I can predict the answer every time I ask the question. Whenever I give a lecture on stroke prevention, I ask the women in the audience to raise their hand if they worry that they might get breast cancer sometime in their lives. I then ask everyone to raise their hand if they think they might have a heart attack at some point. Almost everyone quickly raises their hands in agreement. I then ask, "Who here believes that they may be at risk for stroke? Who believes that there might be stroke waiting for them in their future?" A few arms slowly rise to "half staff," and the audience stays silent. Most people don't see a stroke on their radar screen.
A quick look at some statistics should change their mind. Stroke is the third leading cause of death and the leading cause of disability in adults over 50 years old. Almost 800,000 strokes occur each year, which translates to about one every 40 seconds. These are all large numbers, but just a few small numbers can keep you out of this not-so-exclusive club of 5.5 million stroke survivors.
4.5 Hours
No, it is not the name of a movie, but exactly how much time you have from the point at which a stroke starts to when you can receive a "clot buster" to try and reverse your stroke. The good news? The time has increased from the 3 hours to the new criteria of 4.5 hours , but that is still very little time. If you are lounging in your recliner at home, watching your favorite baseball team on television, and one side of your body goes numb, you do not have the time to watch the end of the game. Call 911 immediately and the ambulance will take you to the closest stroke center that can evaluate you for a "clot buster." The clock is ticking and it is a race against time. Studies have proven that the sooner you get a "clot buster," the better your chances of a good outcome. If you wait for the end of the football game or soap opera, you may lose your chance to escape paralysis and disability. Call 911 immediately.
120/80: Your Blood Pressure
It wasn't that long ago that we considered 140/90 or below the ideal blood pressure number. I can remember 30 years ago when we advised patients that a little high blood pressure was OK and that we would just watch it. No more. While high blood pressure is the single most important risk factor for stroke, it is something you can control. Lowering your blood pressure reduces the risk of stroke by 30-40 percent. The new number is 120/80 and both you and your doctor need to work hard to control your blood pressure through both medications and lifestyle changes that include diet and exercise. For the average person, there is no such thing as "a little" high blood pressure that won't hurt you.
70: Your LDL
I have friends and patients who carefully watched their diets and exercised religiously in an attempt to lower their cholesterol, only to achieve modest success. Then, the "statin" drugs came along. These pills did what all the sweat and workouts could not -- lowered their bad cholesterol to normal levels. In particular, these pills can reduce the risk of a second stroke. If you are at risk for heart disease or stroke, the new number is a LDL lower than 70. It is not just a number, because "statin" therapy reduces the risk of a heart attack and stroke.
126 and 6.5 Percent: Diabetes
Diabetes is a risk factor for stroke. If you have it, you must control your blood sugar. Do you know your blood sugar? The new criteria for the diagnosis of diabetes are a fasting blood sugar of 126mg/dl or more or an A1C greater than 6.5 percent. Hemoglobin A1C is a measure of how well someone's blood sugar has been controlled over the prior two to three months. Know your blood sugar and control it.
1-2: Drinks Per Day
How often have you been at a party and heard someone with a drink in their hand say, "You know, I read that alcohol is good for you and will prevent a heart attack or stroke?" The key is moderation, although the definition of "moderation" is not what you might think. Alcohol, in all forms, seems to have a beneficial effect, but the recommendation is no more than two servings of alcohol a day for men, and no more than one for non-pregnant women. Remember, a serving is one ounce of hard liquor, a 12-ounce beer or a glass of wine.
3: Times a Week
Hopefully you guessed "exercise." Even modest and low impact exercise improves the functional abilities of stroke survivors. However, in order to keep you out of that statistic, we suggest 30 minutes, three times a week of moderate physical activity that causes you to break a sweat or increase your heart rate.
0: Smoking
Not a half a pack or just a few a day -- when it comes to tobacco products, the number must be zero. Smoking not only causes lung cancer, but it is a risk factor for heart disease and stroke. It is never too late to quit smoking and your doctor can help provide a variety of strategies, including oral medications.
You probably can remember the score from your favorite team's last game, particularly if they won the championship. Be a "stroke champion," and remember these new numbers.
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