'Vacuum' Device Is a Clot Buster

Feb. 22, 2008 (New Orleans) -- A tiny vacuum-cleaner-like device can help stroke patients when standard clot-busting drugs fail, researchers report.

Called Penumbra, the recently approved device suctions out clots that can cause an ischemic stroke.

The most common type of stroke, ischemic stroke occurs when blood flow to an area of the brain is compromised by a blood clot. This leads to the death of brain cells and brain damage.

Penumbra restored blood flow in 82% of 125 patients studied, says Cameron McDougall, MD, chief of endovascular neurosurgery at the Barrow Neurological Institute in Phoenix.

"There were no serious adverse events associated with the procedure, and nearly 60% of patients were better neurologically by the time they left the hospital," he tells WebMD.

Also, one in four patients had no to minimal disability three months later.

The findings were presented at the American Stroke Association's (ASA) International Stroke Conference.

Penumbra Helps When tPA Fails

About 780,000 Americans suffer a stroke each year and more than 150,000 of them die. Survivors often face serious disability.

For patients who suffer an ischemic stroke, tissue plasminogen activator, or tPA, can mean the difference between permanent brain damage and a return to normal activities. TPA breaks up the clot, restoring blood flow to the brain.

But tPA has to be administered in the first three hours after symptoms strike, and the vast majority of people fail to get to the hospital in time. Plus, it only works in about 40% of patients who get it.

Penumbra could help both these groups of people, McDougall says.

A catheter is inserted through a small puncture in the groin. Under X-ray guidance, it is advanced through the blood vessels until it reaches the closest edge of the blockage. A wire is advanced to dislodge the clot, which is sucked into the catheter.

McDougall says that originally, the system had a plan B -- a clot-grabbing device that doctors could use if the vacuum failed. "But we never really needed it," he says.

Not everyone benefited from the new device. By three months after the procedure, about one in three of the patients had died, many due to bleeding in the brain.

Given the severity of their illness, "this was not an unexpected result," says Philip Gorelick, MD, head of the committee that chose which studies would be presented at the meeting and chairman of neurology at the University of Illinois in Chicago.

They "had ischemic stroke that was pretty severe for a clinical trial," he tells WebMD.

Penumbra isn't the only clot-dislodging device. Doctors can also use a corkscrew-shaped wire called the Merci Retriever to pull out clots.

According to McDougall, the two devices compare "favorably." But the only way to really know is to pit one against the other in a clinical trial, Gorelick says.

The new study was sponsored by Penumbra Inc.

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More Strokes in U.S. Than in Europe

Feb. 22, 2008 (New Orleans) -- Stroke is more prevalent in the United States than in Europe -- and higher rates of obesity, diabetes, and lifetime smoking in the U.S. play a major role, researchers report.

Barriers to care in the U.S. -- chiefly a lack of universal health care coverage and minimal focus on prevention -- also contribute to its higher prevalence of stroke, says study head Mauricio Avendano, PhD, a research fellow in public health at the Erasmus Medical Center in Rotterdam, Netherlands.

The researchers looked at what is known as stroke prevalence -- the number of people who have a disease at any given point in time.

Compared with European men, American men had a 61% higher chance of having had a stroke in their lifetime, Avendano says. U.S. women had almost twice the odds of having had a stroke as European women.

"Most of this gap is among relatively poor Americans who were, in our data, much more likely to have a stroke than poor Europeans, whereas the gap in stroke prevalence is less marked between rich Americans and rich Europeans," Avendano says.

The study was presented at the American Stroke Association's (ASA) International Stroke Conference 2008.

Stroke Deaths Down in U.S.

ASA spokesman Larry Goldstein, MD, a stroke expert at Duke University in Durham, N.C., says looking at stroke prevalence may give a blurred snapshot of what's going on the U.S.

That's because prevalence goes up as the chance of dying of a disease goes down. "If everyone has a disease and everyone survives, then prevalence is 100%," he tells WebMD.

The fact that the U.S. has made great strides in reducing deaths due to stroke -- there's been a 25% drop in recent years -- may play a role in its higher prevalence, Goldstein says.

That said, "there are a lot of data linking lower socioeconomic status and lack of access of care to a variety of ill health effects, including stroke," he says.

African-Americans Have Highest Stroke Odds

The researchers analyzed 2004 data from the U.S. Health and Retirement Survey (HRS); the Survey of Health, Aging and Retirement in Europe (SHARE); and the English Longitudinal Study of Aging (ELSA). These surveys include twice-yearly interviews among people age 50 and older.

Altogether, there were data on 13,667 people in the U.S. and 30,120 individuals in 11 European countries.

Among the findings:

• Overall, women were about 25% less likely to have had a stroke, on average, than men.
• When age was taken into account, stroke was most prevalent in the U.S. and least prevalent in the southern Mediterranean European countries of Spain, Italy and Greece, as well as Switzerland.
• African-Americans had the highest odds of having a stroke of any group studied -- they were nearly three times more likely to have had a stroke in their lifetime than "other Americans," the dubious winner of the second-place prize.
• In the U.S., stroke prevalence is higher in the southern and western states.

Within Europe, "there was a north-south gradient, with the northern countries, especially Denmark and Sweden, having the highest prevalence of stroke," Avendano says.

Avendano says that while rates of lifetime smoking are higher in the U.S. than in Europe, "the proportion of current smokers is lower in the U.S. So going forward we could see a positive effect of that trend."

