HEALTH NEWS

MANAGING THE RISK OF STROKE

Wong Li Za

It can be crippling both physically and mentally. It attacks the most crucial part of our body, usually without warning.

And even though the common perception is that it affects older people, in actual fact, even adolescents are not spared.

The third most common cause of death in Malaysia after heart attack and cancer, stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel bursts.

This blocks the flow of blood to certain parts of the brain and kills the cells in the surrounding area. This leads to loss of functions that were once controlled by affected area of the brain such as speech, movement and memory.

"Out of all stroke cases, one third leads to death, while another third suffers permanent disability," says Prof Graeme J. Hankey, guest speaker at a lunch symposium on Hypertensive Stroke: Issues in Management, sponsored by international pharmaceutical company Sanofi-Synthelabo recently.

The most common stroke symptoms are sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, difficulty speaking or understanding; sudden problem walking, dizziness, loss of balance or co-ordination; sudden sight problem; and sudden severe headache.

Risk factors for stroke can be divided into two categories--controllable risk factors and uncontrollable risk factors.

Uncontrollable risk factors

The uncontrollable risk factors for stroke include age, gender, family history and diabetes.

"The highest risk (under uncontrollable risk factors) is age. It is not unusual for a person to have a stroke after the age of 45," says Dr Haniffah Abdul Gafoor, adviser for the Penang chapter of the National Stroke Association of Malaysia.

Men also have a higher risk of stroke compared to women.

"We don't really know the reasons. It could be due to estrogen or other factors," says Dr Haniffah.

He adds that if a person's parent suffers a stroke before the age of 65, that person is at risk.

Diabetics also have a higher risk of stroke. Brain damage may be more severe if blood sugar is high when a stroke happens.

Treating diabetes may delay the onset of complications that increase stroke risk. However, even if diabetics are on medication and have blood sugar under control, they may still have a higher risk.

Controllable risk factors

These include high blood pressure, high cholesterol, heart problem, sleep apnea (difficulty breathing during sleep), personal history of stroke, smoking, alcohol consumption and being overweight.

The most common reason for a stroke to occur is high blood pressure (BP). "It is good if a person has a 130/80mm Hg or less, all the more if he is diabetic," says Dr Haniffah.

A high BP contributes to blockage of blood to the heart, brain, and legs.

"Our message is 'Go to the GP (general practitioner) to check your BP'," urges Prof Hankey, consultant neurologist and head of the stroke unit at the department of neurology, Royal Perth Hospital, Perth, Australia.

"The same way that you get your car serviced, you should also get your body serviced every year, particularly (to check) your BP," says Prof Hankey, adding that 75% of patients worldwide are hypertensive in the acute phase.

"Haemorrhage stroke is common in 15 to 20% of stroke patients in the West, compared to 30 to 40% in Asians. This (higher percentage in Asians) could be because of high blood pressure due to lifestyle and also genetics," he says.

Meanwhile, coronary artery disease alone does not increase the risk of stroke, says Dr Haniffah. "However, those with a weak heart, abnormal heart valve or rhythm face a higher risk."

He adds that those with a personal history of stroke have a two-fold risk or a 30% lifetime chance of getting another attack.

Sleep apnea is a major cardiovascular and stroke risk factor. It increases blood pressure that may cause stroke or heart attack.

Studies have indicated that people with sleep apnea develop dangerously low levels of oxygen in the blood while carbon dioxide levels rise, which may lead to blood clots or a stroke.

Smoking also doubles the risk of stroke. It damages blood vessel walls, speeds up the clogging of arteries by deposits, increases blood pressure and makes the heart work harder.

A weight problem contributes to other risk factors like high cholesterol, high blood pressure and diabetes--all risk factors for stroke.

"Just knowing your total cholesterol level is not good enough. You need to know your level of good (HDL) and bad (LDL) cholesterol. Basically, the 'highs' must be high and your 'lows' must be low," advises Dr Haniffah.

"The first thing to do is to achieve an optimal body weight through diet and exercise. Then, reduce your salt intake and also quit smoking," adds Prof Hankey.

Source: The Star, 6 May 2001