Renee Van Stavern, MD, a Washington University neurologist at Barnes-Jewish Hospital, provides an overview of controllable and uncontrollable stroke risk factors.
My name is Renee Van Stavern, and I am an associate professor of neurology here at Washington University. I am part of the administration for teaching young doctors how to be better neurologists. And a large part of that is teaching them how to deal with stroke patients.
There are a number of different types of strokes. Stroke isn’t just one disease. We typically divide strokes into two types. There is a blood vessel blockage kind of stroke, which is called an ischemic stroke. There are strokes where blood vessels break open. Those are called hemorrhagic strokes. And even within those broad categories, there are multiple other types of strokes. Certainly reasons why folks might have strokes as well.
So it’s really a multitude of different diseases rather than just one disease, which is why here at Barnes-Jewish Hospital and Washington University, we take such pride in trying to provide a tailored approach to stroke care when we see our patients in the hospital.
What I’d really like for folks to learn is probably two things. Just keep it very simple. Number one, to recognize the sorts of signs and symptoms that they could have if they were having a stroke at the time, so that they know to call 911. And number two would be, to use it as an opportunity to make themselves healthier. To start working with their doctors if they’re not already, on some of these medical problems that we can do something about that prevent strokes.
To use it as an opportunity to eat healthier, to become more active. I mean, they don’t have to start running a marathon. But just to even add five minutes to their walking routine or get started on a walking routine, or it doesn’t even have to be walking. Just some way that they’re more active on a day-to-day basis. Using the step counter on their, you know, on their smart phones, for example. But I think those would be the two things that if I were designing a program, that I would probably focus on.
Some of the primary risk factors for stroke, there are some that we can control and some that we can’t. Sorts of things that we can’t control are things like gender and age. Things that we can control include things like high blood pressure, cholesterol, diabetes to some degree. Are, you know, kind of exercise and lifestyle habits. And treatments of other medical conditions, like cholesterol blockages in the arteries of the neck or abnormal heart rhythms. And then, of course, a big lifestyle thing like smoking.
In particular, high blood pressure is one of the biggest risks and modifiable risks for stroke, and honestly, other vascular diseases. So it covers a lot of ground from a health, a wellness and risk prevention perspective. So the biggest thing there is doing the best that you can to keep your blood pressure normal.
And so for some people, all that means is regular exercise at least 30 to 90 minutes a day, five days a week. For other people, that may mean one or more medications that they take on a daily basis and work on with their regular doctor to try to adjust the doses of those medications, so that they find the right balance between getting their blood pressure as close to normal as possible versus any potential side effects that they might have from those medications.
I think that certainly over the next 10 to 20 years, there will be additional advancements. What we’ve seen just in the last five to 10 has certainly very recently made a big difference in how we are approaching our stroke patients. Certainly, TPA, which is also known clot buster, was one of the biggest advancements. But that treatment came out in 1995, and it was really slow to be adopted by, by a lot of hospitals and communities. I think then the last decade, that’s really been on the uptick. And certainly these inside the blood vessel treatments are also things that now people are really latching onto as something that can potentially be done for our acute stroke patients. So I think we’re going to see more and more of that from the perspective of acute stroke and when people are first having their symptoms.