As I write this, the city of Detroit is sending prayers to Dan Gilbert and his family upon reports that at age 57 he suffered a stroke yesterday. One can only hope that this hero will be back at the helm of rejuvenating Detroit soon and in full capacities.
Although heart attack treatment and prevention has been my passion for over 30 years, stroke has been in the headlines in younger people of late. This year alone, headlines sadly reported that Luke Perry and John Singleton died of strokes in their early 50’s. Many more celebrities have suffered strokes that serve to remind us that all of us are vulnerable
While I am not changing my focus, reinforced in the last month by the tragic loss in Detroit of a 58 year old friend who seemed fine on the outside only to die suddenly in sleep of an unsuspected Widowmaker blockage, there is an approach to identify and prevent many factors that raise the risk of stroke.
The approach to stroke prevention as or more challenging than heart attack prevention as there are many causes of stroke and no simple test like the coronary artery calcium CT scan of the heart that can identify silent atherosclerosis of critical arteries.
Signs of a Stroke
Although early diagnosis of a stroke is not prevention, it may lead to an opportunity for quick intervention by stroke teams, similar to how heart attcks are treated. Therefore, knowing the early symptoms is crucial for all to recognize.
Types of Stroke
Strokes are generally divided upon diagnosis as to those that are due to bleeding in the brain found on CT or MRI (hemorrhagic) and those that are free of blood (ischemic). Hemorrhagic strokes will be more common in individuals on blood thinners or with a hereditary or acquired predisposition to bleeding like low platelet counts.
Causes of Stroke
Stroke maybe due to cardiac, blood vessel, or blood disorders, some genetic, making the prevention of stroke challenging. Each needs to be addressed to lower the risk of stroke to the minimum. Identification and prevention of hypertension remains the biggest challenge whether dueto diet, obesity, stress, sleep apnea, kidney conditions, hormonal disorders, medications, or genetics.
Lifestyle Factors Raising the Risk of Stroke
Although the causes of stroke are many, there are lifestyle factors that overlap with heart disease that must be identified and reversed before tragedy strikes.
Prevention of Stroke: Basic Measures
Addressing risk factors for blood vessel are crucial both to the prevention of stroke and heart attack. These basic measures should be stress by all health practitioners.
Stroke Prevention: Advanced Measures
In my preventive cardiovascular clinic I go beyond these basic measures to assess the risk of stroke. These include:
1) Evaluating any symptoms suspected of sleep apnea with home sleep apnea studies.
2) Monitoring heart rhythm by Apple 4 watches or the Kardia Alivecore device when appropriate searching for silent atrial fibrillation.
3) Advanced laboratory studies for inherited clotting disorders (Factor II, Factor V, Protein C, Protein S, lipoprotein(a) and homocysteine), and inflammatory markers. Along with these, hemoglobin, platelet counts, assessments of insulin resistance, and advanced cholesterol panels will be performed.
4) Carotid artery imaging whether via screening panels at hospitals (eg. 5 for $50 studies) or more advanced carotid IMT (CIMT) studies.
5) If abnormal EKGs or examinations are identified, an echocardiogram with a bubble contrast study for congenital cardiac shunts found in 1% of the population will be ordered.
6) Advanced thyroid evaluation as hyperthyroidism increased the risk of atrial fibrillation and stroke.
7) Ambulatory blood pressure 24-hour monitors for more accurate assessments.
8) Assessing “biotoxicity” from heavy metal exposure like mercury and lead, to persistent organic pollutants, to Lyme and mold diseases.
As we wait, praying for a speedy recovery for Dan Gilbert and his family, an understanding of the many causes of strokes leads to a path to try to identify and prevent them before they happen. Perhaps some of the steps listed here should be a consideration in your own health journey.