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Strokes Up in China as Economy Booms

Feb. 29, 2008 -- A new study shows the most common type of stroke increased almost 9% annually over a 20-year period in China as its economy boomed. At the same time, deaths from strokes decreased.

Ischemic strokes, the most common type of stroke, are caused by blood clots.

"The changes in patterns of stroke have raised new challenges and the need to adjust priorities to prevent stroke in China," researcher Dong Zhao says in a news release.

Dong notes that "risk factors have become a new problem and challenge for public health in China."

The study, funded by the Chinese government and the World Health Organization and published in the journal Stroke, looked at nearly 14,600 strokes among people ages 25-74 in seven districts throughout Beijing from 1984 to 2004.

Unhealthy Lifestyle to Blame?

Risk factors for stroke include obesity, elevated cholesterol, diabetes, high blood pressure, and smoking. The researchers write that other studies that approximately cover the same time period show that:

• More and more people became obese or overweight, especially those who live in rural areas.
• From 1983 to 2002, fat and daily cholesterol intake shot up in urban areas and nearly tripled in the countryside.
• Cholesterol levels in the blood increased 24% from 1984 to 1999.
• Diabetes skyrocketed 97% from 1994 to 2002.

Dong says cigarette smoking changed very little during the time of the study.

The study shows that the decrease in fatal strokes is likely due to improved health care such as control of high blood pressure and stroke treatment.

The researchers note that stroke is a top killer in China, estimated to be the "second or third leading cause of death, even with dramatic economic development in recent years."

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Getting Back to Work After a Stroke

March 27, 2008 -- A stroke can have a major impact on every aspect of a person's life, including his or her job. New research shows that only about half of stroke survivors are able to return to work, and continuing disability and depression are major causes.

The weakness, speech, and movement problems that often occur after a stroke can lead to a lengthy disability period for many patients. Often stroke survivors also develop depression and other psychiatric problems. All of these factors can contribute to the decision not to return to work.

To assess the impact of stroke on employment, researchers in Australia and New Zealand looked at 210 previously working patients (average age 55) who had had a first stroke between 2002 and 2003. Researchers assessed patients soon after their stroke, then again at one and six months afterward.

Fifty-three percent of patients were able to return to full-time work within a few months of their stroke, the researchers reported in the journal Stroke. "It can be quite heartening to families and clinicians that more than half of stroke patients go back to work," study researcher Nick Glozier, MD, PhD, associate principal director of The George Institute for International Health in Sydney, Australia, says in a news release. "But physicians should continually assess patients' mood after stroke, because it's an important predictor of whether patients will go back to work."

Depression did have a significant independent impact on work status after a stroke. Forty-five percent of patients who didn't return to work at six months were depressed, compared with 33% of those who did go back to work. Only 30% of those patients with depression following stroke reported receiving treatment for this.

"If family members pick up on someone being depressed after a stroke, ask the physician to assess them and intervene if necessary," Glozier advises. "Post-stroke depression can be successfully treated, and treatment can help the patients, their families, and society."

Other important determinants in whether patients could get back to work were the severity of the stroke and the patients' ability to care for themselves independently. Seventy-one percent of those who were working six months after a stroke were rated "independent" on a scale of self-care abilities called the Barthel Index, compared with only 32% of those who didn't go back to work. Glozier says people who are functioning well after a stroke should consider vocational rehabilitation, which can help them make the transition back into the workforce.

The authors say the next step in research is to look at ways to prevent and manage stroke-related depression to help improve patients' quality of life.

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Preventing Strokes: Stents vs. Surgery

April 9, 2008 -- A less invasive alternative to surgery for clearing neck arteries of plaque proved as effective as surgical treatment for preventing strokes in high-risk patients in a three-year follow-up study.

Carotid artery stenting was compared to open-neck surgery in 260 patients considered less than optimal surgical candidates at high risk for strokes.

Stenting is routinely used to open plaque-clogged coronary arteries, which cause heart attacks. But it is still largely considered an experimental treatment for opening the clogged neck arteries that lead to strokes.

The newly published findings are the first to show long-term outcomes for neck stenting to be comparable to surgery in high-risk patients, University of Michigan interventional cardiologist Hitinder S. Gurm, MD, tells WebMD.

The study appears in the April 10 issue of the New England Journal of Medicine. The research was funded by Johnson & Johnson's Cordis, which makes the stent used in the study.

"This is the first data we have to suggest that these two procedures have similar long-term benefits," Gurm says. "But the findings only apply to high-risk patients. The trials examining lower-risk populations are going on now, and we hope to know more over the next few years."

Stent vs. Surgery

The patients who took part in the study were treated at 29 hospitals around the U.S. All were considered at increased risk for complications with surgery because of advanced age (over 80), co-morbid conditions (heart failure, advanced coronary artery disease, lung disease) or a history of prior neck surgery or radiation. Most also had symptoms associated with carotid artery narrowing.

Roughly half were treated with surgery, known as carotid endarterectomy, which involves opening the blocked carotid artery surgically to manually clear out accumulated plaque.

The other half got stents -- tiny wire mesh tubes threaded into the neck artery from an incision in the arm or groin. A filter designed to capture plaque and other debris freed from the arterial walls during the procedure was also used during stent implantation.

Of the participants available for follow-up, 41 of 143 stent-treated patients and 45 of the 117 patients treated with surgery had suffered a heart attack, a stroke, or had died within three years.

Most of the deaths were from cardiac or other non-stroke-related causes.

Strokes accounted for about a third of the adverse events recorded, but most were not serious enough to be life-threatening.

