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In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert in stroke prevention, provides an overview of  current techniques for preventing and managing risk of stroke.

Stroke is the third leading cause of death in the United States. This combined with heart attacks and heart disease result in over 2 million deaths a year.

The common underlying cause is vascular disease or hardening of the arteries. Heart attack and stroke can be prevented with simple life style changes and medications. Treatment of high cholesterol, high blood pressure and stop smoking will significantly lower risk of suffering from these devastating conditions. This combined with supplements and simple medications, such as aspirin with have a dramatic impact in reducing risk for stroke and heart attack.

Listen to this report to find out how you can reduce your risk of suffering from a stroke, heart attack or other cardiovascular disease.

If you are concerned that you or someone you love may be at risk for stroke, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a neurologist in your area.


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Vascular disease or “hardening of the arteries”, also known as atherosclerotic disease, is the number one cause of death in the United States. Contributing risk factors include diabetes, high blood pressure and high cholesterol. Diabetes is a major risk factor, equivalent to that of having had a heart attack. There is a direct association with high cholesterol and increased incidence of coronary artery disease. The most significant risk factor for stroke is high blood pressure. Both high blood pressure and high cholesterol are associated with a higher rate of vascular disease, stroke and heart attack.  Recent publications have indicated that coffee and tea may reduce the risk of having a stroke, stroke symptoms or other vascular events such as heart attack. The studies also indicate that individuals who consume coffee have a lower prevalence of diabetes, high blood pressure and heart disease.

As reported in Neurology Reviews, several independent studies have shown that daily consumption of black or green tea reduced the rate of stroke and number of people dying from stroke. These findings were reported at the 2009 International Stroke Conference. A summary of the findings of the numerous studies done show that tea consumption was associated with decreased brain volume injury from stroke with an increase in the number of brain cells that survive in a stroke. Retrospective analysis of the studies published, showed that 195,000 stroke patients were involved and the total number of strokes was 4,300. Dr. Lenore Arab, PhD reported this information and found that the consumption of three cups of tea daily was associated with an average stroke risk reduction of 21%. The exact mechanism of protection by tea in stroke risk reduction has not yet been completely determined. Dr. Arab’s findings were published in Stroke, 2009 February 19.

Coffee consumption has also been reported to reduce the prevalence of stroke. Information regarding coffee consumption and reduced stroke prevalence was also presented at the 2009 International Stroke Conference. This was published in Circulation, a well respected medical journal. It was reported that stroke and other vascular risk factors decreased the amount of daily coffee consumption increased. This finding was consistent even after considering and factoring out other high stroke risk factors such as smoking. Of the 9,384 patients in the study, for whom coffee consumption information was available, it was found that about 3000 had suffered stroke,TIA (transient ischemic attack) or stroke symptoms. The range of coffee consumption ranged from zero to 20 cups daily. Analysis of the data showed that in the individuals studied, those who drank no coffee had the highest prevalence of stroke. Drinking 1-2 cups daily had a stroke prevalence of 5%, 3-5 cups daily 3.5% stroke prevalence and greater than 6 cups daily 2.9% stroke prevalence. Other analysis of the data showed that there was an overall lowered prevalence of high blood pressure, diabetes and coronary artery disease with daily consumption of coffee, particularly in the higher daily coffee consumption group.

In conclusion, it is clear from the available data published in several medical journals, such as Stroke and Circulation, that there is a significant reduction in rate and prevalence of TIA, stroke and stroke symptoms with daily consumption of tea and/or coffee. Higher coffee consumption appears to be associated with a greater reduction in stroke prevalence. This in combination with a healthy diet, exercise of any kind and optimized medical therapy will provide individuals with the greatest protection against having a stroke and stroke prevention.


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There are many studies that have shown excellent health benefits from taking omega 3 type fish oil. Omega 3 oils are found in fish oils, flax seed and several vegetable oils including canola, soybean and olive oils. There are different components to these oils that provide health benefits. The DHA and EPA oils in fish oil have been linked to reducing hardening of the arteries and lowering triglycerides. They also have the benefit of lowering blood pressure and heart rate to a mild degree. This all results in an overall reduction in risk for coronary artery disease, heart attack, sudden death, irregular heart beat and stroke. Fish oil can also have a blood thinning effect to reduce abnormal blood clotting, similar to that of aspirin. This latter effect is a two edge sword because too much fish oil can increase the risk for serious bleeding. Generally three grams (3000 mg) daily or less is considered safe. Daily intake of Omega 3 should come from dietary sources with no more than 2000 mg (2 grams) coming from supplements.

