YOU & YOUR STROKE or TRANSIENT ISCHEMIC ATTACK
‘Understanding Lessens Fear’
What Happened to me?
You have recently suffered an ischemic stroke or transient ischemic attack (mini-stroke).
An ischemic stroke occurs when a blood clot blocks an artery serving the brain, disrupting blood supply. Very often an ischemic stroke is the end result of a build up of cholesterol and other debris in the arteries (atherosclerosis) over many years.
Ischemic strokes are usually due to:
· A cerebral thrombosis, in which a blood clot (thrombus) forms on an atherosclerotic plaque in a main artery leading to the brain, cutting off blood supply.
· A cerebral embolism, in which a blood clot forms in a blood vessel elsewhere in the body, for instance in the neck or the heart, and is carried in the bloodstream to the brain.
· A lacunar stroke, in which the blockage is in the small blood vessels deep within the brain, often due to atherosclerosis.
Athero …..what?
Atherosclerosis is a condition caused by the build up and inflammation in the arteries, which leads to lesions called plaques. These plaques are made up of excess cholesterol, other fats and inflammatory cells in the artery wall. Such plaques can lead to narrowing of your arteries and cause decreased blood flow to the brain.
At times these plaques can suddenly become unstable and rupture, leading to strokes. Atherosclerosis can be a progressive disease. People with atherosclerosis are 5 to 7 times more likely than the general population to have a vascular event (blood vessel event) thus making them at higher risk for a stroke.
What can be done about atherosclerosis?
There are medications that can be taken and lifestyle alterations that can be made to dramatically lower the risk of strokes by halting, reducing or even reversing the progression of atherosclerosis. In addition to the medications there are important lifestyle changes that can also lower the risk.
At UCLA we are pioneering a novel stroke prevention method called the Stroke PROTECT (Preventing Recurrence of Thromboembolic Events through Coordinated Treatment) Program to assist your doctors in initiating these life saving medications and lifestyle changes.
What are these survival enhancing techniques?
Compliance with every one of these 8 goals is extremely important!!!
1) Antithrombotics
· Prevent the formation of blood clots on the plaques.
· Include: Aspirin, clopidogrel (Plavix), aspirin/dipyridamole (Aggrenox), ticlopidine (Ticlid), warfarin (Coumadin)
· Side effects* may include headache, gastrointestinal upset or increased risk of bleeding.
2) ACE Inhibitors
· Protect the heart and blood vessels from damage. These medications lower the blood pressure but have also been found to benefit individuals who start off with normal blood pressures.
· Include: captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril), ramipril (Altace), quinapril (Accupril), benazepril (Lotensin), trandolapril (Mavik), moexipril (Univasc), and perindopril (Aceon).
· Side effects* are uncommon. Less than 2 out of 100 patients have experienced any severe side effects requiring stopping the medications. They include cough, rash, loss of taste, hypotension (low blood pressure), and swelling.
3) Statins
· Reduce bad cholesterol and inflammation in the arteries thus preventing the build up of plaques in the arteries and preventing existing plaques from rupturing. Although they can lower cholesterol levels, they also benefit individuals who start off with normal or low cholesterol levels.
· Include: simvastatin (Zocor), pravastatin (Pravachol), atorvastatin (Lipitor), lovastatin (Mevacor), fluvastatin (Lescol)
· Side effects* are rare, occurring in less than 3 out of 100 people taking these medications. They include muscle soreness (rare), nausea or stomachache, liver irritation (uncommon), rash, general fatigue (tiredness), insomnia.
4) Diuretics
· In conjunction with ACE inhibitors these further protect the heart and blood vessels from damage. They lower blood pressure as well but are only added to your treatment regimen in certain situations at the discretion of your doctor.
· Include: hydrochlorothiazide (Hydro-chlor), triamterene/hydrochlorothiazide (Maxzide), chlorothiazide (Diuril), benzthiazide (Aquatag), cyclothiazide (Anhydron), indapamide (Lozol), chlorthalidone (Hygroton), metolazone (Zaroxolyn), furosemide (Lasix), spirinolactone (Aldactone)
· Side effects* - Weakness, muscle cramps, rash, throwing up, diarrhea, cramps, dizziness or lightheadedness.
Please note there may be certain conditions that you have or other reasons why you may not be receiving one or more of these medications. You should check with your doctor so you can understand what these reasons are if you are not receiving all three of these medications.
*If any of these symptoms occur you should call your doctor right away.
5) Exercise
Regular exercise decreases LDL (“bad cholesterol”) and increases HDL (“good” cholesterol). It also keeps arteries elastic, which in turn keeps blood flowing and blood pressure low. Once approved by your doctor you should begin a regular exercise program aiming for a minimum of 30 – 60 minutes 3 to 4 times weekly, supplemented by an increase in daily activities. Walking, jogging, cycling or any aerobic activity, are good ways to achieve this.
6) Diet
Diet in conjunction with the statins decreases the risk of progressive plaque build up. A low saturated fat and cholesterol diet would help to maintain your normal weight. The American Heart association recommends a diet containing <30% calories from fat and <7% saturated fat and <200mg a day of cholesterol. Also eating more foods high in fiber, for example the soluble fiber found in oats, beans and fruits can help lower your cholesterol level. Information on the AHA diet can be found in your accompanying stroke package or online at www.amhrt.org.
7) Smoking
If you smoke, you must STOP!! The risk of stroke declines rapidly after stopping smoking. Smoking causes narrowing of the arteries and makes the blood more likely to clot - both risk factors for stroke. It also increases blood pressure - another major risk factor for stroke. Continued smoking makes you 5 times more likely to have a heart attack, stroke and die. If you quit, your risk goes down dramatically even in a few days. Options to help you quit include nicotine replacement therapy, a medication called zyban that decreases the craving for smoking and formal smoking cessation programs. Your family should help you, by making sure that any family members who smoke also quit.
8) Stroke Awareness
Stroke warning signs and instructions on what to do in the event of a stroke are included in your accompanying stroke package.
Please Note these things may seem hard to do. However the payoff is a longer & more productive life. You may not succeed on your first try. Work closely with doctors and nurses and don’t give up. All these measures are important whether your stroke is due to plaque buildup in the blood vessels of the brain, a clot that migrated from the heart, a tear in the wall of the blood vessel or an increased tendency for your blood to clot. There is also the additional benefit of decreased risk of heart disease with adherence to this program.
What happens next?
Make sure that you have appointments scheduled with your doctors before you leave the hospital. Try not to miss appointments, but if you do, make sure to reschedule.
It is important that you follow-up with your doctor and continue to make use of the beneficial therapies started while you were in the hospital. One of the major reasons why patients have another stroke is because they did not continue to take their prescribed medications. The clinic appointments serve to reinforce a strict adherence to the goals of the program.
Are there any goal values I should be aware of?
· LDL cholesterol < 100mg/dl (low density lipoprotein, also known as the “bad” cholesterol)
· Blood pressure <140/90 mmHg
Please note that some individuals believe that they can stop their medications once they have reached the targeted levels, but this is not the case because levels could become abnormal again thus exposing you once more to increased risk. Your LDL and BP need to be continuously monitored. Keep a personal record of your LDL and blood pressure readings.
For more information, please feel free to visit our website at www.strokeprotect.mednet.ucla.edu
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UCLA Ronald Reagan Medical Center
Revised 12/08