Follow-up Needed

The findings suggest that outcomes with surgery and stenting are similar among high-risk patients, but that doesn't mean that stenting will always be the best choice for this group, Gurm says. Importantly, this trial did not include a set of patients treated with medications alone.

"The first thing a patient who has a high surgical risk should discuss with their doctor is whether they really need either procedure," he tells WebMD.

If the answer is yes, the next consideration should be the doctor's prior experience with surgery or stenting.

"There are those that do both, but most people working in this field are either good at surgery or good at stenting," he says.

UCLA Medical Center vascular surgeon Wesley S. Moore, MD, tells WebMD that three years of follow-up is not enough to prove that stenting and surgery are equal for the treatment of high-risk patients with carotid artery blockage.

He adds that there is some evidence that neck arteries cleared using stents become clogged again more quickly than those cleared by surgical means.

"This may not show up in three years, but we can't really say if this is the case at four and even five years," he says.

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Wealth Lowers Stroke Risk in Middle Age

April 24, 2008 -- Having more money and assets just prior to retirement may lower your risk of stroke, but those perks may not last very long, according to a new study.

Researchers found greater wealth was linked to a lower risk of stroke among Americans between the ages of 50 and 64.

For example, middle-aged adults with the lowest 10% of wealth had about two times the risk of stroke compared with those in the 75th-89th percentile, which researchers say translates to the wealthy but not super-rich.

But the protective effect of wealth on stroke risk completely disappeared after age 65.

"We expected wealth to be a strong predictor of stroke in the elderly," researcher Mauricio Avendano, PhD, of the Erasmus Medical Center in Rotterdam, Netherlands, says in a news release. "We were surprised to see that it was not associated with stroke beyond age 65."

Wealth: A New Stroke Risk Factor?

Although previous studies have identified lower socioeconomic status as a risk factor for stroke, researchers say this is the first study to look at how factors that affect socioeconomic status, such as education, income, and overall wealth, evolve throughout middle and old age.

In their study, published in Stroke: Journal of the American Heart Association, researchers analyzed data from the Health and Retirement study, which followed a group of nearly 20,000 Americans aged 50 or older for an average of 8.5 years.

During the follow-up period, 1,542 participants had a stroke. The results showed that higher education reduced stroke risk at ages 50 to 64 but not after adjusting for wealth and income.

Both wealth and income were independent risk factors for stroke at ages 50 to 64. But wealth, including the total of all financial and housing assets minus the liabilities, was a much stronger risk factor, with increasing wealth linked to decreasing stroke risk.

"Wealth more comprehensively reflects both lifelong earnings and intergenerational transfers, and increases access to medical care and other material and psychosocial resources," Avendano says.

Beyond age 65, however, neither wealth, income, nor education was significant predictors of stroke risk.

"We confirmed that lower wealth, education, and income are associated with increased stroke up to age 65, and wealth is the strongest predictor of stroke among the factors we looked at," Avendano says. "After age 65, the association of education, income, and wealth with stroke are very weak, and wealth did not clearly predict stroke."

Researchers say selective survival may explain some of these effects: individuals with lower wealth die earlier than their richer counterparts, and those that survive into old age are the healthiest.

"Further research is needed to understand why the effect of wealth, income, and education on stroke is less clear beyond age 65 and the role of selective survival," Avendano says.

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Few Aware of Stroke Warning Symptoms

May 8, 2008 -- Do you think sudden chest pain is a symptom of a stroke? If you answered yes, you're not only wrong, you're not alone.

A telephone survey of more than 71,000 adults in 13 states and Washington, D.C., has revealed that shockingly few people know the warning signs of a stroke. The CDC analyzed data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey and found that only 16.4% of persons surveyed correctly recognized all five stroke warning symptoms, knew to call 911, and could identify an incorrect symptom of stroke.

According to the CDC, the five warning symptoms of a stroke are:

• Sudden weakness or numbness of the arms, legs, or face, especially on one side.
• Sudden vision problem in one or both eyes.
• Sudden dizziness, loss of balance or coordination, or difficulty walking.
• Sudden confusion or trouble speaking.
• Sudden severe headache with no known cause.

Promptly recognizing stroke warning symptoms and seeking immediate emergency care can mean the difference between life and death or disability. Patients whose stroke is caused by an interruption of the blood supply to the brain (blood clot) can be treated with clot-busting drugs, but such medicines should be given within three hours of symptom onset. Other type of strokes may require immediate surgery to prevent serious disability or death.

In general, most respondents (92.6%) knew that sudden numbness, especially on one side of the body, was a stroke warning symptom, but considerably fewer (68.8%) were aware that sudden trouble seeing was a warning symptom.

Other survey findings:

• Only 60.4% knew a severe headache with no known cause was a symptom of stroke.
• 86.5% of respondents correctly identified sudden confusion or trouble speaking as a symptom.
• Slightly fewer (83.4%) knew sudden trouble walking, dizziness, or loss of balance meant a stroke might be happening.
• Less than half of those surveyed could identify all five stroke warning symptoms.

However, the BRFSS survey showed that correct answers varied by race, ethnicity, gender, education level, and geographic region. In addition to the District of Columbia, states included in the survey were Alabama, Florida, Iowa, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Oklahoma, Tennessee, Virginia, and West Virginia.

Minnesota residents appeared to be the most stroke savvy, topping the list of the most informed across several categories. They were more likely to say they'd call 911 if they thought someone was having a heart attack or stroke compared to those in other areas. Mississippi residents ranked lowest on that list, coming in at 77.7%.

