DID YOU KNOW...
Understanding Stroke Including
Celebrating World Stroke Day October 29th?

By: John Sawdon Director of Education & Special Projects

Every two seconds someone in the World has a stroke. Globally it is the second leading cause of death with someone dying from this leading cause of disability every five seconds. (1) Stroke which is the fifth leading cause of death in the United States kills 130,000 annually - that’s one in 20 people. An estimated 50,000 strokes occur in Canada each year with one occurring every ten minutes. (2) Recent estimates place 315,000 Canadians living in the community with the effects of stroke, which can include a wide range of disabilities. In 2000, the Public Health Agency of Canada estimated the cost of strokes to the Canadian economy at $3.6 billion dollars. (3)

What is Stroke?

Acute stroke is the sudden loss of brain function that occurs when the blood flow supplying oxygen to a part of the brain is interrupted.
There are three major types of stroke:

Ischemic Stroke occurs when the there is a lack of blood flow to the brain due to a blood clot.

Intracerebral Haemorrhage or Hemmorrhagic stroke is the result of a rupture of a blood vessel causing bleeding in the brain.

Atraumatic Subarachnoid Haemorrhage is the rupture of an aneurism at the base of the brain that causes bleeding into the lining of the brain. While all three types can result in a loss of function, they differ with respect to whom they most often affect, their causes, their treatments and their outcomes.
A transient ischemic attack (TIA) or mini stroke displays the same symptoms as ischemic stroke and should be considered the mildest form of stroke. TIA’s although referred to as mini strokes require immediate medical attention and are an important warning sign of a possible future extensive stroke. Each stroke is unique and will impact an individual differently. (4)

Stroke Risk varies by Race and Ethnicity

In the United States risk for having a stroke is nearly twice as high for blacks than whites and blacks are more likely to die following a stroke than whites. (5) Hispanic risk for stroke falls between that of whites and blacks (5). American Indians, Alaska natives and blacks are more likely to have strokes than whites.(5) Although specific frequency figures are not available by Race and Ethnicity for Canadians we do know that 5.8 million Canadians age 20 years and older have been diagnosed with high blood pressure which is a major risk factor for stroke. In 2006 1.5 million Ontarians had hypertension with 500,000 having uncontrolled high blood pressure. In the first cardiovascular disease ethnicity study, the ON-BP study found that Blacks had hypertension rates of 31% and South East Asians 31%, (6) with First Nation Peoples at 20.4 %( 7). In March 2012, a study by the Metis Nation of Ontario found mortality rates were three times higher for Metis people from Atrial Fibrillation which is a major cause for stroke. (8)

Strokes Can Happen at Any Age

The frequency of strokes increases with age with individuals over 70 being most at risk. The Heart and Stroke study posted in 2014 suggests that strokes have increased by 24% for people in their 50’s and by 13% for those in their 60’s. The most troubling finding was that over the next 15 years it is projected that the frequency of strokes for individuals between the ages of 24 to 64 will double. (9)

Know the Signs and Symptoms and Take Action

The Heart and Stroke Foundation of Canada embarked on a journey to make Canadians aware of the signs and symptoms of stroke in an effort to reduce the disabling effects of strokes. This campaign launched in 2015 and entitled
F ACE is it drooping
A RMS can you raise both arms
S PEECH is it slurred or jumbled
T IME to call 911 immediately

The key to recovery is TIME and getting to Hospital as quickly as possible can saves lives and reduces long term disabilities. A life saving clot busting drug ( a thrombolytic drug usually referred to as tPA) is usually given once diagnosis is made and as long as it is within a four and half hour period from stroke onset. This drug breaks up the clot. (10)

Only half of all stroke patients arrive within six hours from symptom onset and less than 40 per cent arrive within the 4 and half hour window for administering tPA. Stroke patients in their 20’s and 30’s take the longest to arrive to hospital which may reflect lack of awareness that strokes can happen at any age.(10)

Risk Factors for Stroke

Nine out of ten Canadians have at least one risk factor for stroke. (10) Conditions which increase risk of stroke are listed below:

  • Previous stroke or Transient Ischemic Attack (TIA) - also known as mini stroke your chances of another occurring are higher;
  • High Blood Pressure - is a major risk factor for stroke;
  • High Cholesterol - which is a waxy like substance made by the liver or found in certain foods. Extra cholesterol can build in the arteries, including those of the brain. This can lead to narrowing of the arteries, stroke and other problems;
  • Heart Disease - can increase your risk for stroke; plaque build up in the arteries can lead to blockages of blood flow and oxygen to the brain causing a stroke. Other conditions including atrial fibrillation, heart valve defects, irregular heart beat and enlarged heart chambers can cause blood clots which break loose and cause a stroke;
  • Diabetes - can increase risk for stroke as a result of sugar build up in the blood;
  • Sickle cell disease - is a blood disorder associated with ischemic stroke. If a sickle cell gets stuck in the blood vessel and blocks the flow of blood to the brain this can cause a stroke;
  • Genetics and family history - can through heredity pass on risk factors which predispose you to stroke
  • Age - is the single most important factor for stroke. The older you are the more likely you are to having a stroke, and chances of a stroke double very ten years for those over 55 years;
  • Sex - men are more likely to have strokes however women are more likely to die from a stroke;
  • Race and Ethnicity - which were addressed earlier identify Blacks, Hispanics, First Nation and Metis Peoples as being more at risk for strokes than whites;

