Are you at risk for a stroke?

Stroke is the third-largest killer of Canadian adults, after heart disease and cancer. It's also the primary cause of physical disabilities and is second only to Alzheimer's disease as a cause of mental disability.

In Canada, there are more than 50,000 strokes a year. About 6% of deaths in Canada are due to stroke – and 20% of cardiovascular-related deaths. On average, one stroke occurs every 10 minutes; 15% of them will result in death, 10% in complete recovery, and the remaining in varying degrees of long-term disability. Although the risk of stroke doubles every 10 years after age 55, there are 6.7 strokes for every 100,000 people under the age of 19.

While anyone can have a stroke, including young healthy people, some of us are more at risk. Stroke has many of the same risk factors as heart disease. Although some risk factors, such as age, cannot be controlled, there are many risk factors that can be controlled.

Risk factors that can be controlled or treated include:

  • high blood pressure
  • high cholesterol
  • diabetes
  • blood vessel disease (such as peripheral artery disease or carotid artery disease)
  • atrial fibrillation (a disorder of the heart rhythm where the upper chambers of the heart quiver instead of beating normally)
  • heart disease (including atrial fibrillation)
  • transient ischemic attacks (TIAs; a "mini-stroke" that has symptoms similar to a stroke, but with no lasting brain damage)
  • some types of blood disorders (such as sickle cell anemia)
  • smoking
  • inactivity
  • obesity
  • diet
  • high alcohol consumption (for men, more than 14 drinks per week; for women, more than 9 drinks per week)
  • recreational drug use (cocaine, amphetamines, and LSD)
  • use of postmenopausal hormone therapy
  • stress

Risk factors that cannot be controlled or treated include:

  • age: stroke risk increases as you age, doubling every decade for people over 55 years of age
  • gender: strokes are more common in men than in women until menopause, but women are more likely to die of stroke
  • family (parents, siblings, or children) history of stroke or heart disease
  • ethnicity: First Nations people and people of African or South Asian descent are more likely to have high blood pressure and diabetes and so are at a higher risk of heart disease than the general population
  • personal history of heart attack or stroke: if you have already had a stroke or heart attack, you're more likely to have a stroke
  • low birth weight

If you're concerned that you might be at risk, speak to your health care professional. They will be able to help you find ways to deal with the risk factors that can be controlled.

Preventing strokes

Your best bet in preventing stroke is to identify your risk factors for stroke, and to work on the ones that can be controlled or treated. Your health care professional will be able to help you identify the risk factors that you can work on, and develop a plan that will work for you.

There are many changes that you can make to your lifestyle that will not only reduce your risk of stroke, but also improve your overall health:

  • Quit smoking and avoid secondhand smoke. Between 5 and 15 years after quitting smoking (depending on how much and how long you smoked), your risk of stroke will be the same as that of someone who never smoked.
  • Drink alcohol in moderation. Limit yourself to no more than 2 drinks per day, to a maximum of 14 per week for men or 9 per week for women.
  • Be active. Try to have at least 150 minutes of moderately intense physical activity each week. It can be as simple as going for a walk at lunch. If you are not very active now, check with your doctor before starting a new exercise program.
  • Try to reach and stay at a healthy weight. Talk to your doctor about a nutrition and exercise program that can help you do this.
  • Control stress. Be aware of what causes stress for you and find ways to cope. To reduce the amount of stress that you have, you can look for ways to simplify your life or delegate some responsibilities to others. To help deal with the physical effects of stress, some people find exercise, yoga, meditation, and deep breathing helpful. It may take a few tries before you find the method that works best for you.
  • Know what you're taking. Some natural health products and over-the-counter products can increase blood pressure and the risk of stroke. Check with your doctor or pharmacist before taking any new medications.

There are a number of health conditions that may increase your risk of stroke. To control these risk factors:

  • Have your blood pressure checked regularly. If you have high blood pressure, work with your health care professionals to keep it under control.
  • Find out whether you have high cholesterol. If so, work with your health professionals to reduce it to a healthy level.
  • If you have diabetes, work with your health care professionals to keep your blood sugar in a healthy range.

If you have already had a stroke or heart attack, your doctor may provide a program of medications, diet changes, and exercise to help prevent a stroke.

Stroke facts and warning signs

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die.

The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.

It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours.

The warning signs of stroke include:

  • sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body), even if temporary
  • sudden confusion, trouble speaking, or trouble understanding speech, even if temporary
  • sudden vision loss (often in one eye only) or double vision, even if temporary
  • sudden trouble walking, dizziness, loss of balance or coordination, or falls
  • sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 9-1-1 (or your emergency medical number if you do not have 9-1-1 service) immediately. Stroke is a medical emergency.

Stroke treatment and rehabilitation

Stroke is a medical emergency. It is important to get emergency medical help right away so that the stroke can be treated.

Strokes can be treated with medications, surgery, or other non-surgical techniques. The exact treatment used depends on the type of stroke, when the stroke started, and the overall health of the person having the stroke. "Clot-busting" tPA (tissue plasminogen activator) medications can be used for certain types of strokes, provided the person reaches the hospital quickly enough (the "window" is within 3 to 4.5 hours of a stroke). This type of treatment can prevent further damage to the brain.

Surgery may be required to repair the damage caused by a stroke or prevent one from occurring. Surgery can remove blood that has pooled in the brain after a hemorrhagic stroke, to repair blood vessels, or to remove plaque from inside the carotid artery. Catheters may also be used to remove plaque buildup and treat aneurysms.

The effects of a stroke depend on which part of the brain was damaged and how severe the damage was. Strokes can affect speech, movement, thinking, vision, and other senses. Not everyone needs rehabilitation after a stroke. But for people who have some level of disability after the stroke, rehabilitation can make a huge difference in their lives. Rehabilitation can help them get some of their old abilities back or learn new ways to adjust to their disabilities.

Rehabilitation starts as soon as possible after the stroke, usually in the hospital, and continues after the stroke survivor goes home. Rehabilitation is done by a team of health care professionals, including doctors, nurses, pharmacists, physiotherapists, occupational therapists, dietitians, and social workers. The survivor's family and friends are also an important part of the team.

Rehabilitation can involve physical exercises to improve balance and muscle control, learning how to use canes or other special equipment, learning to plan healthy meals, improving speech, and learning to deal with emotions such as anger, sadness, or confusion. The survivor's family and friends can be taught to help with the exercises and other rehabilitation activities.