Today marks the start of the National Stroke Association of Malaysia's Stroke Awareness Week. The theme this year is “Let's Get Physical”, and it was chosen to encourage both the young and old to adopt a more active lifestyle because regular exercise can help reduce the risks of high blood pressure, high cholesterol level and obesity, the major causes of stroke, writes TEE SHIAO EEK.
THE unrelenting number of stroke cases is a puzzling matter. It is not for lack of information about the disease. You cannot say that there is little awareness about stroke and its dangers. There are even ways in which one can prevent a stroke or lower the risk of getting one.
Yet, people continue to ignore the warning signs until that terrible moment when the attack occurs. At first, the numbness doesn't seem like much. Then they start slurring. Hours later, they are lying in bed, paralysed and unable to speak. By then, it is too late for regret.
“Stroke is the third most common cause of admission to our hospital and the number three cause of death here,” says Dr Soezyani bt Soegiarto, a neurologist from Hospital Kuala Lumpur.
“Stroke causes a huge (financial) burden, in terms of money spent by the patient on treatment and post-stroke care. It also affects our country's economy, as the patient (often disabled) is unable to work,” she continues.
Preventing a stroke
“The most important thing is prevention,” stresses Dr Soezyani. By identifying whether you are at risk of a stroke, you can reduce those risk factors and prevent a “brain attack”.
The risk factors are divided into those that are modifiable and non-modifiable. The non-modifiable risk factors are:
The modifiable risk factors are:
“This is a powerful risk factor for stroke. Stroke is four to six times more common in people with hypertension compared to those without,” says Dr Soezyani.
While hypertension cannot be cured the way a bacterial infection can be cured with antibiotics, it can be brought under control with medication. Well-controlled blood pressure can reduce the risk of stroke, so it is important for hypertensives to comply with treatment and monitor their blood pressure. A healthy diet and regular exercise also helps to keep blood pressure under control.
Various heart conditions such as congenital heart disease, cardiomyopathy and, in particular, atrial fibrillation, can increase the risk of stroke.
“Atrial fibrillation (AF) is when your heart rhythm becomes irregular, causing blood clots to form inside the chamber of the heart. These clots can dislodge and travel to the brain, blocking blood circulation to certain parts of the brain and depriving it of oxygen.”
Anti-coagulant medication, like warfarin, reduces the risk of stroke in AF patients as it interferes with the normal clotting mechanism and reduces the formation of clots. However, patients on anti-coagulants have to be monitored regularly, as the medication may conversely cause a haemorrhagic stroke (bleeding inside the brain).
“The risk of stroke in people with diabetes is three times compared to those without diabetes. Their risk of stroke is increased because they (are prone to) developing hypertension and high cholesterol. If diabetes is detected early, hypertension and high cholesterol may also be detected early and controlled,” explains Dr Soezyani.
Unfortunately, keeping diabetes under control does not reduce the risk of stroke. Nonetheless, diabetes should still be well controlled to prevent other complications, like eye, kidney or nerve disease.
“Cholesterol is required to produce cell membranes and hormones in the body. But when excessive cholesterol is consumed through the diet, it poses the risk of atherosclerosis (thickening of the arteries).
“There are two types of cholesterol – HDL ('good') cholesterol and LDL ('bad') cholesterol. Excessive amounts of LDL will be deposited on the inner wall of the blood vessel as arterial plaque and cause the artery to harden. This causes less blood to flow to the brain and predisposes a person to stroke. Also, arterial plaque may become unstable and chip off from the wall. As it gets carried by the blood to the brain, it may get stuck in one of the blood vessels and block blood flow to the brain.”
According to Dr Soezyani, a healthy diet and regular exercise are the best ways to lower high cholesterol. If these fail, cholesterol-lowering medication will be prescribed.
A TIA is also known as a “mini stroke”. It has the signs and symptoms of a stroke, but it is transient (patient recovers fully after 24 hours). As its symptoms only last minutes, people who have a TIA may not recognise what it is or may dismiss it without seeking medical help. A TIA is a warning that you will get a stroke, so you should see the doctor immediately.
Smoking doubles the risk of getting an ischaemic stroke as well as increases the risk of haemorrhagic stroke. This is due to the nicotine and carbon monoxide in cigarettes, which reduce the level of oxygen in the blood. Smoking may also lead to atherosclerosis and the formation of blood clots.
“If you stop smoking, the risk of stroke decreases immediately. But a major reduction (in risk) is only seen after two to four years of quitting. It would take several decades for someone who used to smoke to reach the risk level of a non-smoker,” says Dr Soezyani.
Alcohol increases a person's blood pressure, therefore increases the risk of stroke. Dr Soezyani advises to avoid consuming excessive amounts of alcohol.
“Illicit drugs like cocaine, amphetamine and heroin increase the risk of stroke because they cause blood vessels to constrict, which increases blood pressure and obstructs blood supply.”
“Head and neck injuries, as well as certain infections, can also increase the risk of a stroke,” says Dr Soezyani, although she admits that these are risk factors one may not be able to control.
No stroke of luck
“The brain controls body functions. If a certain area of the brain is affected, it will cause loss of function in a (corresponding) part of the body. The effects depend on which part and which side of the brain the stroke occurs,” says Dr Soezyani.
The physical effects of stroke include paralysis, numbness, weakness, visual problems, memory loss, loss of speech or difficulty in talking and incontinence. Stroke patients may also experience behavioural changes like depression, becoming cautious, anxious and disorganised, and poor concentration in learning new skills. A stroke patient may even find himself unable to judge distance, size and position of an object.
Healthy lifestyle the key
One wonders how many people are actually making the effort to change their lifestyles.
“We have to look after ourselves, not expect someone else to look after us. We have to lead a healthy lifestyle – be physically active, eat a healthy diet, stop smoking and reduce alcohol,” says Dr Soezyani. As she correctly points out, it is not that people are unaware of the risk factors. It’s just that they do not realise the seriousness of it until they fall sick.
Most importantly, those who have the major risk factors for stroke, like high blood pressure, high cholesterol, diabetes or heart disease, have to comply with their treatment and go for regular checkups to monitor their condition.
“Maintain the ideal situation. Preventing a stroke is the most important thing,” were Dr Soezyani's parting words of advice.
Related Story:Warning signs of a stroke
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