Stroke Information-Part I
A number of readers of our web site have recently asked us about the prevention of strokes. In this the first of a series of articles on strokes, we will give a statistical picture of strokes. We then will list the risk factors and the potential risk factors under investigation. We will include references in professional literature, where more detailed information can be obtained. Later articles will outline these research articles to enable our readers to have additional information about this disorder.
Statistics and their implications:
It is a rare individual who has not been touched by stroke in some way. It is estimated that there are 3 million individuals alive today who are stroke victims. There are different types of strokes, all of which have a different pathophysiology. Types of strokes include subarachnoid hemorrhage, intraparenchymal hemorrhage, and ischemic stroke. While men have a greater stroke incidence rate than women, the absolute number of women suffering stroke each year is greater due to the fact that women live longer than men.
Stroke is the leading cause of long-term disability and it is the most common neurological cause of hospitalization. The estimate is that 500,000 individuals experience a new stroke or recurrent stroke each year. It is the third leading cause of death, with about 150,000 deaths per year. About 20% of the survivors of a stroke will require some aid in ambulating, including health care attendant, walker, cane or related assistive technology. A little over 30% will require help in activities of daily living including dressing, grooming, shopping etc. Institutional care will be required for approximately 16% of stroke victims. This leaves about 44% who will be able to return to their premorbid level of functioning. The cost of this disorder in both direct and indirect ways exceeds $40 billion.
Since the major risk factor for strokes is age, the $40 billion figure will grow as the age of individuals longevity increases. Strokes, along with dementia, will become the two major medical problems society will have to handle in the near future.
NIH data indicates that the incidence of stroke more than doubles for persons in each successive decade after 55 years of age. The mortality rates also doubles with advancing age after 55. People with diabetes and certain heart problems are at greater risk of having a stroke than are others.
The political literature is replete with "solutions" to this expanding problem. In 1987, Daniel Callahan wrote Setting Limits: Medical Goals in an Aging Society (New York: Simon & Schuster) in which he suggested meaning in life is more important than longevity. The political journal Foreign Affairs recently carried a long essay on the cost of an aging population in industrial societies. It suggested that governments would have to make hard choices as to what kinds of care they want to provide to an aging population without going bankrupt. The implication was that society would not be able to care for its older population without going bankrupt. This is evident in the ongoing discussions over Social Security and Medicare today. While individuals will have to take a more proactive role in their well being, the government must also contribute to the welfare of its citizens without playing one age group against the other.
Someone will suffer from a stroke every 53 seconds in the U.S. Of those who survive, a third to half will be left permanently disabled or institutionalized. A stroke occurs when blood flow to the brain is interrupted. Brain cells begin to die within 4 minutes after being deprived of their nutrients. Stroke victims must be started on treatment within 3 hours of the initial event. This in fact means that the victim must be in a hospital setting within 1 hour of the initial occurrence for proper treatment.
About 20% are hemorrhagic strokes. They occur when an artery leaks blood into the brain. Hemorrhagic strokes can not be treated with t-PA because that could cause additional bleeding. Ischemic strokes which are the most common type of stroke can be treated with t-PA, which dissolves blood clots obstructing blood flow to the brain.
The following lists of factors are based on epidemiological studies and refer to the proportion of strokes in the population caused by that factor. It does not mean that an individual who does not have the high risk factors won’t get a stroke, nor does it mean that an individual with all factors will have a stroke. What it does mean is that statistically the latter person will have a greater chance of having a stroke sometime in his/her life span. Those factors referred to as non-modifiable means that there is nothing that can be done about these factors with the possible exception of genetic factors (though this is a long way off).
Potential stroke risk factors under continued investigation
The following references represent a sampling of studies looking at factors related to stroke:
Stroke Part II-Stroke Treatment
Stroke Part III-Reducing Risk
Stroke Part IV-Role of aspirin and heparin in ischemic stroke
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE " Selecting a Nursing Home"
by Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated May 28, 2003
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