Once a stroke develops, even after active treatment, patients often die or are left with sequelae such as hemiplegia, aphasia, and facial paralysis. Therefore, prevention is much more important than treatment for cerebrovascular diseases, especially before the onset of the disease. So what should we pay attention to in our daily life or who should pay special attention to prevent stroke? Let’s talk about it in detail.
(1) Control of high blood pressure
The close association between elevated blood pressure and the development of stroke has been confirmed by many epidemiological studies. Regardless of the cause of hypertension, whether it occurs at any age or sex, whether it is systolic or diastolic blood pressure or mean blood pressure, and whether it is for hemorrhagic or ischemic stroke, hypertension is a well-recognized, strong, most important, and independent risk factor. There is evidence that the degree of increase in blood pressure is a direct function (positive) of the increased risk of stroke and that the “risk” effect of hypertension does not decline in older age groups.
A review of the medical history of stroke patients reveals that approximately 80% of patients with cerebral hemorrhage have a history of hypertension; approximately 70% of patients with cerebral infarction have a history of hypertension. Patients with hypertension are 3-5 times more likely to have a stroke than those with normal blood pressure. However, a large number of clinical studies have confirmed that with long-term adherence to treatment and effective control of blood pressure, the incidence of stroke can be significantly reduced. One study confirmed that continuous antihypertensive treatment for 2-3 years in most hypertensive patients in a population can reduce the incidence of stroke and mortality by 39%.
(2) Early detection and attention to “mini-stroke”
Transient ischemic attack, or TIA, is commonly known as “mini-stroke”. The risk of complete stroke is 6 times higher in people who have had a TIA than in normal people. It has been reported that 9% to 35% of stroke patients have a prior history of TIA, and about 1/3 of TIA patients will develop a complete stroke.
The pathological basis of TIA is the same as that of complete stroke, but it occurs on the basis of cerebrovascular atherosclerosis, except that the lesions are less severe and the ischemia of the brain tissue is short-lived. It occurs mostly in elderly people with a history of atherosclerosis or hypertension, and the attack can be characterized by three major features, namely stereotypy, transience, and recurrence, depending on the distribution of cerebral vessels and the characteristics of the disease.
(1) Stereotypy refers to the appearance of clinical manifestations with a fixed pattern and two major groups of symptoms based on the distribution of cerebrovascular flow supplying cellular skills sites. One group is the transient dark haze that appears in the internal carotid artery system and the ophthalmic artery with transient ischemia, which is relieved for a short time. One side alone involves numbness and dullness in the limbs of the hands and arms, difficulty walking, and also symptoms of unfavorable speech and slurred speech. Inadequate blood supply to the vertebrobasilar artery presents with symptoms such as blurred vision in both eyes, vomiting, ataxia, unsteady walking, dysarthria, dysphagia, and sudden falls. It is very rare to have ischemic disorders in both systems of the body at the same time.
②Transient Each attack is brief, most of them resolve after a few minutes to a few minutes, and a few patients stop on their own within 24 hours, and the clinical symptoms disappear after the attack resolves, leaving no after-effects. The average attack time of intracranial artery TIA is 14 minutes, and the average attack time of vertebrobasilar artery TIA is 8 minutes to relieve.
③Recurrence refers to the fact that after the initial attack, patients often experience recurrent attacks, some patients may have several attacks a day, some once every few months, and in general the symptoms are recurrent. About 10% of TIA patients with incomplete control within a year may have a severe stroke, and one study reported that about 5% of TIA patients seen in the emergency room can progress to a complete stroke within 48 hours.
”Although minor strokes are mild, short-lived, and do not cause substantial damage for the time being, they are often the precursor to cerebral thrombosis and cerebral hemorrhage. Therefore, the medical profession also calls “mini-stroke” a red alarm signal of stroke. It should be remembered that once the above-mentioned symptoms are detected, they should not be ignored and should be treated seriously by early medical consultation.
