Risk factors for stroke. The main reasons leading to the development of strokes Low fn risk factor for stroke

The main risk factor is age. Every year at a young age stroke develops only in 1 out of 90 thousand of the population, while in old age (75-84 years) it occurs in 1 out of 45 people. At 45 years old stroke risk is relatively low over the next 20 years (occurs in one in 30 people), but its likelihood increases significantly by age 80 (it occurs in one in four men and one in five women).

Generally risk of stroke in men it is 30% higher than in women. However, this is typical only for the age group of the population from 45 to 64 years. Over the age of 65, the risk of stroke does not differ between men and women.

The main risk factors for stroke also include arterial hypertension, heart disease, previous cerebral stroke. smoking, alcohol abuse, high blood cholesterol, excess salt intake. There is mutual influence between many factors, so their combination leads to a more significant increase in the risk of disease than the simple arithmetic addition of their isolated effect.

Know your arterial pressure .

Check it at least once a year. High blood pressure (hypertension) is a leading cause of stroke. If the top number (your systolic blood pressure) is persistently above 140 or if the bottom number (your diastolic blood pressure) is persistently above 90, consult your doctor.

Find out if you have atrial fibrillation .

Atrial fibrillation- These are irregular heartbeats that impair cardiac function and allow blood to pool in some parts of the heart, and the stagnant blood can form clots or blood clots. Contractions of the heart can release part of the clot into the general bloodstream, which can lead to cerebrovascular accident.

If you smoke, stop.

Smoking doubles the risk of stroke. Once you stop smoking, stroke risk your risk of stroke will begin to decrease immediately; after five years, your risk of developing a stroke will be the same as that of non-smokers.

If you drink alcohol, do it in moderation .

A glass of wine or beer every day may reduce your risk of developing stroke(unless there are other reasons to avoid drinking alcohol). Excessive alcohol intake increases the risk of stroke.

Find out if you have high cholesterol levels .

Increased cholesterol levels increase risk stroke development. Most people can achieve cholesterol reduction through diet, physical exercise, and only some require drug therapy.

Having diabetes increases your risk of developing stroke. but by keeping your diabetes under control, you can reduce your risk of developing stroke.

Use exercise to increase your activity in your daily life .

Exercise daily. Walking for 30 minutes daily can improve your health and reduce your risk stroke. If you don't like walking, choose other types of physical activity that suit your lifestyle: cycling, swimming, golf, dancing, tennis, etc.

By reducing the amount of salt and fat in your diet, you will lower your blood pressure, and more importantly, reduce the risk of stroke. Strive for a balanced diet with a predominance of fruits, vegetables, grains and a moderate amount of protein daily.

Risk factors for stroke

Identifying and controlling risk factors for stroke is The best way reduce the patient's individual risk of stroke.

Risk factors for stroke can be divided into controlled(those that can be influenced by the doctor by issuing recommendations or by the patient himself by changing lifestyle) and uncontrolled(which cannot be influenced, but must be taken into account).

High blood pressure(BP above 140/90 mmHg)

Risk of stroke in patients with blood pressure more than 160/95 mmHg. increases approximately 4 times compared to persons with normal pressure, and with blood pressure more than 200/115 mm Hg. - 10 times.

Smoking

Doubles the risk of stroke. Accelerates the development of atherosclerosis of the carotid and coronary arteries. Switching to smoking a pipe or cigars provides little benefit over cigarettes, highlighting the need to quit smoking completely. 2-4 years after stopping smoking, the risk of developing a stroke no longer depends on the number of cigarettes smoked before and the length of smoking.

Alcohol

Studies have shown that moderate alcohol consumption (2 glasses of wine per day and 50 ml strong drinks) can reduce the risk of stroke by 2 times. However, a small increase in this dose leads to a 3-fold increase in the risk of stroke.

Atrial fibrillation and other heart diseases

In people over 65 years of age, the prevalence of atrial fibrillation is 5-6%. The risk of ischemic stroke increases by 3-4 times. The risk of stroke also increases in the presence of coronary heart disease by 2 times, left ventricular myocardial hypertrophy according to ECG data - by 3 times, in case of heart failure - by 3-4 times.

Lifestyle factors (overweight, physical inactivity, poor nutrition and stress factors)

These factors indirectly affect the risk of stroke, as they are associated with high blood cholesterol, high blood pressure and diabetes.

