5th Leading Cause of Preventable Death
Stroke, a preventable condition, is the fifth leading cause of preventable death (Healthy People, 2022) producing roughly 160,264 deaths annually (CDC, 2022) and is a leading cause of disability within the United States (WHO, 2022). Stroke sufferers may experience a range of temporary or life-altering conditions including paralysis, dysphonia, mobility issues, cognitive decline, personality changes, bowel and urinary incontinence, and seizures (Chohan, 2019). Reduce the prevalence of stroke by understanding what a stroke is, how it can be influenced, and how to access available resources promoting stroke prevention and treatment methods. Strokes are either ischemic or hemorrhagic.
Ischemic and hemorrhagic strokes significantly contribute to morbidity and mortality (Sinz, 2020). Ischemic strokes, occurring 87% of the time, are normally caused by thrombotic arterial occlusion, while hemorrhagic strokes occur due to bleeding within the cranial vault (Sinz, 2020). Increased and prolonged systolic forces from uncontrolled hypertension narrow arteries, making them prone to occlusion and causing organ damage greatly affecting stroke likelihood (Sinz, 2020). Hyperlipidemia compounds the effects of hypertension by increasing clot formation (Sinz, 2020). Diabetes and heart disease just like hypertension and hyperlipidemia increase the risk of stroke but are also preventable and reversible (CDC, 2021).
Some stroke risk factors are modifiable while others are not. Non-modifiable risk factors include age, sex, genetics, and race or ethnicity (Healthy People, 2022). Modifiable risk factors for stroke include hypertension, hyperlipidemia, excessive body fat, a poor diet, and physical inactivity (Healthy People, 2022). Practices including clean eating, physical activity, and harmful substance avoidance decrease the physiologic demand placed on vital organ systems and stroke risk contribution from hyperlipidemia, hypertension, diabetes, and heart disease (CDC, 2022).
Healthy eating is a great way to prevent stroke. Stay hydrated and eat whole foods like fruits, vegetables, whole grains, poultry, fish, and foods rich in potassium (NINDS, 2022) to decrease elevated cholesterol levels thereby lowering the risk of stroke (Sinz, 2020). A doctor may also encourage the reduction of sodium intake as it has been shown to lower blood pressure (NINDS, 2022). Dietary lifestyle changes regulate blood pressure and cholesterol levels, which greatly reduces stroke incidence. Augment a healthy diet with regular physical activity to further reduce the chances of stroke.
Be physically active. Individuals leading sedentary lifestyles increase their risk of developing stroke due to obesity (NINDS, 2022). Obesity is clinically defined as a body mass index of greater than 30 percent (WHO, 2022). Sedentary, obese individuals are also at risk for hypertension, diabetes, heart disease, and stroke (NINDS, 2022). Waist to hip circumference ratio equal to or above the mid-value for the population triples the risk of ischemic stroke (NINDS, 2022). Implementing a regular physical fitness regimen mitigates one’s stroke risk although the risk is never zero. The Community Preventive Services Task Force (CPSTF) provided a systematically reviewed study titled Physical Activity: Community-Wide Campaigns, possessing a high degree of evidence (four out of four stars by healthypeople.gov), that found community-based campaigns can reduce risk factors for cardiovascular disease (CPSTF, 2021). Smoking cessation reinforces fitness and lowers one’s stroke risk.
Avoid tobacco. Cigarette smoking doubles the risk of ischemic stroke and quadruples the risk of hemorrhagic stroke (NINDS, 2022). Atherosclerosis, is prevalent in smokers, narrows blood vessels, and increases the chances of stroke. The chief chemical in tobacco products, nicotine, raises blood pressure (NINDS, 2022). Smoking cessation reduces the risk of stroke, lung disease, heart disease, and numerous cancers (NINDS, 2022). Healthy eating similarly reduces stroke by mitigating atherosclerosis, hyperlipidemia, and hypertension (NINDS, 2022). Alcohol is another substance that contributes to elevated stroke risk (Healthy People, 2022).
Limit alcohol consumption. Alcohol possesses a high sugar content which contributes to obesity and diabetes development (Ambardekar, 2021). Alcohol places a significant metabolic demand on the liver and pancreas which can lead to cirrhosis and pancreatitis respectively (Miller, 2022). Limiting excessive alcohol consumption acts synergistically with the other recommended lifestyle modifications to further decrease stroke risk. Committing to a healthy lifestyle is a start to decreasing the chances of a stroke but not everyone’s situation is the same.