Omega-3 is derived from high fat containing fish such as albacore tuna, salmon, flounder, pompano, anchovies, sardines and mackerel. Fish in the equatorial regions around South America have a higher content of Omega 3 than do those caught in the more northern areas around Scandinavia and Iceland. Interestingly flax seed, flax oil and kiwi fruit contain higher amounts of Omega 3 oils than do that of fish. Flax seed can be added to cereal, baked goods or eaten alone. Fish oil capsules are available in 1000 mg and 1200 mg sizes. It is important to not confuse Omega-3 oils with Omega-6 oils. Omega-6 oils do not confer the health benefits that Omega-3 fish oils do. Omega-6 is found in high concentrations in various types of vegetable oils derived from the following: corn, safflower, sesame, soybean, sunflower and walnuts. It is important to reduce the consumption of Omega-6 oils as they compete with Omega-3 oils, thereby decreasing the benefit from Omega-3 fish oils. Eating fish twice a week is the standard recommendation, in addition to taking any supplements.

There have been many studies showing the beneficial effects of Omega-3 oils. The main benefit comes from reduction of hardening of the arteries (atherosclerosis), reduced coronary artery disease, decreased risk of heart attack and potentially fatal heart beat rhythms. Omega-3 oils have also been shown in some studies to have a brain cell protective effect in such conditions as Alzheimer’s and Parkinson’s disease. Fish oils can improve memory to a degree. Several studies have shown that 2000-3000 mg of Omega-3 oil intake daily, has a potent antiinflammatory action as that of high dose ibuprofen. Patients with arthritis or rheumatoid arthritis may benefit from Omega-3, without the risks associated with taking
antiinflammatory drugs for extended periods (such as bleeding stomach ulcers, kidney and liver damage.) It should be noted that the fish oil capsules have a more robust effect for reducing inflammation than that of flax seed oils.

Omega-3 oils can reduce total triglyceride levels and increase “good” cholesterol (HDL) levels. These oils also have an overall beneficial effect on the blood vessels, both in increasing blood flow and improving the health and stability of the vessel walls themselves. This effect is in part responsible for the risk reduction in having a stroke or heart attack as well as patients with problematic varicose veins and leg pains due to peripheral vascular disease. A word of caution: in patients with congestive heart failure, consultation with your cardiologist is first advised. As fish oil has a blood thinning effect, you should check with your doctor if you are taking prescription blood thinners. Additional benefits from Omega-3 fish oils have been shown in improving retinal (visual) function and possibly slowing down macular degeneration. Studies in psychiatric conditions have demonstrated Omega-3 beneficial effects in reducing depression, lessening memory loss and improving memory function.


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Stroke occurs when a blood vessel in the brain becomes blocked or ruptures. The most common form of stroke is due to blockage of a blood vessel. Blood vessel blockage is caused by a condition known as
atherosclerosis, commonly known as “hardening of the arteries.” This is the most common type of stroke. Stroke is one of the three major leading causes of death in the United States. The other two are heart attack and cancer. Stroke is the leading cause of disability in the U.S. It is for this reason that it is much wiser to focus on stroke prevention in the first place rather than trying to limit the damage with stroke treatment after event has occurred. High blood pressure (hypertension) is the single biggest, treatable risk factor for stroke. In the 1970s, there was a push by the medical community to aggressively treat high blood pressure to lower the risk of stroke, premature heart disease and kidney failure. One cannot feel that their blood pressure is elevated but the damage to major body organs (heart, brain, kidneys) continues on. It is only when these organs start to fail or a stoke occurs, will it become apparent that a given individual may have hypertension. On occasion, patients with untreated hypertension may have headaches. Fortunately checking one’s own blood pressure is easy. This can be done at your doctor’s office, pharmacies or the local fire department. If you have high blood pressure with the top number greater than 150 or the lower number greater than 85, you need to see a physician for treatment. Fortunately there are many different types of medication to treat high blood pressure. Many patients can be successfully treated with a single drug, for mild hypertension. Individuals with moderate to more severe hypertension, multiple drug therapy may be necessary. With the aggressive push to treat high blood pressure, the rate of stroke in the United States has dropped dramatically over the past two decades. There is a class of blood pressure medication, the ACE inhibitors, that have been shown in well designed clinical studies to significantly reduce the risk of stroke independent of their ability to lower blood pressure. Current evidence based medicine strongly suggests that addition of an ACE inhibitor should be done in patients with high blood pressure, even if their blood pressure is adequately controlled on other agents. Ideal blood pressure range should be with the upper number (systolic) being less than 130 and the lower number (diastolic) less than 80.