Increased cholesterol(increased total cholesterol levels more than 200 mg% or 5.2 mmol/l, as well as increased low-density lipoprotein levels more than 130 mg% or 3.36 mmol/l)

This is an indirect risk factor for stroke. It is associated with the development of atherosclerosis and coronary heart disease.

Diabetes

People with diabetes have a high risk of developing stroke. They more often have lipid metabolism disorders, arterial hypertension, various manifestations of atherosclerosis and excess weight.

Previous transient ischemic attack (TIA) and stroke

TIAs are a significant predictor of both stroke and myocardial infarction. The risk of developing ischemic stroke in patients with TIA is about 4-5% per year. More than 1/3 of patients who have a TIA will develop a stroke.

After the first stroke, the risk of another stroke increases 10 times.

Use of oral contraceptives

Drugs containing more than 50 mg of estrogen significantly increase the risk of ischemic stroke. The combination of their use with smoking and increased blood pressure is especially unfavorable.

Uncontrolled (unregulated) risk factors:

"Five Percent" Stroke Risk Scale

Shirokov Evgeniy Alekseevich

Prognostic systems

Diagnostic criteria for the degree of risk, based on the relative prognostic significance of risk factors, determine the values ​​of absolute risk (AR) for each patient. The ten-year risk for all categories of patients is estimated at 15 to 30%. Consequently, the probability of cardiovascular complications (stroke and heart attack) for patients at very high risk will be approximately 1.5 - 3% per year. This is not much, taking into account the incidence of stroke (336 people per 100,000 population per year). The creation of more reliable prognostic systems is associated with the identification of pathogenetic subtypes of ischemic stroke. All strokes are divided according to the mechanisms of disruption of the blood supply to the brain, and not according to morphological characteristics. From this moment on, the doctor was able to judge the pathogenesis of a future stroke.

It is not the RF as a statistical sign of relative danger, but the clinical-instrumental syndrome as a fragment of the picture of a disease that can lead to a stroke that becomes the basis for assessing individual risk.

Stroke risk estimates

To assess individual risk, from examination data (clinical, ultrasound, laboratory), you need to select information that has proven its prognostic value.

The main source of evidence-based information about the degree of risk I is the results of clinical trials medicines(RCT). RCTs determine the effect of drugs on pathological syndromes. Symptom complexes that have obvious prognostic significance, a reliable statistical connection with a vascular event, and that correspond to a reduction in absolute risk (AR) to a therapeutic effect are representative syndromes (RS). They present to the doctor the most prognostically significant pathological processes.

AR characterizes the probability of developing a stroke over a certain period of time and is usually expressed as a percentage. An individual prognosis is based on data obtained during prognostic studies or clinical trials in a similar group of patients.

To assess individual risk, in practical terms, it is enough to operate with numbers divisible by 5, which greatly simplifies calculations. The individual risk must be calculated for one year.

Modern publications are based on the analysis of four main groups of diseases that are most closely associated with the development of stroke and therefore bear all the signs of MS. These are: 1) AG; 2) heart disease with rhythm disturbances and intracardiac hemodynamics; 3) stenosis of the brachiocephalic arteries; 4) hypercoagulation.

The most complete data on the degree of risk can be obtained by studying hypertension (Carter, HSCSG, TEST, PROGRESS). A meta-analysis of 9 prospective studies conducted over 10 years (420,000 people) found that increased BP increased the 10-year risk of stroke by up to 46%]. Therefore, the absolute, individual risk of stroke in hypertensive patients is approximately 4.6-5% per year.

The annual risk of stroke due to heart disease ranges from 3 to 6% per year. Greater value have heart rhythm disturbances, which are associated with more than 20% of ischemic strokes. The five-year risk of stroke in patients with arrhythmias is 21.3%. This means that the absolute risk for heart disease is close to 5% per year.

Stenosing atherosclerosis of the brachiocephalic arteries has a significant impact on the prognosis - when the carotid artery is narrowed by more than 75%, AR reaches 5.5%. If plaque ulceration is present, the risk of stroke increases to 7.5% per year. According to generalized data, the risk of stroke with asymptomatic stenosis ranges from 1.9 to 5.9% per year.

The term “hypercoagulation” (HC) most accurately reflects the results of disturbances in the hemostatic system that form atherothrombosis. The magnitude of AR can be judged from the placebo group in an RCT. During 3 years of observation (ACILA study), 15% of patients suffered a stroke - the annual risk was 5%. Other studies have demonstrated similar results.