Life style Behaviours which can increase risk for a stroke

  • Unhealthy Diets - which are high in trans fats and cholesterol including too much sodium have been linked to stroke;
  • Physical Inactivity - can increase risk of other factors which cause strokes including obesity, high blood pressure, high cholesterol and diabetes;
  • Obesity - which is excess body fat is linked to heart disease, diabetes, high blood pressure and increased levels of Bad cholesterol all of which are risk factors for stroke;
  • Alcohol - too much can raise risk levels for high blood pressure and stroke;
  • Tobacco - increases risk for stroke by damaging the heart and blood vessels, it also raises blood pressure;(11)

Prevention Strategies in Reducing your Risk for Stroke

  • Know and control your blood pressure;
  • Be physically active; try to get 150 minutes of moderate exercise weekly. Start with incremental walks of ten minutes a day and work to increase this to 3 ten minute walks a day;
  • Eat a healthy and balanced diet by aiming for 5 to 10 servings of vegetables and fruit per day;
  • Achieve and maintain a healthy weight; reduce waist circumference to less than 88 centimetres for women and 102 centimetres for men;
  • Reduce your consumption of alcohol to two drinks per day;
  • Be smoke free;
  • Manage your diabetes;
  • Keep your blood cholesterol in check;
  • Be pulse aware and ask your Doctor about atrial fibrillation;
  • Manage stress and identify the source of stress. Some helpful strategies include mindfulness, yoga, meditation and or deep breathing(12)

Additional Life Saving breakthroughs in Treating Stroke

The Heart and Stroke Foundation and the Canadian Stroke Prevention Network forged a partnership to increase access to health services in reducing mortality and disabilities occurring due to a stroke. This includes designation of specific stroke centres across Canada and early access to cat scans in identifying strokes and initiating treatment. Other efforts include training of Para-medics across Canada in stroke treatment and prevention. This latter initiative is designed to support the messaging which is to call 911 when you suspect a person is having a stroke.

Other treatments are also being tested in improving the treatment and survival rates of individuals having a stroke. This includes the ESCAPE study which involved 315 patients in which a clot retrieval device similar to a retrievable stent was used to capture the blood clot and remove it. All Patients in this study were given the tPA drug and half were also treated with the clot retrieval device. Three months after their strokes, 53% of patients whose treatment included clot retrieval were functionally independent compared to 29% of those who only received tPA. In the clot removal group 90% of patients were still alive after three months compared to 81% of those receiving tPA only. Similar results have occurred in Australia and with Dutch researchers. These breakthroughs demonstrate the progress that health care professionals have made in treating stroke victims. (13)

Staying Informed About Stroke Prevention and Treatment Break-Through

The Heart and Stroke Foundation has prepared two Stroke reports, one for 2014 and one for 2015. Follow this organization and encourage them to continue with progress reports on their work with strokes and stroke recovery.
Also the American Heart Association and the American Stroke Association produce on line quarterly newsletters which are informative in providing up to date information on strokes and stroke recovery. The Stroke Magazine is called Stroke Connection and the heart magazine is entitled Heart Insight.

We hope this adds to your knowledge on stroke in answering Did You know...? Let us know if this is helpful, including questions that you hope we might address in the future.
Send an e-mail to jsawdon@cardiachealth.ca or bkennedy@cardiachealth.ca


References:

  1. American Stroke Association “Stroke Connection Fall 2015 World Stroke Day page 8
  2. National Center for Chronic Disease Prevention and Health Promotion(/nccdphp),Division for Heart Disease and Stroke Prevention(/dhdsp) March 24, 2015
  3. Heart and Stroke Foundation 2014 Stroke Report Together against a Rising Tide: Advancing Stroke Systems of Care page 3
  4. Public Health Agency of Canada “tracking Heart Disease and Stroke in Canada- Stroke Highlights 2011
  5. High Blood Pressure in African Americans: Genetics, Risks, Causes and More' Hypertension/High Blood Pressure in African Americans http://webmd.com/hypertension-high-blood-pressure/guide/hypertension-in-african-americans 2015 WEB MD LLC.
  6. Heart and stroke Foundation Press release High Blood Pressure Rates Still Very High, Particularly For Some Ethic Groups
  7. Assembly of First Nations 2007 High Blood pressure Rates and other health Risk Factors for First nation peoples
  8. Metis nation of Ontario “ Cardiovascular Disease In the Metis Nation of Ontario Clinical significance Report March 2012 Mathew Mercurri PhD, Sonia S Anand MD PhD, Diana Withrow, Alethea Kewayosh, and Loraine Marrett
  9. Heart and Stroke Foundation 2104 Stroke Report: Together Against a Rising Tide: Advancing Stroke Systems of Care page
  10. Heart and Stroke Foundation 2015 Stroke Report: Access to Stroke Care pg 5 and page 11 and page 15
  11. CDC Centers for Disease Control and Prevention : Family History and Other Characteristics that Increase Risk for Stroke http://www.cdc.gov/stroke/family_history.htm March 17, 2014
  12. Jsawdon 2015 Cardiac Health Foundation of Canada Heart Wise Exercise Program presentation at Myles Nadal JCC
  13. American Stroke Association Fall Edition of Stroke Connection Retrieving Blood Clots page 3

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advice. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.