While lifestyle modification is the best defense against stroke they are occasionally unavoidable due to a lifetime of poor choices or pre-existing conditions. HealthyPeople.gov provides a summary of a systematic review from the Cochrane Review titled Interventions for Improving Modifiable Risk Factor Control in the Secondary Prevention of Stroke boasting a high degree of evidence (four out of four stars). The review found that behavioral interventions showed no clear effect on “mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events” (Bridgwood, 2018). Lifestyle modification may not be enough for some people with comorbidities requiring advanced medical therapies (CDC, 2021). Stroke victims require prompt recognition and treatment to ensure recovery and mitigation of life-long complications, management of modifiable risk factors is essential to reducing stroke occurrence (CDC, 2022).
Recognize stroke symptoms with the F.A.S.T. acronym; facial droop, arm drift, slurred speech, and time to call 911 (Sinz, 2020). Stroke victims may be unable to move or have difficulty communicating (Sinz, 2020). Prompt, advanced treatment from emergency medical services and hospital personnel is vital to stroke patient survivability (Sinz, 2020). The treatment provided by medical professionals depends on the type of stroke a person is suffering from. Computerized tomography (CT) is utilized to differentiate between ischemic and hemorrhagic strokes (Sinz, 2020).
Ischemic strokes identified within three hours from symptom onset are treated with fibrinolytic therapy and those exceeding three hours, from symptom onset, receive mechanical thrombectomy (Sinz, 2020). Hemorrhagic stroke is treated with surgery to repair the damaged vessel (Sinz, 2020). Former stroke sufferers, or those at risk for stroke, are encouraged to work with a healthcare team to prevent future strokes (CDC, 2022). The CPSTF published a systematically reviewed article titled Cardiovascular Disease: Clinical Decision-Support Systems (CDSS), rated four out of four stars by healthypeople.gov for a high degree of evidence, that found prompt screening and preventive care services improved patient outcomes (CPSTF, 2021). The Centers for Disease Control and Prevention (CDC) and HealthyPeople.gov provide stroke resources for public health professionals and individuals.
The Stroke Educational Materials for Health Professionals and Stroke Communications kit are two excellent resources provided by the CDC to aid Public Health Professionals learn about and educating the community and patients on stroke (CDC, 2022). The Stroke Educational Materials for Health Professionals provides factsheets, webinars, podcasts, current guidelines, and links to national stroke campaigns and organizations (CDC, 2022). The Stroke Communications kit includes tools for public awareness by listing stroke awareness dates, social media captions, and graphic images to inform others on how to prevent and respond to stroke (CDC, 2022). Both resources have a compendium of information contained within them to provide both the health professional and the community at large with pertinent and meaningful stroke resources. Another powerful resource is the CDC’s State and Community Health Media Center.
The State and Community Health Media Center provide resources that inform one about what a stroke is, risk self-identification, treatment and recovery from stroke, signs, and symptoms, and testimonials from stroke survivors (CDC, 2022). These resources provide fundamental information about stroke from a knowledge, mitigation, and post-stroke perspective. The first step in preventing stroke is to know what it is and how it affects the human body.
The resource Learn About Stroke and Its Causes describes the difference between ischemic and hemorrhagic strokes, how the disruption of blood flow causes brain tissue death, the importance of urgent treatment, and the differentiation between a stroke and a transient ischemic attack (CDC, 2022). These critical pieces of information are foundational components of awareness for both Health Educators and persons globally. Knowledge about what a stroke is, albeit essential, is not the only component of stroke prevention preparedness. Individual risk factor assessment is key to distinguishing one’s chances of developing a stroke.
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Know Your Risk for Stroke provides a synopsis of stroke-related risk factors. Health-related predispositions like hypertension, hyperlipidemia, cardiovascular disease, diabetes, obesity, and sickle cell disease are briefly defined within this resource. The CDC also identifies non-modifiable risk factors for stroke including behavioral factors, family history or genetics, age, sex, and race or ethnicity. This is a powerful resource because it stratifies the likelihood of stroke development across multiple variables in an easy-to-read format (CDC, 2022). Unfortunately, not all strokes can be prevented for some people, which is why the Treat and Recover from Stroke resource is necessary.
