Editor’s Note: This article, the third in our heart-health series, focuses on strokes and what Arkansas has done to reduce them.

Strokes are a type of heart disease. Many of the lifestyle choices and treatment options associated with strokes are also the same as for heart disease. Until recently, Arkansas was the nation’s leading state for the number of stroke deaths per capita. After a statewide effort to reduce stroke deaths beginning in 2008, Arkansas now ranks sixth in the nation. A program that has been credited with lowering the number of stroke deaths and complications is called the Arkansas Stroke Assistance through Virtual Emergency Support, or AR SAVES.

A partnership between the University of Arkansas for Medical Sciences and the Arkansas Department of Human Services, AR-SAVES provides 48 Arkansas hospitals with round-the-clock access to stroke specialists. By using a high-speed video communications system, a stroke neurologist can evaluate a patient at a partner hospital that lacks such specialists. The expert evaluation determines if the patient can be helped with medication. Timing is critical because meds must be given within three- to four-hours after stroke symptoms first appear. AR SAVES also conducts statewide outreach to educate the public, medical providers and first responders to recognize stroke symptoms and get help fast.

Strokes are the fourth leading cause of death in Arkansas and fifth leading cause of death in the United States. Strokes are also the leading cause of preventable, long-term disability. Among women, strokes are the third leading cause of death. A stroke occurs every 40 seconds in this country – 800,000 a year. Every four minutes someone dies from a stroke. While more women (60%) have strokes than men (40%), the death rate is about the same for both genders. African-Americans have a significantly higher death rate from strokes than Caucasians.

What’s a brain attack?

A stroke is often called a brain attack because it affects the brain like a heart attack affects the heart. (The illustration shows a CT scan of a brain attack.) A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is suddenly blocked or bursts. If the blockage is caused by a clot in a blood vessel supplying the brain it is called an ischemic stroke. If a blood vessel bursts, causing bleeding in and around the brain, it’s called an hemorrhagic stroke. A stroke deprives brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die and various types of damage start to occur.

A transient ischemic attack (TIA), commonly called a “mini-stroke,” is caused by a temporary clot. TIAs can occur suddenly, but only last a few minutes up to several hours. TIAs greatly increase the risk for strokes and are often an early warning sign of a future full-blown stroke. TIAs should be reported promptly to your doctor.

Affects whole body

A stroke is a disease of the brain. But, because it often causes paralysis or weakness, it can affect the whole body. Strokes can cause problems with memory, judgment, learning, thinking, attention and speech. Problems controlling emotions or expressing them appropriately can also result. Depression is common for stroke survivors. Stroke survivors often have pain and/or numbness in their hands and feet.

Learn stroke symptoms

Strokes can happen to anyone at any age. Everyone should know the warning signs of a TIA or stroke. Strokes are treatable but only if you get help quickly. Treat all strokes as a medical emergency and get the patient to a medical facility without delay.

An easy way to identify if someone is having a stroke is by using F.A.S.T.:

  • Face drooping or uneven smile, especially on one side
  • Arm or leg weakness or numbness
  • Speech difficulty, slurred speech, problems understanding speech
  • Time to call 911 and get to a hospital immediately

Additional warning signs include:

  • Sudden inability to move, especially on one side of the body
  • Sudden confusion or trouble speaking
  • Sudden trouble seeing in one or both eyes
  • Sudden difficulty walking, loss of balance or coordination, dizziness
  • Sudden severe headache with no cause
  • Falling or loss of consciousness

According to the National Institutes of Health, woman may have these additional warnings signs of stroke:

  • Hiccups that occur with unusual chest pain
  • Dizziness not associated with vertigo
  • Headaches

Who is at risk?

Strokes are preventable. Knowing the risk factors for a stroke is the first step in prevention. Most (80%) of strokes can be prevented by carefully controlling or treating these risk factors:

  • High blood pressure, which causes at least half of all strokes
  • Heart disease, especially atrial fibrillation (AF) and transient ischemic attacks (TIAs). AF causes the heart to beat very fast and irregularly, allowing blood to pool in the heart and increase the chance of blood clots
  • Atherosclerosis and carotid artery disease
  • Smoking
  • Diabetes
  • High blood cholesterol/lipid levels
  • Physical inactivity and obesity
  • Unhealthy diet, especially if lacking fresh fruits and vegetables
  • Certain blood disorders
  • Drinking too much alcohol
  • Illegal drug use including cocaine, amphetamines and other drugs
  • Certain medical conditions such as sickle cell disease or bleeding disorders

The buildup of a fatty substance called plaque inside arteries (atherosclerosis) is a frequent cause of strokes. Plaque hardens and narrows arteries, limiting blood flow to the brain and heart. If plaque cracks or breaks away from the artery wall, a clump of plaque and blood platelets can form a blood clot. The clot or piece of plaque can partly or fully block an artery.

