When Stroke Strikes

Strokes kill about 5 million people each year and is considered as the second leading cause of death worldwide. At least 15 million patients have non-fatal strokes annually, and about a third is significantly disabled as a consequence. In the Philippines, it is one of the leading causes of death together with other vascular diseases.

A stroke is similar to a heart attack. It is caused by the malfunction or “death” of a part of the brain when there is a lack of blood supply to that certain part due to a clot or a ruptured vessel. When stroke hits a patient, time lost is considered brain lost. The faster he gets help and able to receive medical intervention, the greater the chance for the patient to recover from the stroke.

Equally important is for one to recognize the warning signs of stroke. Everyone is advised to be conscious of the following signs: sudden numbness or weakness of the face, arm or leg especially on one side of the body; confusion having trouble in speaking, understanding, seeing with one or both eyes, walking dizziness, loss of balance or co-ordination; and severe headache with no known cause.

But before a stroke happens, one needs to understand its risk factors so that medical intervention is administered early and aggressively. The non-modifiable risk factors for stroke include age, sex, family history, face and ethnicity-factors that we cannot control. However there are modifiable risk factors for stroke which when eliminated or controlled reduce the risk of stroke significantly. These are hypertension, cardiac disease (particularly atrial fibrillation), diabetes, hyperlipidaemia or elevated cholesterol, cigarette smoking, alcohol abuse, physical inactivity, asymptomatic carotid stenosis, and transient ischemic attack.

There is a growing concern that because of the lifestyle and diet of Asians, particularly Filipinos, cholesterol levels are rising resulting to an increasing risk for stroke (brain attack). Recently, published in the Journal of Epidemiology, the Asia Pacific Cohort Studies Collaboration reported a 25% increased risk of fatal or non-fatal ischemic stroke in the region, associated with increasing total cholesterol, as the result of assessing outcomes from 29 study groups across the region. The same report confirmed that cholesterol is rising substantially in Asia.

The Link Between Cholesterol and Stroke

In addition to being a leading cause of heart attacks, high cholesterol is emerging as a major risk factor for what is known as ischaemic stroke. In this type of stroke, the blood supply to part of the brain is cut off because either atherosclerosis or a blood clot has blocked a blood vessel. This is in contrast with the other type of stroke that is known as hemorrhagic, where a blood vessel bursts, and allowing blood to leak into an area of the brain.

With an ischemic stroke, blockage can occur anywhere from the heart along the arterial pathways to the brain. For example, high cholesterol can cause a large deposit of fatty material (atherosclerosis) to develop in a carotid artery (supplying blood to the head), reducing its blood flow to a trickle or to stop completely. This condition is serious because each carotid artery normally supplies a large percentage of the brain’s blood supply. Fatty material may also break off from the wall of a carotid artery, travel with the blood, and become stuck in a smaller artery, blocking it completely. Clots can also develop, break off and travel from chambers in the heart to block the brain arteries.

Cholesterol Treatment to Reduce Stroke Risk

As use of the latest main group of drugs known as the “statin” class indicated to reduce cholesterol continues to grow around the region, researchers are also discovering new ways for these drugs to help prevent other dangers caused by high cholesterol, including stroke in addition to heart attacks. A study among hypertensive patients, The ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) study was stopped two years earlier than planned – in part because of the major benefits seen to reduce stroke when patients with existing high blood pressure were treated with atorvastatin. Atorvastatin, a medicine from the world’s number one research-based pharmaceutical company Pfizer, has also been proven effective among diabetic patients in preventing the occurrence of non-hemorrhagic strokes. The Collaborative Atorvastatin Diabetes Study (CARDS) showed that type 2 diabetic patients given atorvastatin 10mg daily reduce their risk of developing non-hemorrhagic stroke by a significant 50%.

For patients who had a previous stroke or transient ischemic attack (TIA), despite the treatment options currently available, they are still at increased risk for an additional stroke or heart attack. Up to 40% of people who have experienced a first stroke suffer a second stroke within five years, despite currently available treatment options. However, SPARCL (the Stroke Prevention by Aggressive Reduction in Cholesterol Levels) – the first large-scale, prospective, randomized, placebo-controlled statin trial designed to evaluate a population consisting only of patients with prior stroke / TIA without CHD – demonstrated that atorvastatin 80mg significantly reduced the risk of stroke by 16% and reduced the risk of major coronary events by 35%, a result never before demonstrated by a statin in this population.

“It is important for patients to be more aware about their disease and its possible risks for better health management. A sensible lifestyle and high quality medication for ailments such as cardiovascular diseases and diabetes would be the key in making sure that healthcare needs are addressed sufficiently, says Dr. James Wee, Pfizer Philippines Cluster Physician for Lipids and Metabolics”. “it is also higly important that patients communicate with their doctors regularly so that they are given ample information about their disease. This will greatly help in making the patient understand his condition,” he adds.