Stroke Archive

Articles

You could be one in a million

Are you doing everything possible to prevent a heart attack or stroke?

Dear Reader,

Information about health is often accompanied by numbers — how many people have this disease, what's the risk of developing that condition. Then there are more personal numbers, such as your targets for blood pressure and cholesterol. Understanding all those numbers can be confusing, and much of what the Harvard Heart Letter does is help you make sense of them.

Daily aspirin prevents dangerous clots

Yet only half the people who should take it, do.

Aspirin is one of the simplest, safest, cheapest — and most effective — ways to prevent a clot-caused heart attack or stroke. It does so by preventing platelets from sticking together in your blood, an early step in clot formation.

Why blood pressure matters so much

Symptomatically silent, it's often the first step toward a stroke or heart attack.

Blood pressure — your doctor routinely checks it because high blood pressure can contribute to strokes, heart attacks, heart failure, and other serious illnesses.

Putting heart attack, stroke triggers in perspective

The brief boost in risk usually doesn't linger.

Artery-clogging atherosclerosis is a slow, silent process that often begins in one's teens or 20s. Some people with atherosclerosis live out their lives completely untouched by it. Some develop chest pain (angina) or other problems when they exercise or are under stress. And some have heart attacks or strokes.

Do antidepressants work in the damaged brain?

Results have been discouraging for Alzheimer's disease, but they may help stroke patients in a variety of ways.

Alzheimer's disease and the depression that often affects people starting at about age 65 can easily be mistaken for one another. Depression can cause dementia-like deficits in memory and other mental functions, and Alzheimer's disease can cause depressive-like apathy and withdrawal.

The hidden burden of high blood pressure

Average life span goes down; rehospitalization rates go up.

A silent condition like high blood pressure is sneaky. You don't feel it, and it generally doesn't cause any outward signs or symptoms. Yet it relentlessly causes problems in the arteries, heart, kidneys, and elsewhere.

More to the story than alcohol = heart protection

Studies showing that alcohol protects the heart raise questions about drinking.

Does moderate, prudent drinking protect the heart and arteries? Two analyses say — shout, actually — that the answer is yes. But they raise a bigger issue: What should we do with this information? The answer to that question may come as a surprise.

The crucial, controversial carotid artery Part II: Treatment

The carotid arteries carry oxygen-rich blood from the heart to the front half of the brain. But these crucial arteries can become narrowed by the cholesterol-laden plaques of atherosclerosis. Blood clots, or thrombi, can form on the plaques, then break off and travel as emboli to the brain, where they lodge in small arteries, interrupting the vital flow of blood to brain cells. If the interruption is partial or brief, the brain cells recover; the patient experiences a transient ischemic attack (TIA) with no permanent damage. But if the blockage is complete, brain cells die, producing a stroke.

In many cases, a TIA warns of a future stroke, giving doctors time to perform a carotid ultrasound test to see if the artery is mildly (less than 50%), moderately (50% to 69%), or severely (70% to 99%) narrowed. Once the diagnosis of carotid stenosis (narrowing) is established, several treatment options must be considered.

Niacin trial stopped early: Now what?

Niacin, also known as vitamin B3 and nicotinic acid, is an essential nutrient. We need a small amount of it to ward off a disease called pellagra.

But like many vitamins these days, niacin has gotten more attention lately because of the benefits it might have when consumed in large amounts. Daily doses of 1,000 milligrams (mg) or more increase "good" HDL cholesterol and also reduce triglycerides. Many people, including quite a few doctors, view niacin as a useful, inexpensive — and perhaps more natural — way to bring about desirable cholesterol levels and reduce the risk of heart disease. Research going back to the early 1980s has shown that to be the case. Drug companies have sensed an opportunity and are selling products like Advicor (niacin plus lovastatin) and Simcor (niacin plus simvastatin) that combine high doses of HDL-raising niacin with statin drugs that lower "bad" LDL cholesterol.

With rising, a fall in blood pressure

Some people experience drops in blood pressure when they stand up. Falls are a risk. But there are often simple ways to counter the problem.

When we stand up, blood tends to pool in the lower half of our bodies, filling veins in the liver, intestines, and other abdominal organs, as well as those in the legs. The downward flow means there's a danger of not enough blood reaching the brain, which can lead to a loss of consciousness. But adjustments occur that keep that from happening. Sensors in the aorta in the torso and in the carotid arteries in the neck trigger a response that revs up the "fight-or-flight" part of the nervous system and dials down the "rest-and-digest" part. The heart beats a little faster and stronger. Blood vessels constrict, squeezing blood into a tighter space. Blood flow and blood pressure stay more or less normal.

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