Know the signs. Early treatment prevents lasting damage
A stroke is a damage caused by a clot or a bleed in the brain. It is the major cause of serious long-term disability in the UK. A quarter of strokes occur in people under 65, and the damage caused ranges from minimal changes picked up on a scan, through to loss of speech, difficulty finding words and loss of power down one side of the body or face. Up to a fifth of strokes are fatal. Prompt diagnosis and treatment mean a better outcome. The Fast test is useful: Face – can you smile? Is your face lopsided? Arms – can you raise them and keep them there? Speech – is it slurred or hard to understand? Time – to call 999 if you see any of these three signs. Other symptoms to urgently act on are sudden weakness or numbness on one side of the body, sudden blurred or loss of vision, unexplained confusion, a sudden fall and very severe headache.
Keep your blood pressure in check
High blood pressure is an important preventable risk factor. Have it checked at a pharmacy, GP surgery or buy your gadget and check it yourself. In the US, pharmacists are checking and treating blood pressure in barbershops as black men are underdiagnosed, undertreated and under-represented in clinical trials. There is evidence that, in the UK, people from African-Caribbean backgrounds are more prone to high blood pressure, strokes and diabetes – although less prone to heart disease. A blood pressure monitor costs less than £25, and you should let your GP know if readings are consistently over 140/90. Lifestyle changes and, if necessary, medication work for most. Some people’s blood pressure remains high despite all conventional treatment; a new technique using ultrasound to zap part of the nerve supply to the kidneys offers hope for the most tricky cases.
Check your pulse
An irregular heart rate (atrial fibrillation, AF) increases the risk of stroke because the heart can throw off small bits of debris when it goes in and out of an irregular rhythm that travels up to the brain and cause a blockage. Thinning the blood (anticoagulation) significantly reduces the risk of strokes. AF may revert to normal, regular (sinus) rhythm on its own but tends to recur and it is this fluctuation that is most dangerous. The heart can also be given an electrical shock (cardioversion), treatment to destroy the rogue electrical source of the problem (ablation) or a pacemaker to override the irregular heartbeat. Some people in AF will experience palpitations, but many won’t feel any symptoms. The best way to detect it is to check your pulse; we all get occasional extra beats but if the rate is consistently irregular, see your GP. There are apps to diagnose and manage AF.
Are your diabetic?
One in 16 of us is living with diabetes, and an estimated 12% don’t know it. Undiagnosed and undertreated diabetes is a major risk factor for stroke. You are more likely to be diabetic if it runs in your family if you are overweight or have southeast Asian or African-Caribbean background. You can buy self-test kits, but it is cheaper and more holistic to get a complete NHS health check if you are aged 40-74 – or see your GP if you think you are at risk. If you are diagnosed with diabetes, careful management to get your blood glucose levels back to the normal range will reduce your stroke risk. If you are diabetic, your blood pressure should be kept under 140/80 and cholesterol below 5mmol/l to keep stroke risk as low as possible.
The more you smoke, the more you stroke
The more you smoke, the greater the risk, so if you can’t quit, at least cut-down. If you do manage to quit, your risk of stroke will be that of a never-smoker within five years. Vaping is almost certainly better than cigarettes, but there are concerns that the nicotine may still increase the stiffness of arteries and the risk of heart disease and stroke.
Check your cholesterol
High levels of cholesterol in the blood can clog up arteries. If early heart disease or stroke (under the age of 60) runs in your family, you may have a genetic tendency to abnormally high cholesterol levels, even if you lead an impeccably healthy lifestyle. A one-off blood test (fasting) will tell you whether you have a problem or not. Again, you can buy a self-test kit or get it done at your GP surgery or pharmacy. To reduce the risk of heart disease and stroke, blood pressure, cholesterol and glucose levels all need to be measured; there is no point in treating one and ignoring the others. High cholesterol levels can be lowered by losing excess weight, by exercising, by cutting down on cholesterol-rich foods and, if necessary, by taking drugs such as statins; they get a bad press, but they do work.
Transient ischaemic attacks (TIAs) cause the same warning signs as a stroke (see Fast above) but typically last for about half an hour resolve completely within 24 hours. However, 40% of people with a TIA will go on to have a stroke, and the risk of that is greatest if you are over 70, have high blood pressure or diabetes and have symptoms that last longer than 90 minutes. Treatments for TIAs include blood-thinning drugs (anticoagulation) and careful control of the risk factors (glucose, cholesterol and blood pressure). People are often dismayed that they end up on a cocktail of drugs despite having made a complete recovery from TIA, but it is worth popping the pills to avoid a stroke.
Credit: Ann Robinson for The Guardian, 11 June 2018.