Representative syndromes and the probability of stroke within a year

Using RS and AR values, you can obtain a fairly simple “five percent” method for individual prediction of stroke.

Like any other disease, stroke has modifiable (over which a person can influence) and non-modifiable (over which a person cannot influence) risk factors.

Non-modifiable risk factors for stroke

1. Age. After age 55, the risk of stroke doubles every 10 years.
2. Floor. Men are more likely to suffer from stroke - 80%.
3. Hereditary tendency strokes are more often transmitted through the maternal line and its probability doubles.

Modifiable risk factors for ischemic stroke

1. Arterial hypertension. 5-7% of hypertensive patients are affected by stroke every year. Statistics show that an increase in diastolic blood pressure by 7.5 mm Hg. in the range from 70 to 110 mm Hg. increases the risk of stroke by almost 2 times. Hypertension is the greatest long-term risk factor for stroke.
2. Diabetes. This disease increases the risk of stroke by 3 times.
3. Previously rescheduled stroke. A transient ischemic attack or a previous stroke increases the risk of developing another stroke by 10 times. The greatest likelihood of a recurrent stroke occurs during the first week. In the next 3 months, the probability of stroke is 10.5%.
4. Obesity. Body mass index (BMI) using Quetelet's formula is calculated by dividing body weight (kg) by the square of height (m). For example, for a person with a body weight of 100 kg and a height of 1.8 m, the Kettle BMI will be equal to

   100/(1,8) 2 = 100/3,24 = 30,8

   A Quetelet BMI value of less than 19 indicates underweight; from 19 to 24 - normal weight; from 24 to 29 - overweight; over 29 - obesity.

5. Cardiac ischemia. This group of diseases includes angina pectoris and myocardial infarction, which develop as a result of atherosclerosis of the heart vessels. Having a heart attack increases the risk of developing a stroke by 3 times. With extensive anterior infarction - up to 20%.
6. Lipid metabolism disorder. An increase in “bad” cholesterol in the blood leads to the development of atherosclerosis of blood vessels.
7. Carotid artery stenosis. Atherosclerotic lesions of the carotid arteries in the form of vascular stenosis are the cause of 5-7% of cerebrovascular accidents.
8. Heart rhythm disturbance. Atrial fibrillation increases the risk of stroke by 3.6 times. Attacks of atrial fibrillation are most often observed at night during sleep or early in the morning, with a sharp turn of the body in a horizontal position, after a heavy meal, with bloating, constipation, diaphragmatic hernia, gastric ulcer, physical and psycho-emotional stress, acute myocardial infarction, prolapse mitral valve.
9. Heart failure. A syndrome based on a decrease in the pumping capacity of the heart, which is manifested by a discrepancy between the body's need for a certain volume of circulating blood per unit of time and the ability of the heart to provide this volume. Heart failure increases the risk of stroke by 3 times. For more information about heart failure, see the section Heart attack.
10. Smoking.
11. Alcohol.
12. Use tablet contraceptives and postmenopausal hormone therapy.
13. Frequent stress.
14. Low physical activity. Minimum physical activity can be considered 30 minutes of physical activity 5 times a week.
15. Low testosterone levels(male sex hormone) in men's blood.

Risk factors for hemorrhagic stroke

1. Arterial hypertension.
2. Morphological changes in the vessels supplying the brain.
3. Changes in the blood coagulation system.
4. Excessive alcohol intake.
5. Taking psychostimulants.

Situations that provoke a stroke

1. Quick transition from a lying position to a standing position.
2. Hearty food.
3. Very hot weather.
4. Hot bath.
5. High physical and mental stress.
6. Heart rhythm disturbance.
7. Any heating of the head.
8. Lifting weights.
9. A sharp drop in blood pressure.

ATTENTION! Information provided on the site website is for reference only. The site administration is not responsible for possible Negative consequences in case of taking any medications or procedures without a doctor’s prescription!

A repeated stroke develops when a person who has previously suffered from this disease ceases to pay due attention to his health. A diagnosed stroke requires further caution and compliance with specialist recommendations, otherwise relapses will occur. With each subsequent stroke, the risk of death increases exponentially.

