Tag Archives: Public Health

An Active and Long Life Springs from Your Vascular Health (Part 2)

By Hui Xie-Zukauskas

Continued on Strategies to control risk factors for stroke – 

Norm & Artheroma Arteries_AHAFundamentally, atherosclerosis (particularly in carotid artery) is the primary cause of a significant portion of ischemic strokes. Cardiovascular risk factors can facilitate the progression of atherosclerotic plaque.

Atherosclerotic disease can be asymptomatic initially because it develops over time. When a plaque grows larger enough to reduce blood flow supplying to vital organs (usually >70% stenosis or narrowed vessel), ischemic symptoms may occur. However, it doesn’t mean that smaller plaques (30-40% stenosis) are stable without rupturing to cause a blockage.

How do you prevent or slow down atherosclerosis and stroke by reducing risk factors?

First, before I lay out key preventive strategies, let me quickly draw your attention to some risk factors for stroke, especially those modifiable and those beyond conventional cardiovascular risks. They include:

  • 3 Highs (high blood pressure, high blood lipids, and high blood sugar)
  • Atherosclerotic disease and/or other cardiovascular disease
  • Obesity
  • Smoking and alcohol abuse
  • Unhealthy lifestyle such as poor diet and physical inactivity
  • Atrial fibrillation
  • Sleep apnea and other sleep problems
  • Chronic kidney disease
  • Sickle cell disease
  • Illicit drug use (marijuana, cocaine or heroin)

Illicit drug use can increase the risk of all types of strokes. Cannabis or marijuana use has been linked to vasospasm, ischemia, and increased hemorrhagic incidence in the brain, likely due to the vasoactive properties of delta-9-tetrahydrocannabinol (THC), a key component of these plants.

  • COVID-19 infection

Acute ischemic stroke and intracerebral hemorrhage are known neurological complications in patients with COVID-19, frequently in individuals 50 years or younger with asymptomatic COVID infection. The possible mechanisms include that blatant inflammatory response and “cytokine storm” associated with COVID cause endothelial injury; that the disease causes arterial and venous clots, thus resulting in poor outcomes.

  • Socioeconomic factors (e.g., lower income with inequality in health care, etc.)

Certainly, there are risk factors out of your control, such as age, gender, family history, a history of stroke, transient ischemic attack (TIA) or heart attack, and race. Note that black people have twice the risk as white, particularly young black population.

Here are 8 Key preventive strategies to put into actions:

I’d also like to stress that the point is not just knowing to have a healthy diet or exercise more, but to know important reasons behind and why these strategies work on targets to avert stroke.

1.      Lower your blood pressure (BP).

As stroke doesn’t discriminate (by) age, neither does high blood pressure. High blood pressure is a leading cause of stroke. Young people should never disregard their elevated blood pressure, especially those with a family history of stroke or hypertension and black women.

High blood pressure is also the most significant controllable risk factor. Better BP control works, because evidence shows that tight BP control (systolic <130 mm Hg) was associated with a 42% lower incidence of stroke compared with standard control (130–139 mm Hg).

I’ve notified the danger of high BP, including to watch BP in young people. If you haven’t done so yet, please check out this article – Hypertension can be asymptomatic but potentially fatal.

If you have hypertension but with difficulty to manage it, try to figure out where you can target; for example, whether medication not working or side effect issues, whether your diet is healthy, you exercise enough or you have adequate support.

2.      Lower your blood cholesterol. Critically, lower your bad cholesterol (LDL).

LDL increases plaque formation or growth in the arterial wall, and high cholesterol can also cause blood clots due to fatty deposits’ suddenly breaking off; if the blood supply to the heart or brain is significantly blocked, heart attack or stroke occurs. Avoiding or limiting diet high in saturated fat and trans fats, along with physical activity, can minimize the risk for stroke.

3.      Lower your blood sugar, control your weight, and prevent diabetes.

Diabetes is an independent risk factor for stroke, and with combined overweight, its damaging impact on health piles up over time. Again, diabetes is controllable. Obesity and excess bodyweight pose an increased risk for diabetes, hypertension, heart disease and stroke.

