease is largely preventable. It is caused by plaque buildup in the arteries (atherosclerosis) or problems with how the blood vessels work. The risk of developing ischemic heart disease increases with the number of risk factors present. While some risk factors are non-modifiable, such as age, sex, family history, and ethnicity, others can be mitigated through lifestyle changes. Here are some of the key risk factors for ischemic heart disease:
- Age and Sex: The risk of ischemic heart disease increases with age, especially after 45 years in men and 55 years in women, likely due to the influence of hormones on blood vessels.
- High Blood Pressure: Hypertension damages artery walls and accelerates atherosclerosis. It is a significant modifiable risk factor that can be addressed through lifestyle changes such as quitting smoking, losing weight, and exercising.
- Hypercholesterolemia: Elevated levels of LDL ("bad") cholesterol and triglycerides increase the risk of coronary disease. In contrast, higher levels of HDL ("good") cholesterol offer protection against infarction.
- Diabetes: Increased blood glucose levels are associated with a higher risk of ischemic heart disease. Maintaining good control of blood sugar levels through medication, weight loss, a healthy diet, and regular exercise can help reduce this risk.
- Genetics and Family History: A family history of premature cardiac disease, particularly if male relatives were diagnosed before 55 or female relatives before 65, suggests a possible genetic predisposition.
- Sedentary Lifestyle: Physical inactivity is linked to a higher rate of obesity, high blood pressure, and poorer control of diabetes and cholesterol levels. Regular exercise helps control these risk factors.
- Obesity: Being overweight worsens other risk factors and increases the likelihood of ischemic heart disease. Even modest weight loss can have cardiovascular benefits.
- Smoking: Smoking significantly increases the risk of ischemic heart disease and is one of the most preventable risk factors.
- Stress: Stress and anxiety trigger hormonal mechanisms that can damage arteries over time.
- Diet: Unhealthy dietary patterns, such as consuming high amounts of saturated fats and refined carbohydrates, contribute to obesity, high cholesterol, and atherosclerosis.
- Other Medical Conditions: Certain medical conditions can increase the risk of ischemic heart disease, including autoimmune diseases, chronic kidney disease, HIV/AIDS, mental health disorders, and sleep disorders.
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Plaque build-up in arteries
Atherosclerosis, sometimes called "hardening of the arteries", is a common disorder that occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can narrow or completely block the arteries, causing issues throughout the body.
Healthy blood vessels are flexible, but with age and unhealthy lifestyle choices, they can become thickened and stiff, restricting blood flow. Atherosclerosis is a slow, progressive disease that may start as early as childhood, but it can also progress rapidly. The development of the disease is complex, but the primary event appears to be an injury to the arterial wall. Many different factors can injure the artery wall, triggering plaque formation, for example, turbulent blood flow due to high blood pressure, inflammatory immune responses, certain infections, and chemical abnormalities in the blood such as diabetes and high cholesterol.
Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it builds up in the arteries, the artery walls become thickened and stiff. Atherosclerosis can occur anywhere in the body. For example, when it occurs in the vessels leading to your arms and legs, it can cause peripheral vascular disease. When it occurs in the arteries that supply blood to the heart muscle, it can trigger angina or a heart attack. When this process occurs in arteries supplying blood to the brain, the arteries become narrow with plaques, and a blood clot can form and block the blood supply to the brain (thrombotic stroke).
Atherosclerosis often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them. Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them. These blockages starve tissues of blood and oxygen, which can result in damage or tissue death. This is a common cause of heart attack and stroke.
High blood cholesterol levels can cause hardening of the arteries at a younger age. For many people, high cholesterol levels are due to a diet that is too high in saturated fats and trans fats. Other factors that can contribute to hardening of the arteries include a family history of the condition, being overweight or obese, and smoking.
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Lifestyle choices to reduce risk
Ischemic strokes are caused by a blockage in the brain's blood vessels, often due to a blood clot. This can be triggered by a build-up of fatty substances and cellular waste (plaques) in the blood vessels, known as atherosclerosis.
