Stroke Prevention: Early Screening Saves Lives

Strokes are a leading cause of adult disability and can lead to permanent brain damage, but they can be prevented and treated if addressed early on. While strokes may seem to occur suddenly, they are often the result of long-term damage to blood vessels and the growth of artery-clogging plaque. Early screening and lifestyle changes can help to prevent strokes, and timely treatment can reduce and reverse any damage caused.

Carotid ultrasound scans can detect cholesterol-filled plaque build-up in the carotid arteries

Carotid ultrasound scans are a non-invasive imaging test that can detect cholesterol-filled plaque build-up in the carotid arteries in your neck. These arteries are crucial as they supply blood to your brain.

The test is painless and uses sound waves to identify any narrowing in the carotid arteries. It is recommended for people who have experienced stroke symptoms or a transient ischemic attack (TIA), also known as a ministroke. Additionally, it is a reasonable screening tool for asymptomatic individuals with a very high risk of stroke.

The test is particularly useful for those with known risk factors for stroke, such as high blood pressure, high cholesterol, obesity, diabetes, smoking, and physical inactivity. By detecting plaque build-up early on, individuals can make necessary lifestyle changes and reduce their risk of stroke.

However, it is important to note that the U.S. Preventive Services Task Force advises against routine carotid ultrasound screening as a preventive measure. This is because only about 1% of the general population has significant narrowing of the carotid arteries, and false positives are common in people without stroke risk factors.

ASCVD risk scores can assess your 10-year risk of stroke and heart disease

Atherosclerotic cardiovascular disease (ASCVD) is caused by the hardening or narrowing of the arteries due to the growth of artery-clogging plaque. This can lead to a stroke or heart disease. To prevent this, it's important to get your risk assessed and make the necessary changes to your lifestyle.

The ASCVD Risk Estimator Plus is a tool that assesses an individual's likelihood of developing heart disease over the next 10 years. It is a screening tool that uses personal health information to calculate the risk of future cardiovascular disease. It is intended for use by individuals aged 40 to 79. The risk score is calculated as a percentage, with a lower percentage indicating a lower chance of developing heart disease in the next 10 years. The risk categories are:

• Low: Less than a 5% risk
• Borderline: A 5% to 7.4% risk
• Intermediate: A 7.5% to 19.9% risk
• High: More than a 20% risk

The ASCVD Risk Estimator Plus takes into account various factors, including:

• Systolic and diastolic blood pressure
• Total, HDL, and LDL cholesterol levels
• History of diabetes
• Smoking status and history
• Family history of heart attacks or heart disease
• History of aspirin therapy

Once the risk has been assessed, individuals can work with their healthcare providers to make necessary lifestyle changes or take medications to prevent heart disease. This may include eating a heart-healthy diet, getting regular exercise, losing weight, managing stress, quitting smoking, and managing conditions like high blood pressure, diabetes, and high cholesterol.

It is important to note that cardiac risk calculators are only useful if you haven't already had a heart event, such as a heart attack or stroke. For individuals who have already experienced such events, the information provided by these calculators may not be as relevant or useful.

Lifestyle changes such as improved diet, increased physical activity, and smoking cessation can help prevent strokes

Improved diet

A healthy diet can help prevent strokes. The following foods are associated with a decreased risk of stroke:

• Fruits and vegetables
• Fish
• Chocolate
• Coffee
• Tea
• Long-chain n-3 polyunsaturated fatty acid (n-3 PUFA)
• Saturated fat (SFA)
• Monounsaturated fatty acid (MUFA)
• Dietary fiber
• Vitamin B6
• Folic acid
• Vitamin C
• Β-carotene
• Vitamin D
• Magnesium
• Potassium
• Flavonoid

The following foods are associated with an increased risk of stroke:

• Red meat, especially processed red meat
• Sugar-sweetened beverages
• Carbohydrates
• Sodium

Increased physical activity

Physical activity can help prevent strokes by reducing blood pressure and the risk of developing hypertension. It can also help improve functional outcomes in stroke patients.

Smoking cessation

Smoking is a well-established risk factor for all forms of stroke. Quitting smoking can significantly reduce the risk of stroke.

Routine health screenings and medication can help manage risk factors for cardiovascular disease and stroke

Instead, the focus should be on reducing primary risk factors. The American Stroke Association recommends routine health screenings and managing risk factors for cardiovascular disease and stroke with medication. Modifiable risk factors like high blood pressure, overweight and obesity, elevated cholesterol, and elevated blood sugar can be identified through physical exams and blood tests. These conditions can then be addressed with lifestyle changes and, in some cases, medication. For instance, antihypertensive medications can reduce blood pressure, and statins can lower cholesterol. Additionally, the American Heart Association's Life's Essential 8 health metrics outline essential lifestyle behaviours that can help reduce stroke risk, including healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep, and weight control.

Furthermore, it is crucial to address social determinants of health that contribute to inequities in care and overall health. These non-medical factors include education, economic stability, access to care, discrimination, structural racism, and neighbourhood factors. By advocating for their patients and providing education and resources, healthcare professionals can help address these social determinants of health.

While stroke can have devastating consequences, up to 80% of strokes may be preventable. By combining routine health screenings with lifestyle changes and, when necessary, medication, individuals can effectively manage their risk factors for cardiovascular disease and stroke.

Stroke prevention education and addressing risk factors from birth can help primary care health professionals promote brain health for patients

There are also certain risk factors that can increase a person's likelihood of having a stroke. Some of these risk factors are controllable and include high blood pressure, diabetes, heart disease, smoking, diet, obesity, and physical inactivity. Other risk factors are uncontrollable and include health history, family history, age, race, and gender.

Primary care health professionals can play a crucial role in promoting brain health and preventing stroke by educating patients about risk factors and helping them make necessary lifestyle changes. This may include encouraging patients to quit smoking, maintain a healthy weight, exercise regularly, and eat a heart-healthy diet. Additionally, primary care providers can also help manage coexisting health conditions, such as diabetes and high blood pressure, which can reduce the risk of stroke.

Furthermore, integrating neurological and psychiatric care into the public health system can improve coverage and provide a low-cost, accessible service. This integration involves collaboration between primary care providers, such as community health workers and nurses, and specialists in neurology, psychiatry, and related fields. By working together, they can develop and implement prevention strategies, early detection methods, and timely treatments for brain disorders, including stroke.

In conclusion, stroke prevention education and addressing risk factors from birth can be effective tools for primary care health professionals to promote brain health and reduce the risk of stroke in their patients. By providing education, monitoring, and support, they can empower patients to make informed decisions about their health and well-being.

Frequently asked questions