Response from Dr. Kevin M. Barrett, Neurology, Mayo Clinic, Jacksonville, Florida, USA:

In order to achieve reduce the risk of another stroke in someone who already suffered one, it is essential to understand the possible cause for the former, because that will guide future prevention tactics.

A stroke occurs when blood supply to part of the brain is interrupted or greatly reduced, depriving oxygen and nutrients to brain tissue and causing neuronal death. There are several common causes for a stroke. A frequent cause is narrowing of the neck arteries that carry blood to the brain (carotid arteries) due to the presence of fatty deposits. On the other hand, a tear or a break in the wall of a blood vessel, heart disease and blood clotting disorders may also lead to stroke, especially people like you who still does not meet 45 years. If any part of the reasons mentioned in stroke treatment and prevention should be directed to that issue.

However, in about 35 percent of people who have suffered a stroke can not establish the cause (cryptogenic stroke). If that is the case, then your goal should be to strive together with your family doctor or your neurologist to find risk factors for stroke that you would change in order, to the extent possible, reduce their risk in these areas.

Some risk factors for stroke can not be changed, for example, sex, ethnicity, age and family medical history, all of which participates in any way at risk for stroke. In addition, men are more likely to suffer strokes than women, Asians and African Americans are also at greater risk. After 55 years, each new decade doubles the risk for stroke.

The impact of focus on modifiable risk factors for stroke can be great because it is possible that several treatable conditions alter this risk significantly. People who suffer from hypertension, for example, or have high cholesterol or uncontrolled diabetes are at higher risk for stroke. If you have any of this, talk to your doctor to develop an effective treatment plan. In case you have elevated low-density lipoprotein (LDL or “bad”), take a statin could reduce not only cholesterol but also your risk for stroke.

Besides controlling any underlying conditions, it also helps to choose the lifestyle. You mention that you exercise regularly and eats healthy. Both are important because exercise can lower blood pressure, increase the level of high density lipoprotein (HDL or “good”) and improve the health of blood vessels and heart. It can also help you lose weight, control diabetes and reduce stress. A good goal for exercise is to participate in moderate activity for at least 30 minutes most days of the week.

A diet rich in fruits and vegetables with low saturated fat and cholesterol may reduce the risk of stroke and help you maintain a healthy weight. This is important because excess weight contributes to other risk factors for stroke such as hypertension, cardiovascular disease and diabetes. Other changes in lifestyle to prevent a stroke you can do is to stop smoking and keep your alcohol intake to less than one or two drinks daily.

Similarly, it may also be appropriate for you to take preventive medications, depending on your medical history. Antiplatelet drugs such as aspirin, or aspirin combined with extended-release dipyridamole (Aggrenox) and clopidogrel (Plavix) can make the blood less likely to clot. Anticoagulants such as heparin and warfarin, may serve to prevent a stroke if you have heart problems or blood clotting disorder.

The point is that you can take steps to reduce the risk of having another stroke, but the specific measures that would be appropriate for you depends largely on your medical history. Talk to your doctor about stroke prevention approach that best fits your personal situation.

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Diabetes

“Diabetes is a chronic disease that can cause serious complications such as heart disease and stroke, high blood pressure, blindness, kidney failure and nervous system damage,” said ACP President Dr. J. Fred Ralston in a press release from school on the occasion of Diabetes Month in November.

Among the risk factors for type 2 diabetes include: being over 45 years, have a family history of diabetes, being overweight, not physically active, have had gestational diabetes, high blood pressure or high cholesterol, being African American, American Indian, Asian American, Hispanic or Pacific Islander.

“It’s important to know the risk factors and warning signs of diabetes and what you can do to treat the disease if you have it,” said Ralston.

Among the warning signs of diabetes include: excessive thirst and / or extreme hunger, frequent urination, fatigue, unusual weight loss, blurred vision, tingling or numbness in hands or feet, frequent infections, and slow healing bruises.

A simple blood test can diagnose diabetes.

Those who have been diagnosed with diabetes can control the disease if: exercise regularly, follow a healthy diet rich in vegetables, fruits, fish, poultry and whole grains lose weight, control their levels of blood sugar and inform your doctor and take medication every day.

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Why keep it under control

This is the main factor responsible for the greatest number of deaths worldwide. Some call it “the silent murderer.” It is a very common risk factor in the general population and increases the risk of a major stroke, heart attack, kidney failure and sudden death.

Recent data from population-level studies estimate that nearly half of the Spanish adult population (over 18) is hypertensive. In over 65 years exceeds 65% of what follows is most common being hypertensive, to have the normal stress in the elderly. Its frequency is increasing as a result of lifestyle and high prevalence of obesity and sedentary lifestyle that exists in developed countries. The relationship between overweight and hypertension is strong.

Obesity is a major risk factor for developing hypertension and diabetes, especially abdominal obesity (accumulation of fat in the abdomen), among other reasons because abdominal fat releases chemicals that raise tension.

Preventing hypertension

Hypertension is closely related to lifestyle, particularly dietary habits, excess calories, alcohol abuse, lack of exercise and mental stress, among others.

a) recommended Habits

Hypertension is preventable by a healthy life: avoiding obesity and exercise.

- The diet rich in fruits and vegetables, low fat and free of excess calories is very effective to prevent it. But the most effective measure is to prevent obesity. Limiting alcohol consumption is also very important.