There are 4 main reasons that can trigger the development of a recurrent stroke:

1. Arterial hypertension - increased pressure has a detrimental effect on the condition of blood vessels, wearing them out, which increases the risk of rupture. It is important to monitor your blood pressure daily using a blood pressure monitor, and also avoid eating foods that can increase it. Against the background of arterial hypertension, arrhythmia and tachycardia can develop, which indirectly contributes to the development of recurrent stroke.
2. Vascular thrombosis - a violation of hematopoietic functions, as well as excessive blood density cause the formation of dense blood clots that settle on the inner walls of blood vessels. With progressive arterial hypertension, these blood clots can break off and travel throughout the body along with the blood flow. Once in smaller vessels, blood clots cause blockage and disruption of blood flow.
3. Vascular atherosclerosis - blockage of the vascular lumen is carried out by cholesterol plaques, which are formed due to excess cholesterol levels in the blood, which is caused by poor nutrition and metabolic disorders in the liver.
4. The presence of foci of inflammatory processes that can spread to areas of the brain, causing fluid retention and cerebral edema.

A repeated stroke is extremely life-threatening, as it reduces the possibility of full recovery and increases the risk of death.

Symptoms

The signs of a recurrent stroke are no different from the primary disease. The only difference is the intensity of the symptoms. Recurrent stroke is diagnosed through clinical manifestations such as:

• severe dizziness, nausea and vomiting;
• paralysis of one part of the body and the whole body;
• numbness of the limbs;
• lack of speech or incoherence;
• impaired coordination of movements;
• fainting state.

A repeated stroke may have a rapid increase in symptoms, which causes the development comatose state. This requires immediate hospitalization and qualified assistance.

First aid

If the patient loses consciousness, lay him on his side and call an ambulance. Before her arrival, you can do the following:

1. Try to bring a person to his senses, but use him for these purposes ammonia not recommended due to cardiac toxicity.
2. If there are convulsions, ensure the person’s safety by removing all dangerous sharp objects from them.
3. If there is vomit, oral cavity carefully clean with a cloth, while the body position must be on its side.
4. The pulse and breathing process should be monitored; when they stop, artificial respiration and indirect cardiac massage are performed.
5. It is necessary to free the body as much as possible from compressive bandages, belts, shirt collars, ensuring the flow of blood to the brain.

Correctly provided first aid can save a person’s life and also reduce the severity of complications.

Treatment

Further therapy in a hospital setting is aimed at eliminating the consequences of acute cerebral circulation, as well as restoring all vital signs. important functions. The following drugs are prescribed:

1. Thrombolytics - indicated for ischemic stroke, as they are able to thin the blood and dissolve dense blood clots. With a hemorrhagic stroke, they can provoke increased intracranial bleeding.
2. Angioprotectors – protect blood vessels and strengthen their walls.
3. Nootropic drugs – improve cerebral circulation and also help normalize the conduction of nerve impulses in the periphery.
4. Vitamin complexes – contribute to the overall strengthening of the body, and also normalize the conductivity of the peripheral nervous system.

Based on the results of hardware diagnostics, a surgical operation may be prescribed to excise the damaged area of ​​the vessel and restore natural blood flow. In the event of a hemorrhagic stroke, it is important to remove the resulting hematoma and sanitize the meninges, preventing the development of an extensive inflammatory process.

How to prevent a second stroke

There are several aspects that influence the high rate of stroke recurrence. If they are minimized, the disease will not appear for a long time.

Nutrition

Since there is a direct relationship between nutrition and blood pressure, it is necessary:

• use a large number of vegetables and fruits rich in vitamins;
• use only lean, steamed meats;
• stop drinking alcohol and sweet carbonated drinks;
• reduce the consumption of pickles, smoked meats and seasonings;
• eat fractionally every 2-3 hours, but in small portions;
• drink enough fluid, which will reduce the viscosity of the blood and facilitate its passage through the vessels.

It is important for a patient who has suffered a stroke to follow a diet that can not only stabilize blood pressure, but also strengthen the entire body.

The diet will help stabilize body weight, which will prevent the development of obesity. Excess fat reserves are also dangerous to health, as they provoke an increase in the level of bad cholesterol in the blood, which contributes to the development of vascular atherosclerosis.

It is important to limit your salt intake. It is this product that stimulates fluid retention in the body and also affects blood pressure. It is better to replace sugar with sweeteners, which are used by diabetics. This will help control blood glucose levels without putting stress on the pancreas.