Women have several unique risk factors that can increase their stroke risk, including:

  • Pregnancy, especially during the final months and immediately after delivery
  • Use of birth-control pills or hormone replacement therapy
  • Lupus
  • Migraine headaches

Treatment options

There are three parts of stroke treatment: prevention, immediate therapy and post-stroke rehabilitation.

Prevention focuses on treating an individual’s risk factors for a stroke. There are several classes of drugs that are used to prevent or treat strokes, including anticoagulants and thrombolytics. Prevention is important because about 25 percent of people who recover from a first stroke will have another within five years.

Immediate treatment for ischemic strokes is to dissolve the blood clot that’s causing it. A clot-dissolving medication called tissue plasminogen activator (tPA) must be given within four hours after the first stroke symptoms occur. Treatment with tPA can greatly improve the chances of surviving and making a full recovery after a stroke. Acute treatment of hemorrhagic strokes focuses on stopping the bleeding.

Post-stroke rehabilitation helps patients overcome disabilities caused by stroke damage. Speech therapists can help the patient learn ways to communicate if speech, memory and thinking ability were affected. Physical and occupational therapists can help with the effects of paralysis or muscle weakness, including the ability to swallow and eat. If the stroke affected the muscles and nerves that control the bladder and bowels, medicines and specialists in this area may be needed. Mental health specialists can help with the depression and frustration of stroke recovery.

Top tips to avoid a stroke

With the exception of a few inherited risks for strokes such as older age, sex, race and family history of strokes or TIAs, strokes are largely caused by the choices we make about our health. Here are seven top tips to avoid strokes:

  • Get preventive screenings. The Affordable Care Act made most preventive services free. Cholesterol and blood pressure checks are two of the important health screenings. Ask your doctor what other screenings you need and make an appointment to have them done. People who check their blood pressure at least twice a month are much more successful at controlling it. Free blood pressure checks are available at grocery stories with pharmacies, Walgreen’s and Fred’s pharmacies and at every Little Rock Fire Department station house.
  • Stop smoking. There are pills, patches, counseling and support groups to help you quit tobacco. Talk with your doctor about adding this step to your personal health plan. Many insurance plans cover smoking cessation.
  • Get moving. As little as 30 minutes of walking, most days of the week, can improve your blood pressure, weight, cholesterol levels and reduce stress and depression. Any activity and any amount of activity helps. Try stair climbing, vacuuming, walking the dog, dancing or a favorite sport. Get an exercise buddy for more motivation and support.
  • Eat healthy. If you need to improve your eating habits, start slowly because changes are difficult to maintain until they become a habit. Start with one small change every month, such as:
    • reduce and eventually eliminate sugary soft drinks
    • stop buying high-calorie desserts and other low-nutrient snack foods (you won’t eat them if they’re not handy)
    • add an extra serving of fruit or vegetable, until you regularly eat five to nine servings daily (a serving is one-half cup)
    • reduce or eliminate fast foods; get in the habit of cooking a little extra for dinner so you can pack a healthy lunch tomorrow
    • limit processed foods like hot dogs, lunchmeat, sausage and bacon
    • eat more fish, seafood, chicken and turkey without the skin, beans, eggs, nuts and seeds
    • avoid saturated fats or trans fats in foods like salad dressings, cooking oil, crackers and snack foods (read the Nutrition Facts label on food packages)
    • use healthy oils like olive, canola, peanut, sesame; soft instead of stick margarine
    • try a new whole-grain food every month; look for whole grain as the first ingredient in pastas, breads and cereals
    • eliminate or reduce the amount of beer, wine or alcohol you drink
  • Maintain a healthy weight.
  • Reduce your stress through exercise, a brief nap, music, prayer or meditation.
  • Get plenty of sleep every day. If you awake without feeling rested, discuss sleep problems with your doctor. Sleep apnea is associated with an increased risk of stroke, more than doubling the risk of stroke in middle-aged and older men.