Health Topics

Stroke Prevention

Andrew Schorr:

Welcome back to Patient Power as we continue our discussion about stroke, and it is so important, remember you have these symptoms or you see it in someone else dial 911.  And as we were just discussing you want to get to a primary stroke center where they're really tuned up, if you will, to give you the right care and do it very expeditiously. 

Back with Dr. Richard Bernstein, a neurologist who specializes in treating stroke.  Now we're going to talk about prevention, Dr. Bernstein.  It is all too common.  We don't want to put you out of business, the stroke business, we have a long way to go unfortunately and neurologists treat many other conditions too, so I'm sure you'll always remain busy, but what could we do to lower that inflow of people who are actually having a stroke?  What could we do? 

Dr. Bernstein:

Well, there are a lot of simple things that people can do to prevent a stroke, and as I mentioned before just these few things may eliminate more than half of your risk of having a stroke.  So I would say the number one thing people can do is to see their primary doctor regularly because most of the things that cause a stroke really sneak up on you and they don't cause symptoms until they cause a catastrophe.  Your doctor can detect them, but just sitting at home you may feel perfectly fine even though you've got a number of ticking time bombs in your body just waiting to cause a stroke.  So number one, see your doctor on a regular basis because doctors are very good at detecting these stroke risk factors. 

What are some of the things that your doctor might do to help you prevent a stroke?  Number one, check your blood pressure.  It's important to know if you have high blood pressure or not.  The vast majority of adults in the United States have high blood pressure, and the vast majority of adults who have high blood pressure don't have it sufficiently treated.  So know your blood pressure, and if it's high don't wait to see if it's going to come down with a change of diet, because it probably won't.  You'll probably need medication, and lowering your blood pressure has a dramatic impact on preventing stroke. 

The same thing goes for diabetes.  Have your doctor check your blood sugar every now and then, and if it's running high and you have diabetes get it under good control. 

Staying active, getting exercise on a regular basis, probably four or five times a week lowers your risk of having a stroke, and it's also good for preventing heart disease and improving your overall sense of well?being. 

And then the other thing we can do is to not smoke.  Smoking kills about 60,000 Americas every day, not every week but every single day, and a lot of them die from a stroke, and those who don't, die of heart disease, which a similar disease.  So if you just put the cigarettes down you have done yourself a great favor in terms of preventing a stroke.

Andrew Schorr:

Wow.  Now, where does obesity come into play?  I mentioned that earlier.  Is that a factor?  Are we developing fat in our arteries and something could break off and go to our brain?  What about that, and diet? 

Dr. Bernstein:

Well, scientifically it's been hard to prove that obesity per se is a cause of stroke.  It's more likely that obesity is a cause of diabetes and diabetes is a major cause of stroke.  And it's also the case that diabetes puts a strain on the heart, can lead to heart disease, and a having heart disease is a major risk factor for going on to have a stroke.  Finally, obesity makes it hard to stay active, makes it hard to get

exercise, so at least indirectly obesity is a cause of a stroke.  And it may even turn out with further research that we'll discover that obesity by itself is also a cause of stroke.

Andrew Schorr:

In your experience, and you alluded to this a minute ago, I wondered, can someone change their diet to lower their blood pressure? 

Dr. Bernstein:

Yes.  The one thing that you can do is to try to eliminate as much salt from your diet as possible.  I usually avoid telling patients to go on an absolutely salt?free diet because they'll come back and see me in three months and they'll tell me they're eating nothing but nuts and berries and they'll be totally depressed and completely miserable and they'll really feel like the stroke completely ruined their life.  So I try not to be a fanatic.  I tell them if you're going to do one thing, cut down on the salt.  And if you want to add a second thing, don't eat eggs.  If you avoid eggs and avoid salt, that's more than half the battle regarding diet, and the rest of it I think we can take care of in other ways.  So I try not to be a fanatic because people are very attached to their food, but if they can cut down on salt, that's really the key.

Andrew Schorr:

Wow.  Okay.  What about recurrence?  So let's say somebody gets properly managed and maybe they have a TIA or they have a stroke, they make a good recovery.  What about the risk of another one if they quit smoking and they try to do all the right things? 

Dr. Bernstein:

Yeah.  So the risk of another stroke never goes away.  That risk is always there even if you do everything right and even if your doctors did all the right tests and have you on all the right treatments.  Unfortunately it's not like giving antibiotics to somebody with an ear infection where they're going to be cured and no longer face any risk.  But there are a lot of things we can do to lower the risk.  Antiplatelet agents, like aspirin and some other drugs, lowering cholesterol, lowering blood pressure, all of those things push people in the right direction. 

The risk of another stroke is right now between four and six percent per year in most patients for the first couple of years after a stroke.  If you make it out two years or so without having another stroke that risk actually plummets quite a bit, down to more like one or two percent, and from that point on your risk stays fairly low at one or two percent.  It's that first two months and year or two after a first stroke that patients have the highest risk, and that's when in my practice I like to see patients back frequently to make sure they're doing everything right.

Andrew Schorr:

You touched on something that I wanted to ask you about in a little greater depth, and that is about aspirin.  So aspirin is over?the?counter but it really is an antiplatelet medicine, right? 

Dr. Bernstein:

Yes, it is.