(3) Early detection and active treatment of heart disease
Heart damage from various causes is considered to be a major risk factor for stroke. Types of heart diseases include rheumatic heart disease, coronary arteriosclerotic heart disease (coronary heart disease), acute bacterial endocarditis or cardiac mucosal tumor. In particular, the chance of stroke is greater when accompanied by cardiac rhythm disturbance and atrial fibrillation. It is suggested that there may be a synergistic pathological mechanism between ischemic heart disease and the formation of cerebral thrombosis. When the heart is ischemic, the blood supply to the brain is insufficient due to the reduction of cardiac output and circulating blood volume, and the brain tissue is under conditions of ischemia and hypoxia and altered hemodynamics, especially for middle-aged and elderly people with cerebral atherosclerosis, which greatly increases the risk of stroke development. Moreover, heart disease can directly lead to the occurrence of stroke, such as rheumatic heart disease when the attached wall thrombus dislodged and caused by cerebral embolism, which is the direct cause of stroke.
(4) Control of diabetes
Studies in North America and Europe have confirmed that diabetes is a definite risk factor for stroke, especially ischemic stroke, and a high percentage of stroke victims in these countries have a diagnosis of diabetes on their death certificate. Stroke due to diabetes has the following characteristics that should be highly alarming
(1) Type of stroke: Ischemic stroke is more common than hemorrhagic stroke. The literature reports that ischemic strokes account for 89.1% of diabetic strokes and hemorrhagic strokes account for 10.9%.
(ii) Age characteristics: there are more elderly people, 80% of them are over 50 years old and 10% are under 50 years old.
(③) Mode of stroke onset: slow onset, with peak values between 12 and 72 hours in the complete group, and up to 30% of cases within 30 hours.
④Site characteristics of the onset: more small and medium-sized infarcts, more multiple infarcts, more sites, involving the basal ganglia, pontocerebellum, cerebellar penetrating branches and other sites.
⑤Many TIA episodes are associated: 6% to 28% in diabetics, three times more than in non-diabetics.
(6) High recurrence rate of stroke, and some may be accompanied by vascular dementia.
(5) Pay attention to weight control
The relationship between obesity and stroke is not as obvious as the relationship with coronary heart disease, but it can indirectly affect the occurrence of stroke through blood pressure factors. Longitudinal epidemiological studies have confirmed that changes in body weight are positively correlated with changes in blood pressure, and that reducing body weight can reduce the risk of hypertension. The prevalence of hypertension is 2.9 times higher than that of normal weight people. Since hypertension and coronary heart disease are both risk factors for stroke, it can be assumed that obesity (overweight) is indirectly related to stroke.
(6) Smoking cessation
Most studies have also failed to confirm that smoking increases the risk of stroke, although it is well established that it increases the risk of coronary heart disease. It is believed that smoking plays a role in the multifactorial effect of stroke, especially ischemic stroke. However, when considered as a single factor, the effect is small. A foreign scholar used xenon inhalation to continuously measure cerebral blood flow in smokers and controls, and found that blood flow in both cerebral hemispheres was significantly reduced in smokers, especially in those with stroke risk factors, suggesting that long-term smoking, especially long-term heavy smoking, can reduce cerebral vasodilatory function and accelerate atherosclerosis and increase the risk of stroke. A study in rural areas of 21 provinces in China also showed that smoking is associated with ischemic stroke, so it can be considered that encouraging smoking cessation should be considered as one of the measures to reduce the risk of stroke.
(7) Limit the amount of alcohol consumption
It is generally accepted that either a single episode of intoxication or chronic alcohol abuse increases the risk of hemorrhagic stroke, including subarachnoid hemorrhage and intracerebral hemorrhage. However, in the case of cerebral infarction, studies in various countries have shown conflicting results, with some suggesting that alcohol abuse increases the risk, while others suggesting that the two are unrelated. Studies in China have not reached a clear conclusion either. In 6 urban studies, no association between alcohol abuse and stroke was found, while in 21 provincial rural studies, alcohol abuse was associated with cerebral infarction. It is believed that alcohol increases the number of platelets in the blood and poorly regulates cerebral blood flow, which can lead to hypertension, arrhythmia and hyperlipidemia, thereby increasing the risk of stroke.
(8) Reduce salt intake
The role of different electrolytes (sodium, potassium, calcium, etc.) in the pathogenesis of hypertension is still debated.
Prior et al. and Shape reported that a low-salt diet maintained blood pressure at a low level and did not increase with age. In addition to increasing the risk of stroke through hypertension, salt also has a direct damaging effect on the vascular wall, exacerbating the complications of cerebrovascular disease. The association between high salt intake and stroke has been confirmed in case-control studies conducted in both urban and rural areas of China.
