What You Should Know About Increasing Stroke Numbers

Preventing and treating cardiovascular disease, an umbrella term that includes stroke, heart attack, coronary artery disease, peripheral artery disease and more, has been one of my great passions in life. I suspect it’s impossible to be a primary care physician and not be passionate about heart and circulatory health.

Coronary heart disease, specifically, is the leading cause of death in the U.S. and has been since 1910. Stroke isn’t far behind. Combined, they kill nearly 1 million Americans a year.

Ten years ago, the number of heart disease and stroke deaths were falling at a rate that made many of us think these diseases wouldn’t continue being the top causes of mortality that they are today. This is why a new global report about stroke is so troubling for me. This report shows the numbers of strokes, are increasing. And heart disease seems to be entrenched as the number one cause of death.

Interestingly, stroke among those over 70, an age we tend to associate with heart disease, has continued to decline, but incidents in younger people are going up precipitously.

What happened? Hypertension, type 2 diabetes and obesity. We got a whole lot unhealthier, particularly on diseases that contribute the most towards stroke risk. And it’s impacting people at younger ages.

There are two main types of stroke — ischemic and hemorrhagic. Most strokes are of the ischemic variety, which occur when there is a blockage in the brain caused by a piece of plaque or a blood clot. Hemorrhagic stroke happens when a weakened blood vessel ruptures.

What Puts You at Risk for Stroke

The primary cause of stroke is high blood pressure. When our blood pressure is too high, it can cause blood clots or damage blood vessels deep inside the brain. There are often no symptoms of hypertension, which is why you should have yours checked often.

The way we rate hypertension has also changed. In the past, physicians weren’t as concerned about slightly elevated blood pressure levels, but now anything higher than 120/80 is a concern. If your numbers are at or above this marker, you should talk to your doctor.

High cholesterol contributes to strokes just as it does to heart attacks. Cholesterol builds up in the arteries, even those in our brains. This can narrow the arterial pathways, triggering a stroke or other problems. Also, when cholesterol builds up inside of our artery walls it becomes plaque, a sticky substance that can block arteries potentially causing them to rupture, resulting in an ischemic cerebral event like stroke.

Diabetes also raises your risk for stroke. Uncontrolled diabetes can allow blood sugar to build up and block oxygen and nutrients from getting to your brain. High blood pressure and high cholesterol are also common in people with diabetes.

Being obese or overweight is problematic because it's linked to higher cholesterol levels, higher blood pressure and type 2 diabetes.

And atrial fibrillation, an irregular heart rhythm, is a major risk for stroke because it can produce blood clots in the heart that travel to the brain.

All these conditions can be treated by your primary care doctor, which is why it’s important to see them regularly — even if you’re younger. If you know you have one of these conditions, it’s important to keep them under control. Stroke can be devastating and raise the risk for disability and death.

But it’s also preventable. Eating a healthy diet, getting plenty of exercise, reducing our alcohol intake and quitting smoking are baselines for preventing stroke. We can also do a better job managing chronic conditions and reducing our weight. In particular, new drugs that target obesity are helping lower stroke risk for people who have never had a stroke and survivors’ risks of additional strokes.

While the increase in bad stroke numbers frustrates me, I know we have the tools to identify and treat stroke risk. We just need to do a better job of using them.