Lifestyle choices that can reduce the risk of ischemic heart disease include:
Diet
A healthy, balanced, and low-fat diet is recommended, including plenty of fresh fruit and vegetables (aiming for 5 portions a day) and whole grains. The Mediterranean diet is also recommended, which is rich in fruits, vegetables, nuts, seeds, and whole grains, with limited red meat and sweets. Olive oil is the main source of dietary fat. Eating foods high in omega-3 fatty acids, like salmon, trout, tuna, herring, and mackerel, is also beneficial.
It is important to limit salt intake to no more than 6g (0.2oz) a day, as salt increases blood pressure. Saturated fats should also be avoided, as they increase bad cholesterol levels. These include sausages, fatty cuts of meat, ghee, and foods containing coconut or palm oil. Sugar intake should be limited, as it increases the risk of diabetes, which is a significant risk factor for heart disease.
Exercise
Regular physical activity is crucial for maintaining a healthy weight and reducing the risk of high blood pressure. Any aerobic exercise, such as walking, swimming, or dancing, is beneficial as it makes the heart work harder and keeps it healthy. The Physical Activity Guidelines for Americans recommend that adults aged 18-64 engage in at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic activity per week.
Smoking
Smoking is a major risk factor for atherosclerosis and increases the risk of heart disease and death. Quitting smoking is, therefore, an important step in reducing the risk of ischemic heart disease.
Alcohol
Excessive alcohol consumption is linked to an increased risk of heart disease, so it is important to drink in moderation and not exceed the recommended limits. For context, the recommended limit is no more than 14 units a week for both men and women.
Weight
Maintaining a healthy weight is crucial, as excessive weight is linked to high cholesterol, physical inactivity, and an increased risk of diabetes, all of which contribute to heart disease.
Stress
Managing stress through techniques like muscle relaxation, breathing exercises, or visualization can help reduce the risk of heart disease.
Medical Check-ups
Regular medical check-ups are important to monitor blood pressure, cholesterol, and blood sugar levels, especially for those with diabetes or a history of heart disease in their family.
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Heart disease and stroke statistics
Heart disease and stroke are both types of cardiovascular disease. In 2013, heart, stroke, and blood vessel diseases accounted for nearly one-third (30%) of all deaths in Australia, with an Australian dying of these causes every 12 minutes. Cardiovascular disease produces immense health and economic burdens in the United States and globally.
The biggest cause of death from cardiovascular disease is the progressive blocking of blood vessels with a build-up of fatty substances and cellular waste (plaques). Atherosclerosis is a form of arteriosclerosis that involves the build-up of plaques, which can either partially or totally block blood vessels. Atherosclerosis can occur in the arteries supplying blood to the brain, causing a thrombotic stroke. It can also trigger angina or a heart attack when it occurs in the arteries supplying blood to the heart muscle.
Healthy blood vessels are flexible, but with age and unhealthy lifestyle choices, they can become thickened and stiff, restricting blood flow around the body. This process is known as arteriosclerosis, or "hardening of the arteries". Lifestyle factors such as unhealthy eating habits, physical inactivity, smoking, and maintaining an unhealthy weight and blood pressure contribute significantly to cardiovascular disease.
The American Heart Association, in conjunction with various government agencies, compiles up-to-date statistics on heart disease, stroke, and other vascular diseases in the Heart Disease and Stroke Statistical Update. This resource provides valuable data on disease morbidity, mortality, and risks; quality of care; medical procedures; and associated costs. The statistical update is a critical tool for monitoring cardiovascular health and disease in the population.
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Frequently asked questions
Ischemic heart disease, also known as coronary artery disease (CAD), is the most common form of heart disease. It occurs when the blood vessels that supply blood, oxygen, and nutrients to the heart become damaged, narrowed, or blocked due to a buildup of plaque.
Ischemic heart disease can lead to a stroke when plaque buildup and blood clots form in the arteries supplying blood to the brain, blocking blood flow.
Risk factors for ischemic heart disease include high blood cholesterol and triglycerides, lack of physical activity, smoking, age, sex, family history, and Indigenous or South Asian and African heritage.
Symptoms of a stroke may include weakness or numbness on one side of the body, loss of vision, difficulty speaking or understanding speech, severe headache, loss of balance, confusion, and memory loss.
You can reduce your risk of ischemic heart disease and stroke by making healthy lifestyle choices, such as maintaining a healthy weight, eating a balanced diet, exercising regularly, avoiding smoking, and controlling conditions like high blood pressure, diabetes, and high cholesterol.