They eat only lean varieties of meat and fish, which are prepared without vegetable and animal fats that contain large amounts of cholesterol.

Bread should be limited, but this product should not be completely excluded. It contains B vitamins and fiber necessary to support the digestion process.

Pressure control

Arterial hypertension is one of the provoking factors, so it is important for patients to constantly monitor blood pressure levels. This procedure is carried out using a tonometer, after which the data obtained is recorded.

You should pay attention to psycho-emotional health, minimizing stress. It is experiences that make the heart beat faster, increasing blood and intracranial pressure.

If increased blood pressure and deterioration in general health are detected, it is necessary to take antihypertensive drugs prescribed by the doctor. If you cannot stabilize your blood pressure at home, you need to call an ambulance.

Taking medications

During the rehabilitation period, it is important to take all medications prescribed by the doctor. Some of them can be used on an ongoing basis (Aspirin Cardio, Cardiomagnyl).

With the help of medications it is possible to:

• keep blood pressure normal;
• control blood sugar and cholesterol levels;
• prevent pathological blood thickening and the formation of blood clots;
• protect blood vessels from the harmful effects of environmental factors;
• eliminate spasms and cramps.

Self-rehabilitation

A person who has previously suffered a stroke needs to understand that self-rehabilitation and a responsible approach to one’s own health will save life and reduce the likelihood of relapse of the disease. To do this you need:

1. Avoid stress and overexertion.
2. Spend more time outdoors, preferring walking.
3. Perform daily physical exercise recommended by a rehabilitation doctor.
4. Get plenty of sleep and rest. If there are problems with sleep, sleeping pills may be prescribed, which are selected by the doctor taking into account the individual characteristics of the body.
5. Take medications even if you feel great. Prevention will help maintain health and prevent relapse.

Forecast and consequences

A recurrent stroke has a conditionally unfavorable prognosis due to the following statistics:

• survival rate and life expectancy up to 5 years – 15%;
• survival rate and life expectancy up to 1 year – 45%
• survival rate and development of death after 1-2 months – 4%
• instant death – almost 40%.

High mortality risks necessitate preventive treatment and compliance with all doctor’s recommendations, excluding bad habits, sedentary lifestyle and poor diet.

Elderly people, especially men, are at risk. The mortality rate among men is 80% higher than among women.

If a primary stroke provokes the development of consequences that can be gradually restored, then a repeated stroke practically deprives a person of this right and inevitably leads to disability.

Life expectancy cannot be predicted or predicted. In some cases, even the most advanced situations allowed a person to live to old age, while in other patients death occurred with favorable prognosis.

The most serious complications that can occur after a recurrent stroke are:

• cerebral edema and impaired brain activity;
• complete loss of speech without the possibility of recovery;
• blindness and deafness;
• paralysis of the whole body or individual parts;
• spontaneous urination and defecation;
• decreased reflexes and mental activity.

In the best case, a person will receive a disability with which he will learn to live for the rest of his short life. The worst outcome is death.

A feature of a recurrent stroke is the fact that the rehabilitation process in most cases does not bring the desired result. Even the most expensive medications that help during recovery may not be effective if you have a recurring stroke. Only A complex approach and prevention will save life and avoid the development of a life-threatening condition.

The main strategy to reduce morbidity and mortality from cerebral stroke is a clear organization of its prevention, based on the identification and stratification of risk factors. There are non-modifiable, modifiable (correctable) and putative risk factors.

Non-modifiable risk factors

Elderly age

Ischemic stroke- This is a disease primarily of people, average age which is 73-75 years old; 3/4 brain strokes occur after 65 years of age.
Due to the increase in elderly and senile people among the population of Ukraine in the next decade, an increase in the number of cases of cerebrovascular pathology, including cerebral stroke, is predicted.

Brain stroke is more common in men aged 44-85 years than in women. Taking oral contraceptives and pregnancy contribute to an increased incidence of strokes in women under 44 years of age.

Low birth weight

The incidence of cerebral stroke doubles among individuals whose birth weight was less than 2.5 kg. These patients also have a higher incidence of mortality from stroke.

Hereditary factor

A family history of stroke increases the likelihood of having one by 30%. A number of genetic diseases are associated with stroke - cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy, Marfan syndrome, neurofibromatosis types 1 and 2, Fabry disease.