It is also interesting to find that the difference in geographic distribution of stroke high in the north and low in the south shown in the domestic neuroepidemiological survey is not only consistent with the difference in geographic distribution of hypertension found in previous studies in China, but also with the geographic differences shown in salt consumption surveys in various provinces and cities across the country. In conclusion, it can be concluded that high salt consumption is one of the risk factors for stroke. Recent studies have also suggested the role of potassium and calcium in the development of hypertension. Several animal studies and population studies have shown that high salt alone is associated with a higher risk of stroke.
Several animal and population studies have shown that high salt alone does not necessarily lead to hypertension, but rather to hypertension when combined with “low calcium intake”. Potassium can counteract the effects of sodium in dilating extracellular fluid and damaging blood vessels, so limiting salt to hypertensive patients and eating foods high in potassium can lower blood pressure.
(9) Low-dose aspirin
2005 Chinese Expert Consensus In 2005, the Chinese Society of Cardiovascular Diseases and the Editorial Board of the Chinese Journal of Cardiovascular Diseases organized and wrote an expert consensus, recommending the use of aspirin (75-100 mg/d) for primary prevention in the following high-risk groups: (1) patients with hypertension but satisfactory blood pressure control (<150/90 mmHg) and one of the following conditions, including age 50 years or older (1) hypertension with satisfactory control of blood pressure (<150/90 mmHg) and one of the following conditions, including age 50 years or older, target organ damage (including moderate increase in plasma creatinine), diabetes mellitus; (2) type 2 diabetes mellitus, age 40 years or older, and cardiovascular risk factors, including family history of coronary heart disease, smoking, hypertension, overweight and obesity (especially abdominal obesity), albuminuria, dyslipidemia; (3) 10-year risk of ischemic cardiovascular disease ≥10% or a combination of three or more of the following risk factors, including dyslipidemia, smoking (2) obesity, age ≥50 years, family history of early-onset cardiovascular disease (men <55 years, women <65 years)
(10) Lifestyle changes
In recent years, the incidence of cerebrovascular disease in China has been increasing year by year, especially in the northern regions, showing a trend of the onset of “younger”. In this regard, experts believe that the main reason for the increase in the incidence of cardiovascular and cerebrovascular diseases is people’s poor lifestyle. Bad lifestyles such as smoking, alcoholism, overweight, increased cholesterol intake, lack of exercise, mental stress, prolonged late nights, lack of sleep, excessive intake of animal protein and insufficient intake of vegetables and fruits and cereals are closely related to the onset of the disease in young people.
(11) Other risk factors
(1) Dyslipidemia and stroke Dyslipidemia is also a risk factor for stroke, which has been confirmed in recent years by the use of statin drugs to lower cholesterol. Low serum cholesterol levels predispose to cerebral hemorrhage, while high serum cholesterol levels predispose to cerebral infarction. A domestic study among Shougang workers in Beijing showed that elevated total serum cholesterol increased the risk of cerebral thrombosis and had a negative effect on cerebral hemorrhage. In conclusion, the risk of stroke is not as clear as the risk of coronary heart disease.
(ii) Season and climate. The relationship between seasonal and climatic stroke onset and season and climate has long been noted. Most of the literature suggests that the incidence of cerebral hemorrhage is higher in winter, whereas the incidence of cerebral infarction is higher in summer.
(iii) Genetic role. The role of genetic factors in stroke remains unclear. Most authors believe that cerebrovascular disease is multifactorial and that its heritability is strongly influenced by environmental factors. Case-control studies conducted in 7 cities and 21 provinces in China have shown that positive cerebrovascular disease and family history of hypertension are clear risk factors for both hemorrhagic and ischemic strokes.
Some foreign studies have also shown that parents of patients with cerebrovascular disease die four times more often than controls, and there is a consistency in stroke in twins, suggesting that genetic factors have some significance in the development of stroke. However, to date, many studies in Europe and the United States have not definitively confirmed the relationship between genetic factors and stroke onset, and as mentioned earlier, studies of Japanese immigrants have demonstrated that environmental factors are more important than genetic factors. Therefore, we should not give too much importance to genetic factors and do nothing to prevent stroke, but should actively prevent it by changing environmental factors.