What Should We Do to Reduce Stroke - Brain Paralysis Risk as We Age?

What Is a Stroke?

Stroke is a sudden interruption or reduction of blood flow to the brain; it is commonly known as brain paralysis . In medical terminology, it is classified among "cerebrovascular events." As a result, because the brain does not receive adequate oxygen and nourishment, brain cells are damaged. Even if this situation returns to normal, it is difficult to reverse the damage to the brain. The most important cause of stroke is atherosclerosis, the accumulation in the vessel wall of substances that restrict blood flow.

Atherosclerosis can affect any vessel in the body, such as vessels in the heart, brain, arms, legs, and kidneys. It damages the organ whose vessels it affects. As substances such as cholesterol, fat, and calcium build up inside vessels, they block them and a stroke occurs. Risk factors for atherosclerosis are:

• high blood pressure,
• high blood cholesterol,
• smoking,
• diabetes,
• obesity,
• little physical activity, and
• familial predisposition

As can be seen, most of these risk factors (smoking, obesity, little physical activity, and familial predisposition) are among the main causes of cancer.

HOW SHOULD WE EAT to Reduce Stroke Risk at an Older Age?

According to research, the most beneficial dietary patterns for reducing stroke risk are vegetarianism and the Mediterranean diet.

In the Lyon Diet and Heart Study, coronary heart disease patients' diets were examined. The findings showed that the Mediterranean diet reduced stroke and heart attack by 60% over a period of 46 months. However, egg yolks and red meat, which have a high fat content and are included in these diets, contain a molecule that is a precursor to atherosclerosis. Therefore, among people who followed these two diets for an average of 17.5 years, cardiovascular risk increased because of their consumption of eggs and high-fat foods in the diet. For this reason, older people in particular should pay attention to egg yolk and meat consumption when following these diets. As a solution, the benefit of eating white meat instead of red meat was investigated. It was found that the level of this atherosclerosis-precursor molecule decreased by half in 1 month.

Atherosclerosis does not develop solely because of diet. In some people, atherosclerosis-precursor molecules are found at increased levels in the blood regardless of diet. Molecules involved in the development of atherosclerosis are excreted from the body through the kidneys. Our kidneys function more slowly as we age. When this happens, atherosclerosis-precursor molecules increase further in the blood. Therefore, people with kidney disease and older people should also consume egg yolks and red meat in limited amounts.

Is Having Low Blood Pressure Positive for Everyone?

According to the Turkish Society of Cardiology's National Blood Pressure Monitoring and Treatment Guideline, the gold standard for accurate blood pressure measurement is intra-arterial measurement.

Apart from intra-arterial measurement, blood pressure can also be measured with cuff-type monitors and electronic blood pressure monitors, which are found in our homes. Cuff-type monitors give more accurate results for home measurements. However, people who cannot use these devices or have hearing difficulties can use electronic monitors. Whether these also give accurate results should be checked at regular intervals with a cuff-type monitor.

Factors affecting our blood pressure:

• whether we are hungry or have eaten
• physical activities
• smoking
• coffee

We should pay attention to these situations before measuring blood pressure:

• After sitting with our back supported, we should make sure that our arm is at heart level and take care not to speak during the measurement.
• If we use a cuff-type blood pressure monitor, we should make sure that the cuff size is appropriate for our arm circumference.
• We should not rely on a single measurement, so as not to overlook a potentially adverse situation. We should take at least 2 measurements with an interval between them and accept their average as correct.
• Likewise, we should measure both of our 2 arms and count the higher reading as the correct value.
• If measurements are to be taken continuously and the patient is undergoing blood pressure monitoring, the Turkish Society of Cardiology states that measurements from the right arm may be preferred.

In a study of patients with low blood pressure, their blood pressure was measured using a blood pressure monitor and directly inside the artery. In half of these patients, the blood pressure measured inside the artery was found to be up to 30 mmHg lower than that measured with the monitor. The blood pressure in the vessels in our brain is always lower than in our arm. In patients with hardening of the arteries, a blood pressure monitor is more likely to give an incorrect reading. When a low blood pressure reading is obtained from the arm of someone with hardening of the arteries, the possibility that the actual blood pressure may be lower than the measured value should be considered. Therefore, older people with low blood pressure are advised to see a doctor for an intra-arterial assessment.

Is Lipid-Lowering Treatment Appropriate for Very Old Patients?

Lipid-Lowering Treatment Definitely Reduces Stroke Risk!

In the clinical study called SPARCL, stroke rates were found to decrease by 31% in patients taking lipid-lowering medication. Older people have a higher-than-normal risk of stroke. Based on this study, we can say that older people should receive more intensive lipid-lowering treatment.

Do Blood Thinners Do More Harm Than Good at an Older Age? 

Blood thinners are used to prevent vessel blockage in people with atherosclerotic disease. Since the risk of cardiovascular disease increases with age, blood thinners could be used for prevention even before disease developed.

Recent studies have raised doubts about the appropriateness of this practice. The risk of bleeding increases as we age. Aspirin used to thin the blood further increases this risk, so questions about its use remain. Patients were also found not to obtain an adequate blood-thinning effect with warfarin. Direct-acting oral anticoagulants have been shown both not to increase bleeding risk and to be more effective than warfarin. It is therefore said that using these drugs may be more effective.

Of course, the use of these drugs varies between patients. Therefore, we should always listen to our doctor's advice.

Does Vitamin B Reduce Stroke Risk by Lowering Homocysteine Levels?

Homocysteine is a factor that initiates the atherosclerosis process that results in heart attacks and stroke. A deficiency of B vitamins raises homocysteine levels in the blood. It has been shown that B vitamins reduce stroke risk through the reduction in homocysteine, and that high-risk patients benefit more.

Carotid Stenting or Endarterectomy at an Older Age

A stent is a material placed inside vessels to keep them open. Endarterectomy is an operation in which an accumulated layer that could block the vessel in the future is stripped away and removed.

Patients with narrowing of the carotid artery have a high risk of heart attack. If there is no severe narrowing, this can be treated with intensive medication. However, if the condition is serious and has reached a level that affects life, these procedures should be performed as a next-level treatment.

Conclusion and Summary

We know that stroke risk increases with advancing age and that its most common cause is atherosclerosis.

Therefore, to protect ourselves from atherosclerosis:

• We should adjust our lifestyle habits from an early stage.
• Starting at a young age, we should take care to maintain our blood cholesterol and glucose levels, not smoke, or quit if we do.
• We should pay attention to physical activity and remember that inactivity is a risk factor.
• If we have chronic diseases such as hypertension and diabetes, we should attend regular medical checkups because these increase the risk of atherosclerosis.
• At the same time, if atherosclerosis has developed, we should follow the treatment plans recommended by the doctor. In this way, we can reduce our risk of stroke.