A person who opts for healthy lifestyle choices can have an 80% lower risk of first time stroke compared to individuals who do not, scientists have revealed in an article in the medical journal Stroke. Of the 795,000 strokes that occur in the USA, over 77% are first events, the authors explain. After heart disease and cancer, stroke is the biggest cause of premature death in America. It is a major cause of disability.

New stroke prevention guidelines, which had previously been updated in 2006, are being issued.

The researchers say two factors can significantly reduce the incidence of first time strokes: Health lifestyle choices Emergency room interventions Larry B. Goldstein, M.D., director of the Duke Stroke Center in Durham, N.C., said: "Between 1999 and 2006, there's been over a 30 percent reduction in stroke death rates in the United States and we think the majority of the reduction is coming from better prevention." Up to 1999 stroke incidence had been on the rise. There had been a 39% increase in hospitalizations due to stroke from 1988 through 1997.

The authors say the stroke rate in America will rise because people are living longer.

This time the stroke prevention guidelines address the condition as a broad continuum of related events, including ischemic stroke, non-ischemic-stroke and TIA (transient ischemic attack).

A stroke is a condition in which a blood clot or ruptured blood vessel interrupts the flow of blood to a specific area of the brain. Lack of glucose and oxygen flowing to the brain results in the death of brain cells and subsequent brain damage. The patient may have problems with speech, memory and movement. There are two main types of stroke: Ischemic stroke - represent about 87% of all strokes. A thrombus (blood clot) forms, blocking blood flow to a part of the brain. Sometimes the clot can form in another part of the body, becomes dislodged and free-floating (an embolus). The embolus can make its way through the bloodstream to the brain where it can cause an ischemic stroke. Hemorrhagic stroke (non-ischemic stroke) - a blood vessel ruptures. The leaking blood fills the space between the brain and skull (subarachnoid hemorrhage). Can also occur if a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). In both cases there is poor bloodflow to the brain, plus the accumulation of leaking blood places excessive pressure on the brain. A transient ischemic attack (TIA), also known as a mini-stroke, is a temporary interruption of blood flow to a part of the brain. TIA symptoms may be similar to a stroke, however they last for a shorter time and do not leave noticeable permanent damage. TIAs are considered major risk factors for a later, larger stroke.

Goldstein said there is little difference along the stroke spectrum for effective prevention.

Highlighted below are some major updates in the new stroke prevention guidelines: Healthy lifestyle choices - don't smoke, follow a healthy low fat diet with plenty of fruits and vegetables, if you consume alcohol do so in moderation, keep your body weight within normal limits, and exercise regularly. People who adopt ALL these lifestyle choices can have an 80% lower risk of developing a stroke. Emergency room doctors - attempts should be made to spot those who are at high risk for stroke. The doctors should consider screening, referrals, or even starting preventive treatment. Genetic screening - not recommended for the general population. However, in some cases, depending on family history and some other factors, screening might be appropriate. Stenting vs. endarterectomy - this is still uncertain. Doctors need to view each case individually, and take into account advances in standard medical therapies, including hypertension treatment, administering antiplatelet and cholesterol lowering medications, and encouraging healthy lifestyle choices. Carotid artery narrowing screening - no recommended for the general population. Aspirin - for low risk individuals, patients with diabetes, and those with asymptomatic peripheral artery disease aspirin does not help prevent a first stroke. Aspirin is recommended for patients whose stroke risk is higher than bleeding risk (which aspirin can cause). "Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association"
Goldstein LB, Cheryl D. Bushnell, M.D., M.H.S.; Robert J. Adams, M.S., M.D.; Lawrence J. Appel, M.D., M.P.H.; Lynne T. Braun, Ph.D., C.N.P.; Seemant Chaturvedi, M.D.; Mark A. Creager, M.D.; Antonio Culebras, M.D.; Robert H. Eckel, M.D.; Robert G. Hart, M.D.; Judith A. Hinchey, M.D., M.S.; Virginia J. Howard, Ph.D.; Edward C. Jauch, M.D., M.S.; Steven R. Levine, M.D.; James F. Meschia, M.D.; Wesley S. Moore, M.D.; J.V. (Ian) Nixon, M.D.; and Thomas A. Pearson, M.D.
Stroke Journal 2010; DOI:10.1161/STR.0b013e3181fcb238

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