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Carotid ultrasound to prevent stroke
Q. I often receive offers in the mail to perform an ultrasound of my carotid arteries. Should I sign up for a carotid ultrasound?
A. You probably don't need this test unless you are experiencing certain warning signs. Stroke is the third leading cause of death in the United States, and the major risk factors for stroke are age, high blood pressure, and cigarette smoking. Narrowing of the carotid arteries could cause a clot that blocks blood flow to the brain (ischemic stroke).
Fish, not fish oil, prevents stroke
Are you fishing for a way to lower your risk of stroke? If so, put that jar of omega-3 supplements back on the shelf and head for the seafood aisle, according to a science review in BMJ.
Researchers identified published studies that examined the links between stroke and either consumption of fish or intake of omega-3 fatty acids. The search identified 39 separate studies involving a total of 794,000 individuals. Here are the main findings:
Ask the doctor: When to remove carotid blockage?
Anthony L. Komaroff, M.D.
Q. At what percentage of blockage of the carotid artery do you consider surgery? I am a 73-year-old man with a 70% blockage, and my doctor says to wait a year and check back then.
A. As you know, your carotid arteries are the main blood supply to a large part of your brain. Blockages definitely pose a threat to the brain, but there are risks to the treatments as well.
What you should know about: Statins
Statins are among the most widely prescribed drugs in the world, because they are effective at lowering low-density lipoprotein (LDL, or unhealthy) cholesterol levels. Elevated LDL levels are a major risk factor for heart disease, heart attack, and stroke. But there are many opinions about who should take statins. Some cardiologists believe statins should be prescribed to people with mild heart disease risks. Others feel statins should be reserved only for those with moderate or severe heart risks.
Two recent studies add to the debate. One, published in The Lancet, suggested that the guidelines for statin therapy be revised to include even people at low risk for a vascular event. The other, from Harvard-affiliated Brigham and Women's Hospital (BWH), published in The Lancet, counters recent concerns that statins can be associated with an increased risk of type 2 diabetes. The BWH study found that the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, even among those with the highest risk of developing diabetes. "The risk of developing diabetes while on statin therapy was limited almost entirely to people who had at least one major risk factor for diabetes prior to statin therapy," says Dr. Paul Ridker, the study's lead author and the director of the Center for Cardiovascular Disease Prevention at BWH. "Yet even in this high-risk group, the benefits of treatment greatly outweighed the diabetes hazard."
Carotid stenosis treatments compared
Both surgical and nonsurgical options can prevent stroke.
The same process that causes obstructions in the heart's arteries can block the carotid arteries in the neck, a disease known as carotid stenosis. If these interfere with blood flow, a stroke can occur.
Symptoms of pending stroke (see box) usually require treatment to reduce the risk. One option calls for opening the artery and removing the plaque—a surgical procedure known as endarterectomy. A less-invasive option, called carotid stenting, involves inserting a catheter into an artery in the groin, advancing it to the carotid artery, opening the blockage with a balloon, and leaving behind a wire cage (or stent) to hold the artery open.
New devices compensate for foot drop
Nerve stimulation can help many people walk normally again.
Stroke and other diseases can damage nerves that control motion, resulting in foot drop. People with this condition have difficulty controlling the affected foot when walking. Although a conventional below-the-knee leg brace can provide stability, it cannot help these people pick up their foot normally with each step. Harvard-affiliated Spaulding Rehabilitation Hospital offers two devices that can. Dr. Randie Black-Schaffer, medical director of the stroke program at Spaulding, says the devices are significantly helpful.
Protect your brain from stroke
Reducing your salt intake may help.
You've heard for years that too much salt can raise your blood pressure and is dangerous for the heart. A new study finds that salt may also be a threat to your brain. The study, published in the journal Stroke, finds that among older adults, a high-sodium diet can significantly raise the risk of stroke. "The findings are associations and don't prove causality," says Dr. Helen Delichatsios, assistant professor of medicine at Harvard Medical School. "But I don't think the concerns about excess salt intake are overrated."
Stroke and salt
A stroke occurs when an artery that supplies blood to the brain becomes blocked or bursts. Without blood, brain cells go without oxygen and begin to die.
Prediabetes is associated with stroke risk
People with higher-than-normal blood glucose levels but who do not have diabetes—a condition known as prediabetes—may be at a higher risk of stroke. A diagnosis of prediabetes should sound a warning to better manage weight, diet, and exercise, which may contribute to diabetes and stroke.
Heart attack accelerates plaque
Heart attack survivors are at high risk for another heart attack or stroke, but until recently, no one knew why. Now an international study led by Harvard physicians and published online in Nature has found that heart attack triggers an immune response that accelerates the development of atherosclerosis and inflammation in cholesterol-filled plaques embedded in artery walls. "It's an ancient ‘fight-or-flight' response to injury, but instead of healing the wound, it accelerates the underlying disease," says senior author Dr. Matthias Nahrendorf of the Center for Systems Biology at Massachusetts General Hospital (MGH) and an assistant professor of radiology at Harvard Medical School.
During a heart attack, sympathetic nervous system activation causes stem cells to be released from the bone marrow. Stem cells induce production of monocytes and other immune cells in the spleen. These cells accumulate at yet-unruptured plaques, aggravating existing inflammation and triggering the release of enzymes that may cause those plaques to rupture.
Unique stroke risks in women with atrial fibrillation
Women with atrial fibrillation, a common heart-rhythm problem, are at greater risk for a stroke than men, and may need to be treated more aggressively with medicine that protects against stroke by preventing the formation of blood clots.
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