Whites, women, and persons with a college degree were more likely to know all five stroke warning symptoms and the importance of calling 911 than blacks, Hispanics, men, and those who had not received a high school diploma.

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Leukemia Drug May Improve Stroke Treatment

June 23, 2008 -- A leukemia drug may help make a clot-busting drug used to treat strokes more effective and safer to use.

Blood clots in the brain cause about 80% of the 15 million strokes that occur each year worldwide. Immediate treatment of these strokes is limited to the use of tissue plasminogen activator (tPA), which works by dissolving clots.

While tPa can reduce potential brain damage associated with stroke, the downside is that it is only given within three hours of the start of a stroke, and it carries the risk of dangerous bleeding in the brain.

But a new study suggests giving the cancer drug Gleevec prior to tPA can extend the time frame during which the clot-busting drugs are effective as well as reduce the risk of bleeding in the brain. So far, the combination has been studied only in mice, but researchers say the findings are promising.

"Our findings may have immediate clinical relevance, and could be applied to find new treatments that will benefit stroke patients," says researcher Daniel Lawrence, PhD, professor of cardiovascular medicine at the University of Michigan Medical School, in a news release.

Cancer Drug for Stroke Treatment?

In the study, published in Nature Medicine, researchers examined the effects of Gleevec on mice with induced strokes.

First, they induced strokes in two groups of mice and gave one group Gleevec an hour after the stroke began.

The results showed mice that received Gleevec experienced less leakage in the brain as a result of the stroke, and 72 hours later the Gleevec-treated mice had 34% less brain damage than the others.

Then the researchers evaluated Gleevec as a pretreatment before clot-busting tPA therapy. Mice were given Gleevec one hour after the stroke began and then a dose of tPA five hours after the onset of the stroke.

Researchers assessed bleeding in the brain by measuring the amount of hemoglobin in the stroke-affected side of the brain. Mice who received Gleevec prior to tPA treatment had significantly less bleeding in the brain area than those who didn't receive pretreatment.

Researchers say this last finding is especially encouraging because stroke diagnosis often takes hours. If these findings are confirmed in humans, Gleevec could be given immediately when a stroke is suspected to extend the window in which tPA may be given.

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The Tangled Truth About Your Health

Midlife women are twice as likely as men to have a stroke. So why do doctors overlook the danger? What you must know to protect yourself

In the popular imagination, strokes happen at senior centers, not motorcycle rallies. They're certainly not supposed to befall a woman like Sandra Thornburg. In 2001, she was a vibrant, 43-year-old exercise fanatic attending nursing school in Phoenix. Newly divorced, she embraced singlehood by meeting new people and trying new things, Harley-Davidson bikes included.

Thornburg was sleeping after a day's ride in northern Arizona when a sharp pain knifed through her head. She tried to get up, but her left side didn't work and her mind was in a fog. "I had no idea what was going on," she says. When she got to the hospital, her prognosis was grim. "They told my family I wasn't going to survive," she says.

A decade ago, it took a massive effort by researchers and others to alert women--and doctors--to the long-overlooked risk of female heart attacks. Now, experts say, it's time to turn the spotlight on another lurking danger: the devastation that can occur from a stroke, or "brain attack." More than 100,000 American women under age 65 suffer strokes every year, according to the American Stroke Association. That eclipses the 83,000 women in that age range who have heart attacks. Even more surprising: The risk surges between ages 45 and 54. In those years, women are more than twice as likely as men to have strokes. And at every age, strokes are harder on women--they're more likely than men to wind up physically and mentally impaired.

"We all learned in medical school that strokes and heart attacks are male problems," says Lewis Morgenstern, MD, director of the stroke program at the University of Michigan Medical School. "The reality is far different."

Those grim statistics reflect plenty of missed opportunities: Doctors often overlook chances to prevent strokes in women, especially those that hit at relatively young ages. If a woman does have a stroke, studies show that her physicians will almost certainly take longer to diagnose it than they would for a man. And even after her problem is recognized, she's less likely to get all the treatments and tests that can improve her chances of a successful recovery.

But it doesn't have to be that way. Here is what's behind the gender bias--and the facts that can save your life.

Who's vulnerable

Thornburg felt perfectly healthy before her stroke, but a simple medical exam would have shown the ingredients for a catastrophe. "If the right risk factors are in place, a woman can have a stroke in her 40s instead of her 70s," says David Katz, MD, MPH, director of the Prevention Research Center at Yale University. "But if she takes care of herself, the chances are very remote."

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Older Women's Stroke Risk Linked to Sleep

July 17, 2008 -- Getting too much sleep may be a more serious sign of stroke risk among older women than not getting enough sleep, according to a new study.

Researchers found that postmenopausal women who slept nine or more hours per night were 70% more likely to suffer an ischemic stroke than women who slept an average of seven hours a night.

An ischemic stroke is the most common type of stroke caused by a blockage in an artery supplying blood to the brain.

In comparison, women who slept six hours or less per night had a 14% higher risk of stroke compared to those who slept seven hours a night.

"What we don't know is whether the longer sleep time was the reason for the increased risk or whether there was some other factor that both led people to sleep more and was also a risk factor for stroke," researcher Sylvia Wassertheil-Smoller, PhD of the Albert Einstein College of Medicine in New York City says in a news release.

"In other words, this study does not mean that if you cut your hours of sleep you would lower your stroke risk. It does mean that people who sleep excessively long hours habitually (or who sleep less than six hours habitually), should discuss this with their doctors and be sure to lower their other risk factors for stroke, especially high blood pressure."

