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Decline In Stroke Deaths Reinforces “Brain Attack” Prevention

Stroke killed 2,000 fewer Americans in 2008 (the last year with complete numbers) than it did in 2007, the Centers for Disease Control and Prevention (CDC) said yesterday in its latest annual Deaths report. That dropped stroke from the third leading cause of death in the United States to the fourth.

Good news? Yes and no. It’s always good news when fewer people die. The reduction suggests a payoff for efforts to prevent stroke and improve the way doctors treat it.

Yet the drop from third to fourth place is due largely to an accounting change. The CDC reorganized another category, “chronic lower respiratory diseases” (mainly chronic bronchitis and emphysema), to include complications of these diseases such as pneumonia. The change substantially increased the number of deaths in this category, which had long trailed stroke as the fourth leading cause of death.

More worrisome is that the decline in deaths from stroke isn’t matched by a decline in the number of strokes. On the rise since 1988, stroke now strikes almost 800,000 Americans a year, and that is expected to grow.

Better recognition of stroke and better treatment mean more people survive this sudden cut-off of blood flow to part of the brain. The American Heart Association estimates that 6.4 million Americans are stroke survivors. Although some have no physical or mental reminders of the attack, many have long-lasting speech loss, paralysis, or other problems. In fact, stroke is a leading cause of disability — 20 percent of survivors need some kind of institutional care after three months, and up to 30 percent are permanently disabled. The financial cost of stroke, $73.7 billion per year, is staggering. The human toll is incalculable.

Treatment of stroke and rehabilitation following it have vastly improved over the last few decades, but they are still no match for prevention. Prevention isn’t complicated and it doesn’t require fancy tools or expensive medications — but it works. In fact, new guidelines on the prevention of stroke suggest that a healthy lifestyle can prevent up to 80 percent of strokes. Here are the key steps:

Know your baseline. Things you can’t change, like your age, sex, genes, and race or ethnicity influence your risk of stroke. The higher your so-called nonmodifiable risk, the more important it is to pay attention to things you can change.

Exercise and diet. Regular exercise and physical activity, along with a healthy diet, are the foundation for stroke prevention.

Smoking. Don’t start. Try to quit if you do smoke. Avoid secondhand smoke when possible.

High blood pressure, high cholesterol, and diabetes. Each of these elevates your stroke risk. Controlling blood pressure, cholesterol, and blood sugar with diet and exercise, and medications if needed, can help prevent stroke.

Atrial fibrillation. The wild, erratic beating of the upper chambers of the heart known as atrial fibrillation is an important cause of stroke. Taking a medication such as warfarin or aspirin can help prevent stroke.

Sickle cell disease. Having this blood disorder, which mostly affects African Americans, strongly increases the chances of suffering a stroke. Managing sickle cell disease can significantly reduce the chances of having a stroke.

The 68-page report lists numerous other factors that may increase the risk of stroke, along with ways to minimize their impact, from obstructive sleep apnea to oral contraceptives, migraine, and drug abuse.

It’s best to start early — like childhood or young adulthood. That said, it’s never too late to start. The beauty of these prevention strategies is that they have a ripple effect that extends far beyond stroke. They also work against heart disease, cancer, osteoporosis, and other chronic conditions. It’s an investment well worth making.

*This blog post was originally published at Harvard Health Blog*

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