4.      Lower your stress level.

Cumulative psychological or mental stress is associated with increased inflammation in the body, and more significantly, with mortality, cardiovascular disease, and stroke.

Depression has a direct or indirect link to a number of illnesses including Alzheimer’s disease, and cardiovascular events. Studies also showed that stroke survivors who experienced high and persistent levels of stress negatively affected the brain repair process and recovery outcome.

5.      Quit smoking.  Non-smokers should encourage people around you to do so.

This sounds repetitive or nothing new, but this is one of the most valuable things you can do to save lives of people for whom you love and care.

Smoking increases inflammation in the body and plaque buildup in the blood vessels, and makes the blood thicker to facilitate clot formation, leading to heart attack and stroke. Needless to say, toxicities from smoking (e.g., nicotine and carbon monoxide, etc.) ravage your cardiovascular system, thus paving the road to stroke.

Don’t overlook second hand smoking and e-cigarette smoking either.

6.      Practice a healthy lifestyle.

Poor diet and physical inactivity contribute to several cardiovascular risk factors and metabolic disorders, thereby presenting an increased risk for stroke. So, get more active, get a nutrients-rich diet, get bodyweight controlled, and get social. Equally important, have a well-balanced life including relationship, financial, and psychological wellbeing.

7.      Take seriously alcohol and drug abuse.

Alcohol influences on stroke are not uniform. While low to moderate alcohol consumption (£2 drinks daily for men or £1 for women) may reduce stroke risk, even low alcohol consumption escalates the risk of hemorrhagic stroke.

As mentioned above, regular substance use (e.g., cocaine, heroin, phencyclidine (PCP), amphetamines, and cannabis/marijuana) sets an increased risk for stroke, which is a common predisposing factor for stroke among young individuals.

8.      Recognize warning signs of acute cardiovascular events (heart attack and stroke).

Young folks (those under 50) may think this is too early for you. Not anymore! Learn those signs seemingly not related to heart. For instance, sudden poor vision in one or both eyes are reported in 66.1% of stroke patients, and pain or discomfort in the arm or shoulder, 53.8%.

Take-home message:

Stroke is dangerous and deadly. Greater awareness, better control of modifiable risk factors all help prevention and timely treatment.

To reduce atherosclerotic plaque development, know your critical numbers (blood pressure, cholesterols and sugar), monitor them, and keep them at healthy levels, while maintaining a healthy weight through diet and exercise routine. More importantly, take these measures as early in life as possible.

 

Image credit: heart.org

An Active and Long Life Springs from Your Vascular Health (Part 1)

By Hui Xie-Zukauskas

Norm & Narrowed As_Heart.org & VitalscanWhat jumps to your mind when hearing “stroke”?

Whether you say – it’s a primary cause of death and long-term disability worldwide, or FAST (i.e., the acronym of stroke signs: Face dropping, Arm numbness/weakness, Speech difficulty—Time to call 911), high-five to you!

Have you ever thought of stroke as older people’s disease? If so, you need to know beyond that.

I’m going to provide you with the most recent and significant evidence on changing trends of stroke, based on American Heart Association’s statistics on heart disease and stroke 2022 update and wealth of research publications.

I’ve read some touching stories of stroke survivors from American Heart Association News. A common thread emerging in these stories: The survivors are young, age 20-40s, carrying out a typical routine on an ordinary workday, then stroke hit each of them, followed by a long, courageous journey of rehabilitation and recovery.

So, what’s happening here?

First, let me give you a snapshot of the big picture:

  • Each year, about 795,000 people experience a new or recurrent stroke.
  • Of all stroke types, – 87% are ischemic stroke (a blockage of the brain artery caused by a blood clot), and – 13% intracerebral hemorrhage (a bleed into the brain caused by burst of a weak vessel or ruptured aneurysm), including 3-5% subarachnoid hemorrhage.
  • Approximately 10% of all strokes occur in adults under 50 years of age. 
  • On average, every 3.5 minutes, someone died of a stroke.

Although stroke rates declined slowly over decades in old adults, a concerning trend is that stroke incidence increased in young adults, and noticeably, young women (18-45 years) had a higher risk and incidence of ischemic stroke than men of the same age.  Specifically, women at ages 35 or younger are 44% more likely to suffer from ischemic strokes than their male peers, but no gender difference in young adults age 35 to 45 years. Furthermore, women do worse after stroke.