Sleep and Stroke Risk

In the study, published in Stroke: Journal of the American Heart Association, researchers compared sleeping patterns and stroke risk among 93,175 women aged 50 to 79 years.

Although previous studies have provided mixed results on the link between sleep and stroke risk, researchers say some didn't account for other factors that may affect the risk of stroke, such as race, socioeconomic and lifestyle factors, and depression symptoms.

In this study, researchers accounted for known stroke risk factors in analyzing the link between sleep and stroke risk and found an increased risk among those who slept more or less than seven hours per night.

There were 1,166 cases of ischemic stroke over the course of the study (average follow-up of 7.5 years). The lowest risk for stroke was seen in women who slept seven hours a night. The results showed that compared to women sleeping seven hours a night, women who slept nine hours or more had a 70% higher risk of stroke. Those who slept less than six hours per night had a 14% higher risk of stroke. These findings took into account age, race, socioeconomic status, depression, smoking, exercise, use of hormone therapy, and cardiovascular risk factors such as past history or stroke or heart attack, high blood pressure, and diabetes.

Although the degree of increased risk associated with getting too much sleep was much higher than that associated with getting too little sleep, researchers say nearly twice as many women reported getting less than six hours of sleep a night (8.3%) compared with those who got nine hours or more (4.6%).

"The prevalence in women of having long sleep duration is much lower than having sleep duration less than six hours. So the overall public health impact of short sleep is probably larger than long sleep," researcher Jiu-Chiuan Chen, MD, ScD., assistant professor of epidemiology at the University of North Carolina's School of Public Health in Chapel Hill, says in a news release. "This study provides additional evidence that habitual sleep patterns in postmenopausal women could be important for determining the risk of ischemic stroke."

Chen is careful to point out that these results apply only to postmenopausal women and can't be applied to other groups.

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Spouses of Smokers at Risk for Stroke

July 29, 2008 -- Nonsmokers who are married to someone who smokes have a greatly increased risk for stroke, a finding that further underscores the dangers of secondhand smoke.

Researchers reporting in the September issue of the American Journal of Preventive Medicine say the risk varies depending on whether the nonsmoking spouse has smoked in the past.

Secondhand smoke makes a person more likely to develop heart disease, but until now, few studies have linked such exposure to stroke risk. One trial suggested that a husband's smoking increased a wife's chances for a stroke, but only if the woman also smoked.

For the current study, M. Maria Glymour, ScD, of the Harvard School of Public Health, and colleagues looked at the smoking habits of the spouses of more than 16,000 stroke-free married adults aged 50 and older who were enrolled in the Health and Retirement Study (HRS).

The study only evaluated cigarette use, not cigars or pipe tobacco. Researchers followed the participants for about nine years to document the occurrence of first stroke. During the study period, there were 1,130 first strokes reported.

Being married to a current smoker increased the risk of a first stroke by 42% among those who never smoked.

The risk of stroke was higher for former smokers who were married to current smokers. Former smokers who had a smoking spouse had a 72% increased risk for stroke compared with those who were married to a never-smoker.

The good news, researchers say, is the risk can be cut if the spouse kicks the habit. Participants who had never smoked and who were married to a former smoker had nearly the same stroke risk as never-smokers married to never-smokers.

"These findings indicate that spousal smoking increases stroke risk among nonsmokers and former smokers. The health benefits of quitting smoking likely extend beyond individual smokers to affect their spouses, potentially multiplying the benefits of smoking cessation," Glymour writes in the journal article.

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Fish May Boost Memory, Prevent Stroke

Aug. 4, 2008 -- Regularly eating non-fried fish may help older adults preserve their memory and ward off stroke.

Researchers reporting in tomorrow’s issue of Neurology have found that older adults whose diets include three or more weekly helpings of baked or broiled tuna and other fish high in omega-3 fatty acids are less likely to develop "silent" brain lesions that can lead to cognitive decline and vascular stroke.

A brain lesion, or infarct, is an area of damaged brain tissue. The damage typically results from a lack of blood flow to the area. The lesion is dubbed "silent" if it developed in someone who has not had a recognized stroke or transient ischemic attack (TIA), also called a mini-stroke. Silent brain lesions are very common, especially as a person grows older. The lesions can cause thinking problems, memory loss, and stroke.

"Previous findings have shown that fish and fish oil can help prevent stroke, but this is one of the only studies that looks at fish's effect on silent brain infarcts in healthy, older people," Jyrki Virtanen, PhD, RD, with the University of Kuopio in Finland, says in a news release.

For the study, Virtanen and colleagues looked at magnetic resonance imaging (MRI) brain scans of 3,600 adults aged 65 and older who had no history of cerebrovascular disease. Five years later, researchers rescanned 2,313 individuals who had agreed to the follow-up and asked them questions about their diets, including how much fish they ate.

After comparing scans and analyzing diet information, the team learned that the adults who ate non-fried tuna and other fish high in omega-3 fatty acids at least three times a week had a nearly 26% lower risk of silent brain lesions than those who opted for such foods less often.

Eating just one serving of fish per week also had a protective benefit. Adults in this category reduced their risk of silent brain lesions by 13%.

Those who regularly chose the healthy fish also had fewer changes in the white matter in their brains.

"While eating tuna and other types of fish seems to help protect against memory loss and stroke, these results were not found in people who regularly ate fried fish," Virtanen says. "More research is needed as to why these types of fish may have protective effects, but the omega-3 fatty acids EPA and DHA would seem to have a major role."

In addition to tuna, salmon, mackerel, herring, sardines, and anchovies are all rich in omega-3 fatty acids.

