Cerebrovascular disease, currently the third leading cause of death and the leading cause of disability in the United States, poses an enormous public health problem. Preventing stroke is, therefore, of crucial importance. Each year about 795,000 people experience a stroke: About 610,000 of these are first attacks, and 185,000 are recurrent attacks.
One of the key risk factors for stroke is hypertension, or high blood pressure. It is probably the most important modifiable risk factor for stroke, and an aggressive approach to lowering blood pressure pays great dividends in reducing cerebrovascular events.
It has been shown that antihypertensive drug treatment reduces the risk of first stroke by 32 percent in comparison with no drug treatment. In secondary stroke prevention, risk reduction was shown to be directly proportional to reduction in blood pressure.
The other risk factor is high levels of total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Lowering of these levels and raising of high-density lipoprotein (HDL) is another way of preventing stroke. A large meta-analysis of randomized trials using statins, or cholesterol-lowering medications, for primary or secondary prevention demonstrated a significant correlation between the extent of LDL reduction and the degree of protection from stroke.
Lifestyle changes, including eating a healthful, fiber-filled diet, losing weight, and getting regular physical activity, are important along with any lipid-lowering treatment.
The next risk factor is metabolic syndrome, a constellation of risk factors (atherogenic dyslipidemia, hypertension, insulin resistance, and abdominal obesity) that cluster and promote atherosclerosis.
The Mediterranean diet—characterized by a high intake of monounsaturated fat, plant proteins, whole grains, and fish; moderate intake of alcohol; and low consumption of red meat, refined grains, and sweets—has been shown to be effective in promoting weight loss, lowering the ratio of total cholesterol to HDL, preventing secondary cardiac events, and lowering total and cardiovascular mortality.
In addition, regular moderate-intensity physical activity is associated with a lower risk of stroke. Five lifestyle factors: maintenance of a body mass index of 18.5 to 24.9; regular exercise; consuming a diet rich in fruits and vegetables; abstinence from smoking; and moderate alcohol intake have been associated with a lower risk of stroke.
Neurologist Kiran A. Patil, M.D. practices with Southwestern PA Neurology Associates. He can be contacted at 412-942-6323.