It's all in the mind of the beholder, but I can't think of too many conditions worse than having a stroke. While I don't relish developing a dementing illness, I'm currently thinking that at least I wouldn't be aware (although clearly the suffering will be upon my family & caregivers). But if I suffered a stroke, I'd be fully cognizant that I can no longer perform all the things that I can currently do but take for granted. Not a very happy image.So rather than treating a stroke (2o prevention) & preventing its complications (3o prevention), we really ought to try to prevent one from happening in the first place (1o prevention). Obviously, there are some immutable risk factors which can't be changed/altered: age, sex, low birth weight, race/ethnicity, and family history. But in the American Heart Association and American Stroke Association's newest guideline to be published next February, they review the evidence supporting modification of the following risk factors:
don't smoke/quit smoking
control blood pressure
control cholesterol (lower total & raise HDL)
control sugars
take anti-coagulant if suffering from atrial fibrillation
consider endarterectomy for asymptomatic carotid stenosis
avoid postmenopausal hormone therapy if possible
consider non-hormonal form of contraception if possible
alter diet to decrease sodium & increase potassium
limit alcohol consumption to <2 drinks/d for men and <1 drink/d for women
become physically active (at least 30min/d moderately intense activity)
avoid obesity
avoid/treat heart disease
treat sleep disordered breathing, eg wear your CPAP mask if you have sleep apnea
Now, don't get me wrong. Some of these recommendations are controversial. Plus there are other risk factors that are less well documented, but given the list above, I'd start there first before looking for more trouble. Who knows? But the stroke that's avoided may be yours & mine if we're so lucky.
Will a whole body scan predict a future stroke? What about an ultrasound scan of my carotid arteries?
ReplyDeleteI am not aware of any studies using whole body scans to predict future strokes. A standard ultrasound of the carotid arteries is part of the evaluation for those who've already sustained a (mini-)stroke (in order to prevent another one) and in those for whom the clinician hears noise (bruit) indicating turbulent flow suggesting plaque buildup. An ultrasound of the carotid arteries using a technique to assess carotid intima media thickness has demonstrated some ability to predict increase risk for heart disease prior to development of blockage.
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