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5 Lifestyle Habits Cut Stroke Risk

Aug. 12, 2008 -- A new study shows that five healthy lifestyle factors help cut the risk of the most common type of stroke by 80%.

The study, reported in the journal Circulation, tracked 43,685 men and 71,243 women. The average age at the start of the study was 54 for men and 50 for women.

When the study began, none of the participants had cardiovascular disease or cancer.

The participants reported on their lifestyle habits and medical state between 1986 and 2002. Throughout the study, 1,559 strokes occurred in women and 994 strokes occurred in men.

The researchers defined a low-risk lifestyle as:

• Not currently smoking.
• Keeping your weight right. That means a body mass index of less than 25. A BMI of 25-29.9 is considered overweight and a BMI of 30 or higher is considered obese.
• Moderate to vigorous activity for a half-hour or more every day.
• A top diet score, which included components such as a diet low in "bad" fats and rich in vegetables and fruits, lean protein like chicken and fish, fiber, nuts, and legumes.
• Moderate alcohol intake. For women that's up to about one drink a day; for men it's up to two drinks a day.

Women who said they adhered to all five healthy lifestyle habits had a 79% lower risk of total stroke and 81% lower risk of ischemic stroke than those women who followed none of the healthy habits. Ischemic stroke is the most common type of stroke; it occurs when an artery in the brain becomes blocked.

Men who reported they lived with all five lifestyle factors had a 69% lower risk of total stroke and 80% lower risk of ischemic stroke, compared to those men who said they did not follow any of the five lifestyle factors.

Researcher Stephanie E. Chiuve, ScD, of the Harvard School of Public Health, says in a news release, "More than half of ischemic strokes, 52% in men and 54% in women, may have been prevented through adherence to a healthy lifestyle."

She says, "For total stroke, 47% of cases in the women and 35% of cases in the men may have been prevented."

"This study shows that following a healthy lifestyle, which has been associated with up to 80% lower risk of coronary heart disease and 90% lower risk of diabetes, may also prevent more than half of ischemic strokes," Chiuve says.

In background information published with the findings, the researchers write that stroke is the third leading cause of death in the U.S.

They add that nonfatal stroke is a leading cause of "permanent disability and economic loss."

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Belly Fat Linked to Stroke Risk

Aug. 14, 2008 -- We know that being overweight or obese can contribute to heart disease and heart attacks, but does extra weight around your belly increase your risk of stroke?

A new study says that may be the case.

Led by Yaroslav Winter, MD, researchers from the University of Heidelberg looked at whether people who were obese or overweight had a greater stroke risk than those who were normal weight. Researchers zoned in specifically on expanding waistlines.

There were 1,137 German adults in the study; 379 of those were stroke patients, and 758 comprised a control group matched for age, gender, and place of residence. The stroke group included 141 women and 238 men, with an average age of 67.

Of the stroke group, 301 had suffered a full-blown stroke, 37 had bleeding in the brain, and 41 experienced what is often called a "mini-stroke" or transient ischemic attack (TIA). A TIA occurs when blood flow to the brain is temporarily blocked and then is spontaneously restored. It's often a precursor to a full stroke and is considered a warning sign.

Obesity was measured using some of the following parameters:

• Waist circumference (measured at the level of the belly button).
• Body mass index (or BMI, defined as body weight in kilograms divided by height in meters squared). A BMI of 30 or greater is considered obese.

Waist-hip ratio (or WHR, defined as waist circumference divided by hip circumference). An abnormal WHR for women is defined as anything greater than or equal to 0.85. For men, an abnormal WHR is anything greater than or equal to 1.0.

Belly Fat and Stroke Risk

Obesity was more common in individuals who had suffered a stroke or TIA, affecting 30% of this group. The BMI, however, was not independently associated with an increased risk of stroke.

The risk association for waist measurements was far more powerful. People with bigger waist circumferences (greater than 40 inches for men and 35 inches for women) had four times the stroke risk when compared with people with typical waistlines. Participants with the highest WHR had nearly eight times the risk of stroke when compared to people with the lowest ratios. These striking results were noted even after adjusting for other risks, like whether participants were inactive, smoked, or had diabetes.

"While gaining too much weight can present health risks, it's even more dangerous to have the abdominal type of obesity. People should measure their waistline from time to time and avoid the accumulation of abdominal fat," study senior author Tobias Back, MD, at Saxon Hospital Arnsdorf, says in a news release.

Back also calls for doctors to become aware of the waistline connection: "Physicians should measure patients' waistlines and use the waist-to-hip ratio to estimate stroke risk. World Health Organization-defined categories of WHR or waist circumference should be used. Doctors should also consider the whole vascular risk profile to minimize or modify all possible factors contributing to coronary heart disease, stroke, and peripheral artery disease."

In the news release, Back urges people to do all those things we know contribute to good health, "Physical activity was much more common in the controls than in the stroke and TIA patients."

Back stressed a link between healthy eating and fewer strokes. "A Mediterranean diet containing fish and olive oil can lower your risk of coronary heart disease and possibly also lower stroke risk."

The results are published in Stroke: Journal of the American Heart Association.

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Treadmill Rewires Brain After Stroke

Aug. 28, 2008 -- Treadmill exercise may improve stroke survivors' walking ability by rewiring parts of the brain, according to a new study.

The study also shows treadmill exercise may be better than stretching, the traditional exercise prescribed after a stroke, both for walking and overall fitness.

