Understanding Strokes: Timing And Risk Factors Explored

A stroke can happen to anyone at any age, but certain factors can increase the risk of having a stroke. These factors include age, race, family history, unhealthy lifestyle choices, and underlying medical conditions. Older people are generally considered to be at a higher risk, with age being the most significant factor, as the chances of having a stroke double every decade after the age of 55. Additionally, African Americans and non-white Hispanic Americans are disproportionately affected by strokes, and sickle cell disease, a genetic condition that can narrow arteries, is more prevalent in these ethnic groups. Family history also plays a role, as strokes tend to run in families, and shared genetic predispositions for high blood pressure, diabetes, or other conditions that increase stroke risk can be passed down. Unhealthy lifestyle choices, such as smoking, excessive drinking, poor diet, and lack of exercise, can also contribute to an increased risk of stroke. Finally, underlying medical conditions like high blood pressure, heart disease, diabetes, and high cholesterol are significant risk factors that can affect people of any age. While some risk factors are beyond our control, maintaining a healthy lifestyle and managing underlying health conditions can help reduce the chances of having a stroke.

High blood pressure

• Ischaemic stroke: High blood pressure damages blood vessels by making them narrower and stiffer, and causing a build-up of fatty material. This fatty material can lead to clots, which can travel to the brain and cause an ischaemic stroke. About 87% of all strokes are ischaemic strokes.
• Haemorrhagic stroke: High blood pressure can also damage and weaken blood vessels inside the brain, causing them to burst and bleed in or around the brain. This is called a haemorrhagic stroke.

Several factors can increase your risk of high blood pressure, including family history, age, obesity, lack of physical activity, poor diet, stress, and excessive alcohol consumption. It is important to regularly check your blood pressure, as high blood pressure often has no apparent symptoms. However, there are ways to reduce high blood pressure, such as:

• Eating a healthy diet, including reducing salt intake
• Engaging in regular physical activity and maintaining a healthy weight
• Avoiding tobacco smoke and excessive alcohol consumption
• Taking prescribed medication
• Reducing stress

Smoking

How Smoking Increases the Risk of Stroke

• Raise triglycerides (a type of fat in the blood)
• Lower "good" cholesterol (HDL)
• Make blood sticky and more likely to clot, which can block blood flow to the brain
• Damage cells that line the blood vessels
• Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels
• Cause thickening and narrowing of blood vessels

Dose-Response Relationship

The more cigarettes smoked per day, the higher the risk of stroke. This relationship has been observed across different age groups, races, and genders.

Secondhand Smoke

Breathing secondhand smoke can also increase the risk of stroke. Nonsmokers who breathe secondhand smoke at home or work increase their risk of stroke by 20-30%.

Quitting smoking can significantly reduce the risk of stroke. Within one to two months of smoking cessation, the risk of stroke due to hypercoagulability normalizes to that of nonsmokers. Within a year, the risk of stroke is halved, and within five years, it is similar to that of a nonsmoker in most cases.

Heavy drinking

While a stroke can happen to anyone at any age, heavy drinking is a significant risk factor for experiencing a stroke earlier in life. Heavy drinking is defined as consuming at least 1.6 ounces of pure alcohol daily, which is approximately three alcoholic drinks per day.

Heavy drinkers have a higher risk of experiencing an intracerebral haemorrhage, a type of stroke caused by bleeding in the brain rather than a blood clot. Regular heavy drinkers had a stroke at an average age of 60, 14 years earlier than for people who do not drink heavily. Among younger patients who had a stroke in the deep part of the brain, heavy drinkers had a much greater chance of dying within 24 months than non-heavy drinkers.

Heavy drinkers also tend to have other lifestyle habits that increase their risk of stroke. For example, they are more likely to smoke tobacco, experience liver problems, and show evidence of blood irregularities that increase the risk of suffering from a bleeding stroke.

It is important to note that heavy drinking is only a risk factor for early stroke and not a direct cause. However, it is advisable to maintain a healthy diet and weight, exercise regularly, and avoid unhealthy habits such as excessive drinking to reduce the risk of stroke.

Diabetes

People with diabetes are twice as likely to have a stroke as people without diabetes. This is because diabetes affects the body's ability to create insulin or use it properly. Insulin is a hormone that is needed for glucose to enter cells and provide energy. Without insulin, glucose (sugar) builds up in the blood. Over time, high glucose levels can damage the body's blood vessels, increasing the chance of stroke.

People with diabetes tend to develop heart disease or have a stroke at an earlier age than those without diabetes. Every two minutes, an American adult with diabetes is hospitalized for a stroke.

The risk of stroke can be reduced by managing blood glucose, blood pressure, cholesterol, and weight. It is also important to get regular exercise, eat a healthy diet, and avoid smoking and excessive drinking.

Types of Stroke

There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes are caused by blood clots that cut off blood flow to the brain, while hemorrhagic strokes occur when blood leaks into the brain or between the brain and the skull due to a ruptured blood vessel. Ischemic strokes make up about 87% of all strokes, while hemorrhagic strokes account for 10% to 20%.

Symptoms of Stroke

Recognizing the signs and symptoms of a stroke is crucial for getting help and reducing the risk of severe complications. The symptoms of a stroke include:

• Numbness or weakness on one side of the body, including the face, arms, or legs
• Trouble speaking or understanding speech
• Dizziness, loss of balance, or trouble walking
• Severe, sudden headache
• Trouble seeing or double vision
• Confusion

If you think you or someone else is having a stroke, call 911 or your local emergency services immediately.

Sickle cell disease

SCD is associated with an increased risk of stroke, and it is estimated that around 11% of children with SCD will have a stroke before the age of 20. This risk increases significantly in children with SCD compared to those without the disease. The most common type of stroke in children with SCD is "silent strokes," which do not present any outward physical signs but can be detected through brain imaging. These silent strokes can cause problems with thinking, learning, and decision-making abilities.

The risk of stroke in individuals with SCD can be reduced through close evaluation and treatment. Transcranial Doppler (TCD) ultrasound is a painless test that measures blood flow speed in the brain and is recommended for children with sickle cell anemia. Additionally, treatments such as blood transfusions and medications like hydroxyurea can help prevent strokes in high-risk patients.

SCD primarily affects individuals of Black ancestry, with 1 in 400 Black children being affected by the disease in the United States. It is crucial to detect and manage SCD early to prevent complications like stroke and ensure the best possible quality of life for those affected.

Frequently asked questions