Preventing a Second Stroke
About 700,000 strokes occur each year, and about one third of them are happening to a person who's had a stroke before. The risk of a second stroke is about 40 percent within five years after the first stroke. Experts consider a second stroke the biggest threat to a stroke survivor, because it can lead to more serious disability or even death.
The American Stroke Association recently issued "Guidelines
for prevention of stroke in patients with ischemic stroke or transient ischemic
attack." A transient ischemic attack, or TIA, is also known as a "mini
more about TIAs here.
What the new guidelines say
One difference between the new guidelines and older ones is that they encourage patients and doctors to place as much importance on a TIA as they would on a larger stroke, because both events increase the risk of a second stroke. A TIA causes a disturbance in the brain that leads to stroke-like symptoms, but it's generally very quick and leaves no permanent damage. But prevention of a second stroke is as important for people who've had TIAs as it is for those who've had more serious strokes.
The guidelines also encourage patients to change the risk factors they have that are changeable. Recommendations include
- Quitting smoking
- Limiting alcohol consumption
- Maintaining a healthy weight
- Taking part in regular physical activity
The importance of sticking with medical treatment when necessary, such as taking anti-clotting medication and antiplatelet agents, is also a strong focus of the new guidelines. And they discuss procedures that can help stroke patients, such as carotid artery surgery and angioplasty—when appropriate—to improve blood flow.
Special populations included
Additional updates to the guidelines include recommendations for specific populations. For example, hormone replacement therapy, or HRT, is seen as a factor that increases the risk of stroke. And the elderly, Mexican Americans and African Americans are at higher risk of stroke than other populations, so they need to pay special attention to stroke prevention.
If you or someone you love has had a stroke and recovered, it's important to remember that part of your continued recovery is keeping a second stroke from occurring. Making healthy lifestyle choices, sticking with your medication regimen and visiting your doctor regularly are all part of the second stroke prevention equation.
Sources: Stroke: Journal of the American Heart Association; The American Stroke Association
How Stress Affects Your Heart
When we talk about stress affecting the health of your heart, we're generally referring to the stress of everyday life—pressure at work, balancing caring for children and careers, difficulties in relationships, financial worries, caring for adult parents. When you're feeling like you're always on the go and can't catch up, much less get ahead, your body is under chronic stress.
As a response to this stress, your body releases the hormones cortisol and adrenaline. This can cause chronic inflammation in the lining of blood vessels, and it can damage the walls of the arteries. This damage can promote a build-up of plaque in the arteries, which reduces blood flow and increases the risk of heart disease and stroke.
Signs that your stress level needs to come down
Your body, your behavior and your mental state give you warnings that it's time to get your stress level under control. If you notice the following symptoms, it's likely that you're living with daily, chronic stress.
- Physical symptoms (indigestion, racing heart, upset stomach, headaches, dizziness)
- Emotional symptoms (anxiety, crying, mood swings, sadness, nervousness)
- Mental symptoms (constant worrying, difficulty concentrating, inability to remember things)
- Behavioral symptoms (increased use of alcohol or drugs, sudden impulsive outbursts, bossiness, constant criticism)
Additionally, it appears that people who are under a lot of
stress are more likely to have what's called "metabolic syndrome,"
a condition in which people have three or more of the following: obesity, high
blood pressure, high blood sugar, high triglycerides (blood fat), lower levels
of HDL, or good cholesterol. When you have metabolic syndrome, you're at higher
risk of heart attack, diabetes and stroke.
In a study conducted by the Department of Epidemiology and Public Health at University College in London, researchers found that men who had metabolic syndrome produced more stress hormones—more cortisol and adrenaline—had abnormal heart rates and were more obese than men who did not have metabolic syndrome. Factors such as job strain seemed to play a role in the increased production of the stress hormones.
You can reduce the effects of stress
You can't get rid of all the stress in your life, but there are lots of things you can do to manage stress and change the way you respond to it. First you need to identify where the stress is in your life.
- If your job is too stressful, do your best to change that. Can you talk
with your supervisors or your human resources representative about ways to
reduce job stress? If you take on too much work can you talk with colleagues
and supervisors about creating more of a balance? If you can't imagine making
changes in the job you currently have, it may even be time to look at different
- If your personal relationships are troubling you, consider exploring ways
to deal with that, such as counseling or simply talking with the individuals
about what's going on.
- If you're a perfectionist who never feels satisfied with your accomplishments,
see what you can do to work on changing your attitude and being easier on
yourself. This can involve taking with a counselor or "life coach,"
who may be able to give you a fresh perspective and suggest techniques to
help you take the pressure off yourself.
- If it seems like practically anything at all can stress you out, consider learning some deep breathing exercises or meditation.
Adopt a healthy lifestyle
In addition to making specific changes that can remove some of the stressors in your life, you can also make some common-sense changes that make it easier for you to handle the stress that does come your way. These include:
- Getting regular exercise
- Getting enough sleep
- Eating well
- Drinking alcohol only in moderation, if at all (no more than one drink a day for women, no more than two drinks per day for men)
- Taking the time to relax with friends and family
Consider a workplace stress management program
If your company offers a stress management program, you might want to consider signing up. Research has shown that stress management programs offered in the workplace can have measurable improvements in stress-related symptoms.
The American Heart Association; F. Pashkow and C. Libov. The Women's Heart Book. Hyperion, New York, New York, 10023, 2001; Hypertension: Journal of the American Heart Association, 8 January 2007; The National Heart, Lung, and Blood Institute; Dr. Andrew Weil's Self Healing 2006 Annual Edition