Researchers at the University of Maryland and Baltimore Veterans Affairs Medical Center compared 37 patients who performed "progressive task repetitive treadmill therapy" with 34 patients who did stretching. The patients had chronic hemiparesis, which is weakness on one side of the body, at least six months after a stroke. The patients had all completed conventional rehabilitation.

The treadmill group was given the goal of three 40-minute sessions per week on the treadmill at 60% of their heart rate reserve. They started out slower, adding duration and intensity every two weeks. The exercise program lasted six months.

The stretching group had the same number of sessions, and the length of each session was also the same. They performed a variety of traditional stretches on a raised mat table with the assistance of an instructor.

Researchers measured results in three ways: by looking at brain activity on MRIs, by measuring walking ability, and by evaluating overall fitness level. The treadmill group performed better in all three categories.

Treadmill participants increased their activity in certain parts of the brain by 72% on imaging tests. Brain activity changes did not occur in patients who did stretching exercise.

Researchers checked brain MRIs while participants did knee-flexing exercises that mimic walking. The MRIs showed increased blood oxygenation and flow in the brain stem and cerebellum of the stroke survivors who had used the treadmill but not in those who did stretching.

Researchers say the increases in blood oxygenation and flow indicated that the cerebellum and brain stem had been "recruited" to replace some of the walking functions of the cortical brain that had been damaged by the strokes.

"We saw what we call an equivalent of neuroplasticity -- a change in brain activation that reflects the brain's adaptability," says Andreas Luft, MD, in a news release. Luft is one of the study's lead authors and a professor of clinical neurology and neurorehabilitation in the department of neurology at the University of Zurich, Switzerland.

The treadmill group also increased their walking speed and their fitness more than those in the stretching group. This is particularly important because stroke survivors' immobility can lead to cardiovascular disease and diabetes.

In the study, published in Stroke: Journal of the American Heart Association, the authors argue that treadmill exercise should be included in long-term therapy programs for stroke survivors.

"It is promising that treadmill exercise can stimulate new or underused brain circuits and improve walking in stroke survivors even after completion of conventional rehabilitation therapy," Luft says.

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Stroke After Sex

Sept. 15, 2008 -- Sex triggered a life-threatening stroke in a healthy 35-year-old Illinois woman, her doctors report.

Sex- and orgasm-triggered strokes in relatively young women and men are rare, but not unheard of. They require a combination of factors and events not unusual in themselves, but which are highly unlikely to occur at the same time.

The 35-year-old woman's symptoms were typical of this unusual kind of "cryptogenic" stroke, says Jose Biller, MD, professor and chair of the neurology department at Loyola University, Chicago.

"This young woman ... while having intercourse had numbness on the left side of her face, slurred speech, and weakness in her left arm," Biller tells WebMD. "When she was transferred to our care six hours after onset, she was completely unable to move her left arm, her face was paralyzed, her speech was garbled, and she was in a state of panic."

It was too late to inject the woman with the clot-busting drug tPA, which must be given within three hours of a stroke. So Biller's team quickly ran a catheter from an artery in the woman's groin up into her brain to find the blood clot by angiography. Once it was found, they had only one option: to apply tPA directly to the clot.

It was a risky decision. "We did this with a lot of sweat," Biller says.

The woman's symptoms began to improve almost immediately; within an hour she was out of the woods and within 12 hours the symptoms were almost gone. Today she is well, with only an almost imperceptible fold in the skin under her nose and slight loss of dexterity in her left hand.

Stroke From Sex

Why did sex trigger this young woman's stroke? She shared one thing in common with six other young people who suffered sex-related strokes: a small opening in the wall between the two upper chambers of her heart.

One in four adults has this minor heart defect, called a patent foramen ovale or PFO. A PFO allows some blood to flow from the right side of the heart to the left side. This blood bypasses the lung and goes straight to the brain.

Most people with a PFO have no symptoms and don't know they have it. But 40% of people who suffer a cryptogenic stroke -- stroke of no known cause -- have a PFO.

Blood flow through a PFO increases when a person strains, such as bearing down during a bowel movement or breathing out with the mouth closed and nostrils pinched shut.

It also happens during sex, particularly during orgasm, says Brett L. Cucchiara, MD, director of the Penn Stroke Center at the University of Pennsylvania. Cucchiara was not involved in the Biller report, but studied two cases of sex-related stroke in 2006.

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Late Stroke Treatment Still Has Benefits

Sept. 24, 2008 - The brain clot-busting drug tPA works better the sooner it's given after stroke, but now a new study shows the treatment can help even if given up to 4.5 hours later.

During a stroke, a clot blocks the flow of blood to parts of the brain. It doesn't take long for these parts of the brain to start dying. The clot-dissolving drug tPA (tissue plasminogen activator) restores blood flow to the brain, but the drug must be given soon after a stroke to save brain tissue.

A major U.S. clinical trial in 1995 showed that tPA can help patients for up to three hours after a stroke. Can it work for patients who are treated even later?

European researchers, led by Werner Hacke, MD, of Germany's Heidelberg University, now find that tPA can still help patients up to four and a half hours after a stroke. And this benefit is achieved without an increased risk of destructive bleeding in the brain as compared to receiving tPA within the traditional three-hour window.

However, these findings should not be interpreted to mean that delaying treatment is prudent. Every minute that goes by after a stroke means the death of more brain cells. It's urgent for patients who suffer a stroke to get to a hospital where neurologists can administer tPA.

Patrick Lyden, MD, of the University of California, San Diego, was one of the leaders of the landmark U.S. tPA study. Lyden was fond of reminding medical students of the three-hour window for tPA treatment and then asking them how long they had to treat a patient who suffered a stroke 30 minutes ago.