But about 80% of strokes are preventable, and the key is to control risk factors.

What is sex difference in stroke? Why do women do worse?

Beside those modifiable and non-modifiable risk factors that increase the risk of ischemic stroke regardless of gender (I’ll address later), women have unique risk factors such as:

  1. Pregnancy: Pregnant women have a 3 times higher risk than young, non-pregnant ones. Hypertension related disorders in pregnancy (e.g., preeclampsia, eclampsia) are known as a stroke risk factor, and the risk of stroke can be 5.2 times higher in these women.
  2. Oral contraceptives (Birth control pills): The overall risk is low, but the risk increases in women with other risk factors (e.g., smoking, obesity, and higher cholesterols).
  3. Migraine: It’s more common in women than in men, the risk increases with its frequency, and with additional risk factors (e.g., oral contraceptives, smoking, etc.)
  4. Atrial fibrillation: Despite its high prevalence in men, atrial fibrillation triggered stroke risk increases in post-menopausal women.
  5. Menopause: Higher risk and mortality of stroke occurred in women reaching menopause at age younger than 45 years.
  6. Hormone replacement therapy (HRT): Current users of oral HRT had a higher risk of ischemic stroke than non-users, irrespective of low or high dose(s).

Other documented factors include preterm delivery, social or economic determinants, etc.

Women often fare worse in stroke, because age plays a large role as a nonmodifiable risk factor. Women tend to be older at the time of stroke, experience more severe stroke than men; they are also in poorer health prior to stroke, and more likely live alone and develop depression afterward. Strikingly, young women have a worse functional outcome too.

In addition, initial signs or symptoms of stroke in women may differ from those traditionally recognized ones, leading to certain misdiagnosis and delayed treatment in the clinical setting.

Strategies to control risk factors and prevent (or reduce) stroke – Stay tuned.

For now, remember: no one is too young for stroke, no time is set for stroke. In other words, stroke can hit anybody at any age and at any time!

So, recognize F.A.S.T.

 

Image credit: heart.org and vitalscan.com

Many Thanks to Readers’ Favorite for the Award & Honor!

By Hui Xie-Zukauskas

I’m happy to share this news, and will continue providing values to the public and potential readers.
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Award Winner for Book by Readers Favorite_2020

Breathe Clean

By Hui Xie-Zukauskas

EarthDay_153704793_FlikNowadays, when we take a deep breath, we are likely to be breathing in polluted air. Compared to the air in Beijing, which is typically smoggy, the air in the United States may seem relatively clean. However, there can be many invisible pollutants in our air, including toxic substances, radiation, and infectious agents. Numerous pollutants may also appear in our water and soil.

Today, on Earth Day, let us reflect on how our environment plays a vital role in public health. This includes our risk of contracting cancer, because environmental factors such as exposure to air pollution have been found to be associated with this dread disease. This of course includes smoking, both active and passive, since smoking is one of the most common causes of cancer, accounting for about 30% of cancer deaths in the United States due to exposure to cancer-causing substances in tobacco products.

Other sources of environmental contaminants that you should be aware of include:
-          hazards from the gaseous, vapor, and particulate phases of the atmosphere
-          radiation
-          sun rays (UVA/UVB)
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-          chemicals, toxins, and carcinogens that may be hidden in your food, your cleaning and other household products, and in the air and water in your home and workplace

Pollutants are all around us, many of them man made. One danger of these pollutants is that they can cause DNA damage, which is known to be a critical initial event in the development of cancer. It is disturbing to learn from Asia studies that children in major cities of developing countries have an increased risk for cancer as a consequence of exposure to genotoxic substances in their environment. Evidently, factors outside the body change the components and systems inside the body over time.

Many of these cancers can be prevented by environmental control and lifestyle choices. Making wise choices for all of our family is crucial because we have a responsibility to safeguard not only our own health, but that of our children.

I hope we all strive to make every day an “Unpolluted Air Day”.  A healthy earth with a healthy environment promotes healthy living for each and every one of us.

Image Credit: By jurvetson