Andrew Schorr:

And fairly powerful, and Jennifer I know has been taking like an aspirin a day to lower her risk.  So at least related to heart disease, you know, there have been various ads and things for certain age groups, maybe you should take a baby aspirin a day to lower your risk of a heart attack.  What about taking an aspirin to lower your risk of a stroke? 

Dr. Bernstein:

That's a great question.  Let me correct or respond to one thing you put into your question which is that you said aspirin is pretty powerful.  I would put it that aspirin helps, not that it's all that powerful.  It helps a little bit.  It's about as good as we have.  I would love something better, so I don't want people to think aspirin is the panacea that's going to prevent a stroke.  It nudges people in the right direction, but it's about as good as we have right now for the majority of patients. 

Whether or not people should take an aspirin to prevent a stroke in advance of ever having any stroke symptoms is in my view an open question.  A few years ago I would have said women definitely prevent stroke by taking an aspirin and men definitely prevent heart attack by taking an aspirin.  Now I would have to say the jury is out.  Some newer research has made it unclear whether or not everybody should take an aspirin.  Certainly after you've had a stroke or after you've had a TIA or if you have some other high?risk condition aspirin or other drugs like it may be beneficial, but for just the average person out there who is really at any age who is worried about having a stroke, whether or not to take aspirin is a difficult decision that they really need to talk to their doctor about, and I don't think we truly know the right answer.

Andrew Schorr:

One other point.  It's also been out there that if you feel like you're having the signs of a heart attack you should pop an aspirin and that's helpful.  What if you're having the signs of a stroke? 

Dr. Bernstein:

I think taking an aspirin at the onset of a stroke is not a good idea because it is almost impossible to know when you're at home whether or not the stroke is due to bleeding or due to a blockage.  While the aspirin might be helpful in a blockage it could make matters worse if you're having bleeding.  So the thing to do is call 911.  Let them sort it out at the emergency room.  They'll give you an aspirin if you need it, and there really isn't the same urgency as there is with a heart attack.

Andrew Schorr:

All right.  Well, we've covered a lot of ground with you, Dr. Richard Bernstein.  Thank you for your devotion to helping people prevent stroke and should they need care to get the right care with a whole team fast.  Thank you for all you do. 

Dr. Bernstein:

Thank you.

Andrew Schorr:

All right.  Let's hear more from Jennifer.  Jennifer, so among the risk factors that put someone at higher risk of stroke is smoking.  You have been a smoker in the past and although at such an early age maybe wasn't a factor, but what would you say to people about things they could do to try to lower their risk?  What would you say to them? 

Jennifer:

Well, I would definitely say do not smoke.  And I work in an industry where a lot of people do drugs.  I work in the nightclub industry, I'm an event planner, so obviously drugs and smoking and all things you think are fine in your 20s??I didn't do drugs but I smoked and I had a stroke.

Andrew Schorr:

Right.  And I know now you work hard to keep yourself fit so the last thing you want any time in your life is another stroke for sure. 

Jennifer:

Absolutely.

Andrew Schorr:

Now, what do you want to say to people about acting fast rather than just sort of getting to bed? 

Jennifer:

Obviously the best thing I did was not go to sleep because I wanted to fall asleep I was so tired.  I knew I had to go to work, so I was like, I can't go to sleep, but if I went to sleep I wouldn't have gotten to the hospital in time to get the drugs that stopped the stroke.  So if you ever realize something is going wrong with your body call 911. 

And there are a lot of problems with people not having insurance, so they're scared to call.  I had insurance but I think you should just call because there are benefits for people in an emergency.

Andrew Schorr:

Call 911. 

Jennifer:

Call 911 no matter what.

Andrew Schorr:

Right. 

Jennifer:

Don't freak out if your bills are high and you don't have insurance. 

Andrew Schorr:

Call 911. 

Jennifer:

Call 911.

Andrew Schorr:

Say it 20 times.  Jennifer, I don't know if you're a religious person.  Do you think things worked out that it just wasn't your time? 

Jennifer:

I am a religious person, and I don't think was I was meant to die.  I'm still here and I'm healthy.

Andrew Schorr:

Yeah, we're so glad, Jennifer, and I'm sure you'll be a terrific mom, and we thank you for sharing your story and an example that stroke can happen at any age. 

Jennifer:

Anyone.

Andrew Schorr:

Yeah, it can.  Jennifer McAndrew, thank you so much for being with us on Patient Power. 

Jennifer:

Thank you so much.

Andrew Schorr:

Well, we like bringing these stories and a happy story of really virtually a full recovery with great medical care in Jennifer McAndrew's case.  And thanks to Northwestern Memorial for the care they provide and in sponsoring this Patient Power series where we can connect you with medical experts like Dr. Richard Bernstein.  I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  Thanks for joining us.  

For more information or to schedule an appointment with a Northwestern Memorial physician, please contact our Physician Referral Service at 1-877-926-4664 or visit us online at www.nmh.org.

Please remember the opinions expressed on Patient Power are not necessarily the views of Northwestern Memorial Hospital, its medical staff or Patient Power.   Our discussions are not a substitute for seeking medical advice or care from your own doctor.  That’s how you’ll get care that’s most appropriate for you.