75-80% of all strokes are associated with blockages in the carotid arteries and are preventable.
A powerful approach to stroke prevention would use screening and diagnostic procedures to assess risk, and would implement nutritional strategies and lifestyle changes to reverse plaque formation.

How Stroke Occurs
Stroke develops when some portion of the brain is deprived of blood and oxygen. This usually occurs when a tiny bit of debris dislodges from an atherosclerotic plaque within an artery wall and blocks a blood vessel to the brain. The same sort of plaque accumulates in coronary arteries to cause heart attack. The two carotid arteries that lie on both sides of the neck and the aorta , the body's main artery, are frequent sources of plaque.

Atherosclerotic plaque is a live tissue that, given a chance through poor diet, inactivity, high cholesterol, or excess weight, can grow and become progressively unstable. At some point, the plaque can fragment. Small pieces then break away, travelling to the brain. Fractured plaque also exposes its deeper structures to flowing blood, triggering blood-clot formation, which in turn can also fragment and travel to the brain. Atherosclerotic plaque is therefore a prerequisite of risk for the most common causes of stroke. This disease process requires 30 or 40 years to develop.

Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, as more and better tools become available to us. A carotid ultrasound is the best and most widely available imaging tool to determine stroke risk.

REDUCING STROKE RISK / PREVENTING STROKE
Numerous studies have documented that plaque and stroke risk can be reduced. A 10-20% reduction in plaque size is possible within a year or two. The following are some important tips for preventing stroke

1. Know your blood pressure. Hypertension is the leading cause of stroke. Research has documented the power of lowering elevated blood pressure in helping to prevent stroke. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, recommends a blood pressure no higher than 140/90, and defines normal as 120/80. The commission emphasises that the risks of stroke and heart attack begin to escalate at a blood pressure of 115/75. Most cases of mild to moderate elevations in blood pressure can be managed by making simple lifestyle changes- for example losing excess weight.

2. Control diabetes and correct obesity
3. Eat a low-salt, low-fat diet
Just being overweight substantially increases risk of future stroke. A Swedish study of 7,400 men with body mass indexes above 30 had double the risk of stroke compared to non-obese men. Increased body weight frequently leads to diabetes and its closely related conditions of metabolic syndrome and hyperinsulinemia (increased insulin levels), which play an overwhelmingly important role in increasing stroke risk .

Of people who suffer strokes, approximately 70% will have one of these diagnoses. When diabetes is present, the risk for stroke can be six times greater. High insulin levels and resistance to insulin are powerful drivers of plaque accumulation, causing carotid plaque to grow at a faster rate. The rapidly escalating prevalence of metabolic syndrome and diabetes in the western world virtually guarantees a future epidemic of stroke.

Weight loss is the most immediate and direct way to correct metabolic syndrome. Weight loss of as few as 10-20 pounds can yield improvements across the board: increased sensitivity to insulin, increased HDL, and reductions in triglycerides, blood pressure, CRP, fibrinogen, and small LDL particles. Diet and exercise are fundamental components of any weight-loss programme. Low-carbohydrate or reduced-glycemic diets that are rich in fibres are very effective.

4. Correct disturbances in cholesterol levels . Elevated levels of various lipoproteins ( fat-carrying proteins for example LDL - cholesterol ) carry a greater risk for carotid and aortic plaque growth and subsequent stroke. Lipoproteins cause plaque to grow.

5. Correct blood abnormalities
Fibrinogen. This blood-clotting protein promotes carotid plaque growth and contributes to the formation of unstable plaques. These volatile plaques have more inflammatory cells and a thinner tissue covering, making them more prone to rupture.
C-reactive protein (CRP). This measure of inflammation is proving to be a useful marker for identifying people at higher risk for stroke. High CRP also predicts more rapidly growing carotid plaque.

Homocysteine is an important marker for increased likelihood of both carotid and aortic plaque, as well as stroke . There is more than a doubling of stroke when homocysteine levels exceed 12 umol/L. As homocysteine increases to 20 umol/L the risk for stroke and heart attack increases fivefold over that at a level of 9 umol/L.

6. Include exercise in your daily routine. New scientific studies have found that being moderately to highly active during leisure time significantly reduces the risk of stroke later in life. A study was undertaken by the National Public Health Institute in Helsinki, Finland, to assess the relationship between different types of physical activity with total and type-specific stroke risk.

The study included more than 47,000 Finns aged 25-64 without a history of stroke, cancer or coronary heart disease. Participants rated their activity level over a 19-year period according to the following standards:
. Low: Almost completely inactive (reading, watching TV, or minor physical activity).
. Moderate: Some physical activity for more than four hours per week of light gardening, walking, or cycling (but not walking or biking to work).
. High: Vigorous physical activity for more than three hours per week (such as running, swimming, heavy gardening, competitive sports).

During this period the group had 2,863 strokes. Stroke risk was 26 per cent lower in highly active participants and 14 per cent lower for those reporting moderate activity during leisure time. People who walked or biked to work also had a lower risk of stroke from blood clots, which are the cause 8 out of 10 strokes, according to the American Stroke Association. The study found that in order for us to gain maximum protection against the risk of stroke we must be highly active for more than three hours a week.

7. Strokes may be prevented by including supplements in the diet .Fish oil (omega 3 fatty acids ) is a cornerstone of any stroke-prevention programme. Epidemiological observations suggest a strong relationship between fish intake and reduced stroke risk. Carotid ultrasound studies have demonstrated that less carotid plaque is present in those with the greatest intake of omega-3 fatty acids from fish.

Other important supplements in a stroke prevention programme include the antioxidants - Vitamins A, C , E , selenium , green tea , coenzyme Q 10 , pycnogenol ,alpha lipoic acid, B vitamins , garlic , ginkgo biloba and magnesium.
8. Find out if you have atrial fibrillation, which encourages the formation of blood clots that could cause a stroke
9. Ask your physician if you have circulation problems that could increase the risk of stroke

10. Stop smoking . Smoking dramatically increases stroke risk. This occurs because cigarette smoke causes the narrowing of blood vessels and increases the clotting tendency of blood . Female smokers who take oral contraceptive pills are at risk for stroke.

11. If you drink alcohol, do so in moderation.
12. Treat gum disease .Gum disease leads to higher stroke risk. Fatty deposits lodged in carotid arteries of stroke sufferers shows that 70% contain bacteria - and 40% of those bacteria come from the mouth.

If you experience any stroke symptoms, including sudden weakness of the face or a limb, a blurring of vision, dizziness, or an intense headache, seek immediate medical attention. A stroke is a medical emergency.

Dr. Jacqueline E Campbell is a family physician in private practice
E mail drjcampbell14@yahoo.com

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