- Make regular treatment, which will allow you to live well and is perfectly compatible with a normal life.

- Aerobic exercise (walking, swimming, running, dancing, cycling), and we must get at least three hours a week.

- In men it is good to measure the pressure after 30 years in the case of women must begin to take precautions, especially at the start of menopause.

- If you want to buy a device for measuring blood pressure at home is recommended that either arm. If the person is obese, is more interesting wrist.

- For correct measurement of blood pressure is necessary that the person is relaxed (physically and mentally), you do not have to pee, can not have smoked in the 15 minutes before or taken a stimulant like coffee in the 60 minutes before measurement. Must sit in a chair with your back against the backrest, legs uncrossed and have to rest your arm on a table at heart level. Do not take tight clothing and it is right that roll up to allow free arm.

b) harmful habits

- Excess alcohol, blood pressure rising and are an important source of calories, regardless of other medical problems such as liver damage, osteoporosis, etc..

- The snuff is a cardiovascular risk factor very important, is the factor behind hypertension claims more deaths in the world. Consumption in a hypertensive multiplied almost fourfold the risk of having a stroke, a stroke or die.

- Salt intake affects the increase in hypertension. Many of the most fattening foods are those with a higher salt content such as pastries, sausages, ready meals … The salt can not be removed because we need to live and exist in most foods. What you need to do is limit it, and this is achieved by reducing food previously discussed, by a diet rich in fruits and vegetables, avoiding sauces, flavors concentrate pills and not adding salt to a salt shaker on the table.

Risks

Hypertension decreases the survival and increases the chance of a vascular complication, heart, kidney or brain. But so far as in these complications do not develop symptoms. This is one of the great dangers: the underestimation of risk by not feel anything. Occasionally it can cause vague and not always related to hypertension, such as headaches.

In the psychic aspect, the need to take lifelong medication makes some people may feel sick, although hypertension is initially not a disease but a risk factor for developing the disease.

Pregnant women are one of the populations to be controlled especially if they are hypertensive, but also because during this stage may experience increases in blood pressure for several reasons. In some women, during the second half of pregnancy, there is a pressure increase is not important if they have no other abnormalities such as fluid retention or loss of protein in the urine.

This is called “gestational hypertension” and usually about 10 days to normal after delivery. If you have “pre-pregnancy hypertension (known or not) appear before 20 weeks and persist for several weeks after delivery. It is generally well tolerated, as in the “gestational hypertension”, usually have good prognosis for mother and baby. Of greatest concern is “preeclampsia”, characterized by increased pressure but also by fluid retention and protein loss. Must be tightly controlled because it can affect baby’s growth and can have troubling consequences such as premature labor.

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This relates especially in women who have had multiple pregnancies and have suffered for the same blood pressure as it is considered as scientific studies during pregnancy increases nearly 80% of developing this type of attacks compared with a woman who it is not in a state of motherhood.

Migraine is one of the symptoms that more should be evaluated, as well as temporary loss of vision, blurred vision, flashes lighting etc. As in pregnancy, the woman who is pre menopausal age, you must also pay attention to these symptoms and who have an increased risk of stroke.

Since treatments are much more effective by 3 hours of stroke is started, it is necessary to recognize the symptoms and go immediately to the trusted specialist, so we must keep in mind:

* The loss of sensation, weakness, sudden paralysis in the area of the face, arm or leg especially when they focus on only one side of the body.

* Disorders of speech, understanding or confusion. Visual difficulties.

* Trouble walking, dizziness, vertigo, incoordination, loss of balance, especially headaches sudden and major impact.

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A stroke happens when blood flow to part of the brain is interrupted due to a blood vessel in the liver is blocked or broken. If blood flow is stopped for more than a few seconds, the brain can not get blood and oxygen. Brain cells can die, causing permanent damage. There are two main types of stroke: ischemic stroke and hemorrhagic stroke.

ISCHEMIC STROKE

Ischemic stroke occurs when a blood vessel supplying blood to the brain is blocked by a blood clot. This can happen in two ways:

* You can form a clot in an artery that is already very close, which is called a thrombus. If you block the artery completely, is called a thrombotic stroke.
* A clot can break off from somewhere in the body and travel to the brain to block a smaller artery. This is called an embolism, causing an embolic stroke.

Ischemic strokes can result from clogged arteries, a condition called atherosclerosis (See stroke secondary to atherosclerosis). This can affect the arteries within the brain or neck arteries that carry blood to the brain. The fat, cholesterol and other substances accumulate in the wall of the arteries, forming a sticky substance called plaque. Over time, plaque builds up. This often hinders the proper flow of blood, which can cause the blood to clot.

Ischemic strokes can also be caused by blood clots that form in the heart. These clots travel through the blood and can get stuck in small arteries of the brain, which is known as stroke.

Certain drugs and medical conditions can make blood more likely to clot and increase the risk of ischemic stroke. A common cause of ischemic stroke in people under 40 years is carotid dissection or tear in the lining of the carotid artery. The rupture allows blood flow between the layers of the aorta. This causes narrowing of the artery that is not due to plaque accumulation.

HEMORRHAGIC STROKE
Hemorrhagic stroke occurs when a blood vessel in the brain part weakens and ruptures, causing blood to leak back into the brain. Some people have defects in blood vessels of the brain that make this more likely. Blood flow after the blood vessel ruptures damages the brain cells.

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