Modifiable risk factors

Blood pressure

Arterial hypertension is one of the most significant modifiable risk factors for ischemic stroke. The prevalence of arterial hypertension increases with age, and if at 50 years of age it is detected in 45% of the population, then by 70 years of age - in 70%.

A direct connection has been established between the level of diastolic blood pressure and the risk of developing cerebral stroke. An increase in systolic blood pressure of 10 mm Hg. Art. increases the relative risk of developing cerebral stroke in women to 1.9, in men - up to 1.7. Isolated systolic hypertension also increases the risk of stroke by 2-4 times. Increase in blood pressure by 7.5 mm Hg. Art. in normotensive patients, it doubles the risk of stroke.

Controlling blood pressure and normalizing it is one of the most effective measures to reduce the risk of stroke. In this regard, it is recommended to compulsorily measure blood pressure during medical examinations, dispensary visits and initial patient visits for medical care to medical and preventive institutions. The maximum permissible level of blood pressure in the general population should not exceed 140/90 mmHg. Art., among patients with diabetes - 130/80 mm Hg. Art. The safest target blood pressure for people over 75 years of age is 140-150/90-80 mmHg. Art. Such blood pressure allows you to avoid adverse orthostatic reactions and at the same time maintain an optimal level of brain perfusion. Normalization of blood pressure is achieved through lifestyle changes, refusal bad habits And individual selection antihypertensive drugs.

Smoking

Smoking, an independent risk factor for stroke that remains widespread, doubles the risk of stroke. It increases significantly with smoking women compared to men. The risk of developing a cerebral stroke is twice as high in people who smoke more than 40 cigarettes per day than in those who smoke up to 10 cigarettes per day. Smoking is a predictor of severe atherosclerosis of extracranial arteries. Passive tobacco smoking is also a risk factor for cerebral stroke. Complete smoking cessation reduces this risk by 50%, and after 5 years after quitting smoking, the risk of developing a cerebral stroke is practically no different from that of never smokers.

Diabetes

With diabetes, the risk of developing a cerebral stroke increases by 2 to 6 times. Diabetes mellitus is observed in 13-20% of patients with cerebral stroke. It leads to the development of atherosclerotic cerebral macro- and microangiopathy. The combination of arterial hypertension and diabetes mellitus is especially unfavorable for the development of cerebral stroke. Adequate therapy for type 1 and type 2 diabetes mellitus, which maintains blood glucose levels close to normal, can significantly reduce the risk of cerebral stroke. For patients with diabetes mellitus Strict control of blood pressure, prescription of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended. Prescribing statins for diabetes mellitus and dyslipidemia reduces the risk of stroke, especially in the presence of other associated risk factors. Aspirin is recommended for primary prevention in patients at high risk of developing cerebrovascular disease.
Atrial fibrillation.

Permanent atrial fibrillation is an independent risk factor for stroke. With atrial fibrillation, the likelihood of developing a cerebral stroke increases 4-5 times. In patients with atrial fibrillation, it is necessary to stratify the risk of developing cerebral stroke. Moderate risk of cerebral stroke with atrial fibrillation includes age over 75 years, a combination of atrial fibrillation with one of the following atrial fibrillation: arterial hypertension, heart failure (echocardiographically determined systolic; left ventricular failure less than 3-5%, fractional shortening of systole less than 20%).

The high-risk group for developing ischemic stroke in atrial fibrillation includes patients with a previous transient ischemic attack or cerebral stroke, its combination with two moderate atrial fibrillations. Long-term oral anticoagulant therapy with warfarin is recommended for all patients at high and moderate risk of embolism. If there are contraindications to canticoagulants, patients with atrial fibrillation should be prescribed aspirin 100-325 mg/day.

For patients at low risk of cardioembolism due to atrial fibrillation (age under 60 years without additional risk factors), long-term use of aspirin 100-325 mg/day is recommended. For all patients over 65 years of age, upon initial consultation with a doctor, it is necessary to determine the pulse rate followed by an ECG to exclude atrial fibrillation.