"The correct answer is one minute, not two and a half hours, and the [Hacke] study does not now justify an answer of four hours," Lyden writes in an editorial accompanying the Hacke report in the Sept. 25 issue of The New England Journal of Medicine.

Hacke and colleagues fully agree. "Having more time does not mean we should be allowed to take more time," they note.

Lyden notes that only four out of every 100 stroke patients receive tPA treatment. This, he suggests, means the health care system in general, and neurologists in particular, are failing stroke patients.

He calls for stronger efforts to get patients to stroke centers more rapidly -- and for stroke patients to get tPA injections very soon after they arrive.

"The potential for reversing the disabling side effects of stroke declines with every passing minute," Lyden says in a news release. "Our focus must remain on the door-to-needle time."

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Should Carotid Patients Skip Surgery?

Sept. 25, 2008 -- Surgery or stenting is not necessary for at least 95% of patients with a condition called asymptomatic carotid stenosis (ACS), says a team of researchers from Canada and Greece.

ACS is a condition in which the main vessels supplying blood to the brain are narrowed but the patient has no stroke symptoms.

More intense medical treatment with cholesterol-lowering and blood-thinning drugs has lowered the risk of stroke in these patients by reducing the number of tiny blood clots or plaque chunks (called microemboli) that break off from the artery and travel to the brain, says lead author J. David Spence, MD, a neurologist at The University of Western Ontario in London, Ontario, Canada.

Narrowing of the carotid vessels is considered a risk factor for stroke. But doctors have long debated whether those who have narrowing but no symptoms -- such as strokes or mini-strokes (also called transient ischemic attacks or TIAs) -- should have surgery to remove the plaque or undergo placement of stents to open the vessel.

Such interventions are probably overused, Spence tells WebMD, because the risk of surgery or stenting to prevent stroke could actually be greater than the risk of having a stroke in certain patients.

"So the message is that now less than 5% of patients with ACS tend to benefit from surgery or stenting and you can pick them out by doing microemboli detection," he says. He is slated to present his findings today at the 6th World Stroke Congress in Vienna, Austria.

Not everyone agrees with his conclusions, however.

Carotid Artery Stenosis: Study Details

Led by Spence, the team tested 199 patients treated before 2003 and 269 treated since 2003 for the presence of microemboli. Before 2003, medical treatment was less aggressive.

The ultrasound procedure to find the microemboli, called transcranial Doppler embolus detection, involves placing a helmet on the patient's head to hold ultrasound probes in place, then using the ultrasound to monitor the arteries inside the brain for the tiny clots or chunks.

"If you find two or more microemboli per hour, [the patient] should probably have surgery or stenting," Spence says. All the patients in the study had narrowing of the carotid artery, but had no symptoms.

Although 12.6% of the patients treated before 2003 had microemboli, just 3.7% of those treated since 2003 did, Spence found. The difference is statistically significant, he says.

The research team then followed the patients for at least a year to see what percentage had strokes or heart attacks. In those treated before 2003, "the one-year stroke risk was 4%," Spence says. In those treated since 2003, it was 0.8%.

"Heart attack risk went from 6.5% to zero percent," he says, with the group treated since 2003 having no heart attacks.

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Can Exercise Prevent Severe Stroke?

Oct. 20, 2008 -- The benefits of keeping active may be growing. A new international study looks at whether exercise reduces the severity of strokes.

The study looks at whether how much someone exercised before having a stroke had an impact on how severe the stroke was, and whether being active affected a person's long-term outcome.

The study was co-authored by Lars-Henrik Krarup, MD, with the Bispebjerg University Hospital in Copenhagen, Denmark, and analyzed data on 265 patients who had a first-time ischemic stroke (when an artery to the brain is blocked).

The average age of the stroke survivors was 68. Participants lived in China, Estonia, Poland, and Denmark and were able to walk on their own. Forty-four percent of the participants were women.

Researchers looked at how severe each person's stroke was and what the long-term outcome was. Respondents were also gauged on how much exercise and what kind of exercise they did prior to their stroke. They were asked questions about their typical physical activity during a weeklong period, such as light housework, taking walks, or working outside of the home.

The respondents were followed for two years, with four follow-up visits the first year and two follow-up visits the second year.

Researchers discovered that people who exercised the most prior to their stroke were 2 1/2 times more likely to have a milder stroke when compared to those who exercised the least. And participants who put in the most active hours were also twice as likely to experience a better long-term outcome.

In a news release, Krarup says that "exercise is one possible risk factor for stroke that can be controlled. Staying fit doesn't have to be a scheduled regimen. For the people in this study, exercise included light housework, taking a walk outside, lawn care, gardening, or participating in a sport."

The study authors note that their results help cement previous research showing that increased physical activity is associated with having milder strokes.

The findings are published in the Oct. 21 edition of the journal Neurology.

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Stroke Risk Quiz - How Much Do You Know About Stroke Risk?

Stroke Risk Quiz

How Much Do You Know About Stroke Risk?

Stroke is the third leading cause of death in the U.S. But you can change many of your risk factors if you know which ones count. Test your knowledge here.

1. 1. The most important modifiable risk factor for stroke is high blood pressure.
   True

   False
2. Strokes rarely occur in people under 65.
   True

   False
3. Most people who have a stroke don't survive.
   True

   False
4. Women are more likely to die of stroke than men.
   True

   False
5. People who smoke daily double their risk of stroke.
   True

   False

Review