Treat and Recover from Stroke provides insight into what stroke victims can expect status post stroke occurrence. Common symptoms, including paralysis, dysphonia, incontinence, pain, and various others are listed for stroke patients so they can best prepare for potential stroke outcomes (CDC, 2022). Speech, physical, and/or occupational therapy may be essential for stroke patient recovery (CDC, 2022). Lastly, this resource discusses the importance of preventing recurrence, which can greatly impact a stroke victim’s quality of life. Another credible and useful resource for addressing stroke is Healthy People published by the United States Department of Health and Human Services.
Healthy People comingles the effects of stroke and heart disease due to their related causes and effects. Cardiovascular health greatly impacts the prevention of stroke (Healthy People, 2022). A stroke is considered a cardiovascular emergency where timely treatment can reduce the risk of morbidity and mortality. Public awareness of symptom recognition is vital to accessing appropriate care (Healthy People, 2022). Blood pressure and cholesterol regulation aid the prevention and care of stroke along with these additional objectives: improved cardiovascular health, nutrition, and healthy eating, a routine aspirin regimen, emergency preparedness, initiation of prompt intravenous reperfusion therapy, and stroke survivor rehabilitation services participation.
Although stroke is a leading cause of morbidity and mortality it is preventable. Stroke prevention includes awareness of both preventative measures and risk factors. Influence modifiable risk factors for stroke by emphasizing healthy habits aimed at prevention i.e., healthy eating and physical activity to maintain a healthy weight, avoidance of tobacco products, and limiting alcohol consumption as these habits decrease the chances of experiencing a stroke. Implement healthy lifestyle practices to reduce your risk of developing stroke and stay abreast of new research findings and recommendations surrounding cardiovascular diseases.
References
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Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD009103. DOI: 10.1002/14651858.CD009103.pub3. Accessed 29 April 2022.
Centers for Disease Control and Prevention. (2022, January 13). FASTSTATS - leading causes of death. Centers for Disease Control and Prevention. Retrieved March 31, 2022, from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Centers for Disease Control and Prevention. (2021, August 2). Preventing stroke: Healthy living habits. Centers for Disease Control and Prevention. Retrieved March 31, 2022, from https://www.cdc.gov/stroke/healthy_living.htm
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Chohan, S. A., Venkatesh, P. K., & How, C. H. (2019). Long-term complications of stroke and secondary prevention: an overview for primary care physicians. Singapore medical journal, 60(12), 616–620. https://doi.org/10.11622/smedj.2019158
CPSTF. (2021, December 22). Heart disease and stroke prevention: Clinical decision support systems (CDSS). The Guide to Community Preventive Services (The Community Guide). Retrieved April 29, 2022, from https://www.thecommunityguide.org/findings/heart-disease-stroke-preventionclinical-decision-support-systems-cdss
CPSTF. (2021, November 12). Physical activity: Community-wide campaigns. The Guide to Community Preventive Services (The Community Guide). Retrieved April 29, 2022, from https://www.thecommunityguide.org/findings/physical-activitycommunity-wide-campaigns
Healthy People. (2022). Heart disease and stroke. Heart Disease and Stroke - Healthy People 2030. Retrieved April 10, 2022, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/heartdisease-and-stroke
Leading causes of death, and disability. PAHO/WHO | Pan American Health Organization. (n.d.). Retrieved March 31, 2022, from https://www.paho.org/en/enlace/leading-causes-death-and-disability
MedlinePlus. (2022, March 30). Stroke | CVA | cerebrovascular accident. MedlinePlus. Retrieved April 10, 2022, from https://medlineplus.gov/stroke.html
Miller, L. (2022, March 10). Pancreatitis & Alcohol: Alcohol's effect on the pancreas. American Addiction Centers. Retrieved April 29, 2022, from https://americanaddictioncenters.org/alcoholism-treatment/effects-of-alcohol-onthe-pancreas
NINDS. (2022). Brain basics: Preventing stroke. National Institute of Neurological Disorders and Stroke. Retrieved April 10, 2022, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Preventing-Stroke
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