Dyslipidemia

Violations of the normal ratio of the main lipid fractions (triglycerides; cholesterol, high and low density lipoproteins) in the blood serum are risk factors for the development of vascular diseases. An increase in the content of cholesterol and low-density lipoproteins is directly related to the incidence of coronary pathology, while high-density lipoproteins have the opposite effect. Increased cholesterol levels correlate with the degree and rate of progression of atherosclerosis of the brachiocephalic arteries. Mortality from cerebral stroke has been shown to be higher among men with high blood cholesterol levels. In order to prevent hyperlipidemia, it is recommended to control the level of cholesterol in the blood serum (the norm is less than 5 mmol/l). For patients with coronary heart disease and diabetes mellitus, correction of lipid disorders is carried out when prescribed special diet, lowering the level of low-density lipoproteins. The main sources of saturated fat and cholesterol are fatty meats (lamb, pork), eggs and dairy products. In this regard, it is recommended to eat lean meats (beef, chicken fillet), fish and low-fat dairy products.

If within 6 months patients with average or high level serum cholesterol or low-density protein levels cannot be reduced to normal levels, they should be prescribed statins.

Heart diseases associated with increased risk of brain stroke

Cardiogenic embolism is the cause of 20 - 25% of ischemic strokes and transient ischemic attack. It usually occurs due to the formation of emboli in the cavities or valves of the heart. Proven risk factors for cardioembolism include diseases of the valvular apparatus of the heart (artificial heart valve, rheumatic, bacterial and non-bacterial damage to the valves, their calcification), diseases of the coronary arteries (myocardial infarction within a cardiac thrombus, ventricular aneurysms, mpokinetic and akinetic areas of the myocardium).

Chronic infections and inflammatory processes

In the last decade, it has been shown that chronic infections, particularly those caused by Chlamydia pneumonia, lead to damage to the arterial endothelium, thereby increasing the risk of developing vascular disease. It has been established that an increase in C-reactive protein, a marker of inflammation, increases the risk of developing cardiovascular diseases. Patients suffering from rheumatoid arthritis or systemic lupus erythematosus have an increased risk of developing a cerebral stroke. In patients with positive C-reactive protein and dyslipidemia, statins are recommended.

Annual influenza vaccination is recommended for patients with risk factors for ischemic stroke.

Hyperhomocysteinemia. Patients with hyperhomocysteinemia may be prescribed a complex of B vitamins - pyridoxine (B6), cobalamin (B12), folic acid.

The main objectives of primary prevention are:

• identification of persons at increased risk of cerebral stroke;
• diagnosis and assessment of risk factors;
• development of an individual program for the prevention of correctable and potentially correctable risk factors.

January 28, 2018 No comments

Some of the most important risk factors for stroke can be determined during a physical examination in your doctor's office. If you are over 55 years old, the checklist in this article will help you assess your risk of stroke and demonstrate the benefits of controlling stroke risk factors.

Do you know your risk of stroke?

Many risk factors for stroke can be controlled, some very successfully. Although the risk will never be zero at any age, by starting early and controlling risk factors, you can reduce your risk of death or disability from a stroke. With good prevention, the risk of stroke in most age groups can be lower than that caused by accidental injury or death.

Stroke can be prevented and treated. IN last years A better understanding of the causes of stroke has helped many people make lifestyle changes that have reduced stroke deaths by almost half.

Estimate your risk of developing stroke over the next 10 years - men

Key: GARDEN Diabetes= history of diabetes; Cigarettes= smokes cigarettes; CVD IF LVH

Estimate your risk of having a stroke over the next 10 years - women

Key: GARDEN= systolic blood pressure (assessment of one line only, without or with treatment); Diabetes= history of diabetes; Cigarettes= smokes cigarettes; CVD (cardiovascular diseases) = history of heart disease; IF= history of atrial fibrillation; LVH= diagnosis of left ventricular hypertrophy

Example

This example helps assess the risk of stroke. Calculate your score to determine your risk of having a stroke over the next 10 years.

Maria, 65, wanted to determine her risk for a stroke, so she took this stroke risk checklist. This is how she reached her 10-year stroke risk:

Interpretation:
A score of 15 means a 16 percent chance of having a stroke within 10 years. If Maria quits smoking, she can reduce her score to 12, which means she has a 9 percent chance of having a stroke.

Her current final score does not mean that Maria will definitely have a stroke, but it will encourage her to reduce her risk or even prevent a stroke. A lower percentage score does not mean that Mary will not have a stroke, but rather that her risk of having one is reduced.

No matter what your test result is, it is important to work on reducing your individual risk factors, as Maria did in this example by quitting smoking.

By continuing to focus on reducing the risk of stroke, using currently available treatments and developing new ones, people can prevent up to 80 percent of all strokes.