It has been well known for several decades that aspirin thins out the blood. Cardiologists have used aspirin extensively for 30 years to lower the risk of having a heart attack. Aspirin slows down the formation of clots by blocking the clumping of platelets to form blood clots. In 1994 a hallmark study, the Antiplatelet Trialists’ Collaboration, was published demonstrating the clear benefit of aspirin in the prevention of stroke and transient ischemic attacks (TIA, “mini strokes”.) In 1998, the FDA approved labeling of aspirin for the prevention of TIA and stroke. Dosage recommendations in the range of 81-325 mg daily should be used. Unfortunately aspirin does not entirely prevent stroke or TIA from occurring. Other blood thinning agents can be used in patients who fail aspirin therapy. The other two agents are Plavix and Aggrenox. Either agent can be used in patients who have had a TIA or stroke while taking aspirin. In patients who have no history of heart disease, Aggrenox is the preferred agent. Plavix is preferred in those patients who have known coronary artery disease.

Lastly, high cholesterol has been implicated in the development of accelerated atherosclerosis. There have been studies that have shown some correlation of high cholesterol with the increased risk of having a stroke. Multiple, double-blind, placebo controlled studies have shown that the use of cholesterol lowering statin drugs for cholesterol reduction results in an average of a 27% overall secondary risk decrease in stroke. Studies are ongoing to show if statins may help in primary prevention of stroke and TIA. At this time, it is prudent to be on a statin drug, for cholesterol reduction. The currently available statins include: Lipitor, Zocor, Pravachol, Crestor or Mevacor if you have a cholesterol over 200. The marked benefit of this class of drugs on the reduction of stroke and cardiac events (35%) is dramatic and strongly supports more aggressive treatment for high cholesterol (hyperlipidemia.) The objective is to have a total cholesterol less than 180, good cholesterol (HDL) of greater than 50 and bad cholesterol (LDL) less than 100. A recent study published in the journal Stroke reported that discontinuing statin therapy in the year after a stroke is associated with a significant increase in the risk for death, even in the absence of heart disease.

Medications are not the only treatment for stroke prevention. Smoking is associated with a 2-3 times greater risk of stroke and bleeding in the brain. Smoking also contributes to the accelerated development of heart disease, emphysema and peripheral artery disease. Chantix is a new medication that received FDA approval to help stop smoking. Exercise is important in maintaining overall body conditioning and weight control. This in turn leads to an overall lowering of blood pressure and cholesterol. In summary, stroke prevention is much easier and cost effective than fixing the problem after someone has a stroke. This approach to stroke reduces mortality and disability for the entire United States population. The cost saving are in the hundreds of billions of dollars over stroke treatment. If you feel that you are at risk for stroke, contact a neurologist for evaluation and treatment.


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High cholesterol and triglyceride levels are at epidemic proportions in the United States. It is estimated that there are 30 million affected individuals with this condition but only about 10% are treated with medications. This is an unfortunate fact considering that vascular disease (heart disease, stroke) combined is the leading cause of death in the United States. Multiple clinical studies have shown the dramatic beneficial effects of the main class of cholesterol lowering drugs, the statins. The summary of these studies is that they provide a 25-35% secondary risk reduction in ischemic vascular events. The class of statins include: Zocor, Lipitor, Pravachol, Crestor and Mevacor. While highly effective in lowering total cholesterol as well as “bad cholesterol” and raising “good cholesterol” (LDL and HDL, respectively, these medications require lab monitoring for liver and muscle problems. Fortunately the incidence of severe side effects is low. More commonly, patients treated with these drugs can have muscle and joint pains. With proper treatment and monitoring, patient’s experience an over all improvement in health and marked reduction in their risk for having a stroke or heart attack. For every 1 million patients treated with one of these agents, 10,000 stroke and heart attacks are prevented, annually. The economic and personal benefits of this are staggering.

There are other non-medication ways that individuals can lower their cholesterol. The American Heart Association lists the benefits of taking fish oil supplements in cholesterol reduction. Other nutritional aids can include flax seed and limiting sugar intake. Of course regular, daily exercise, stop smoking and a healthy, low-fat diet are all important in controlling cholesterol levels and blood pressure.

In summary, one cannot “feel” elevated cholesterol levels. It is an insidious disease that causes a slow death by gradually blocking off arteries that carry blood to the vital organs of the body. If you are overweight, have diabetes, smoke or have a family history of these or high cholesterol, you should see you health care professional for further evaluation.


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