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Thursday February 20, 2014
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New guidelines focus on preventing stroke in women

Clinical experts have issued the first guidelines for preventing stroke in women. “If you are a woman, you share many of the same risk factors for stroke with men, but your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors,” Cheryl Bushnell, MD, MHS, author of the guidelines, said in a news release.

The guidelines, published Feb. 6 on the website of the journal Stroke, outline stroke risks unique to women and provide scientifically-based recommendations on how best to treat them:

Women with a history of hypertension before pregnancy should be considered for low-dose aspirin or calcium supplement therapy to lower preeclampsia risks.

Preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol and obesity in these women should be treated early.

Pregnant women with moderate hypertension (150-159 mmHg/100-109 mmHg) may be considered for blood pressure medication, whereas expectant mothers with severe hypertension (160/110 mmHg or above) should be treated with medication.

Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.

Women over age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

The guidelines are geared to primary care providers, including OBGYNs, according to the news release.

Latest stats highlight prevalence of heart disease, stroke

Heart disease and stroke remain two of the leading causes of mortality in the U.S. and pose a significant threat to millions of people, according to the American Heart Association’s “Heart Disease and Stroke Statistical Update 2014.” The update, published Dec. 18 on the website of the journal Circulation, reflects the most up-to-date statistics on heart disease, stroke, other vascular diseases and their risk factors. The statistics noted include:

About 83.6 million Americans are living with some form of cardiovascular disease or the after-effects of stroke.

Direct and indirect costs of cardiovascular diseases and stroke total more than $315.4 billion.

Stroke kills someone in the U.S. about once every four minutes.

The American Heart Association gauges the cardiovascular health of the nation by tracking key health factors and behaviors that increase risks for heart disease and stroke. These “Life’s Simple 7” measures help the association track progress toward the 2020 Impact Goal of improving the cardiovascular health of all Americans by 20% and reducing deaths from cardiovascular disease and stroke by 20% by the year 2020.

Stroke association releases guidance on optimal care

Several key elements in systems of care can reduce stroke deaths and disabilities, according to a recent policy statement by the American Heart Association/American Stroke Association.

Among the recommendations:

Developing public education programs to improve awareness of stroke symptoms.
Establishing protocols to optimize the transfer of patients between hospitals offering different levels of care and within the different units of a hospital.

Supporting the certification of stroke centers that follow treatment guidelines designed to improve patient care and outcomes.

Using telemedicine, especially in rural areas, to ensure patients have 24/7 access to consultation and care.

Video game teaches children about stroke symptoms, calling 911

Children improved their understanding of stroke symptoms and what to do if they witness a stroke after playing a 15-minute stroke education video game, according to new research. The study appeared in the American Heart Association journal Stroke.
Researchers tested 210 9- and 10-year-old, low-income children from the Bronx, New York, on whether they could identify stroke and knew to call 911 if they saw someone having a stroke. They tested the children again after they played a stroke education video game called Stroke Hero.

They found that children were 33% more likely to recognize stroke from a hypothetical scenario and call 911 after they played the video game. They also retained the knowledge when they were retested seven weeks later. Children who continued to play the game remotely were 18% more likely to recognize the stroke symptom of sudden imbalance than were the children who played the video game only once. Ninety percent of the children studied reported they liked playing Stroke Hero.

“We need to educate the public, including children, about stroke because often it’s the witness that makes that 911 call; not the stroke victim,” Olajide Williams, MD, MS, lead author and associate professor of clinical neurology at Columbia University in New York City, said in a news release. •

STROKE HERO IS AVAILABLE FOR FREE TO THOSE WHO REGISTER at HipHopPublicHealth.org.

STUDY: http://bit.ly/1emRqTC

Herpes zoster raises future risk of stroke in people under 40

Having shingles may increase the risk of having a stroke years later, according to a British study. People ages 18 to 40 who had acute herpes zoster were more likely to have a stroke, myocardial infarction or transient ischemic attack years later than people who had not had the virus, researchers reported Jan. 2 on the website of the journal Neurology. People over 40 who had herpes zoster were more likely to have a MI or transient ischemic attack, but not a stroke.

The study involved 106,600 people who had herpes zoster and 213,200 people of similar ages who did not have the virus. Using a United Kingdom database, researchers reviewed the participants’ records for an average of six years after the HZ diagnosis and for as long as 24 years. People younger than 40 were 74% more likely to have a stroke if they’d had herpes zoster, after adjusting for stroke risk factors such as obesity, smoking and high cholesterol. A total of 40 people with HZ (0.21%) had a stroke, compared with 45 of those who had not had HZ (0.12%).

People under 40 were 2.4 times more likely to have a transient ischemic attack if they had HZ and 50% more likely to have a myocardial infarction.

The disparity was not as great in people over 40. They were 15% more likely to have a transient ischemic attack and 10% more likely to have a myocardial infarction if they had HZ.

READ THE STUDY: www.Neurology.org.

Analysis: Stroke increasingly affects younger people worldwide

The number of stroke cases among people ages 20-64 has increased by 25% worldwide in the past two decades, according to new findings. Traditionally associated with older populations, strokes in this age group make up 31% of the total number, compared with 25% before 1990. The overall amount of disability, illness and premature death caused by stroke is projected to more than double worldwide by 2030, according to a news release.

An international team of researchers used data and methods from Global Burden of Diseases, Injuries, and Risk Factors Study 2010 to estimate the global and regional burden of stroke from 1990-2010. Their findings were published Oct. 24 on the website of The Lancet. “This is the first study to compare incidence and impacts of stroke between countries on a global scale,” first author Valery Feigin, MD, MSc, PhD, FAAN, professor and director of the National Institute for Stroke and Applied Neurosciences at AUT, said in the release. “Now every country in the world has estimates of their stroke burden, based on the best available evidence. The worldwide stroke burden is growing very fast and there is now an urgent need for culturally acceptable and affordable stroke prevention, management and rehabilitation strategies to be developed and implemented worldwide.”

High anxiety levels might increase long-term stroke risk

People with high levels of anxiety may be at an increased risk for stroke, according to a recent study. Researchers from the University of Pittsburgh’s School of Medicine evaluated more than 6,000 participants and found those with the highest levels of anxiety are 33% more likely to suffer a stroke compared to those who were less anxious.

Past studies have shown an association between higher levels of anxiety and an increased risk for coronary heart disease. The new research, published Dec. 19 in the journal Stroke, found a link between higher anxiety symptoms and an increased risk for stroke, even after adjusting for other risk factors such as depression. Anxiety disorders affect about 18.1% of U.S. adults in any given year, according to the National Institute of Mental Health, and often can last at least six months.

The findings show the importance of considering the effects of anxiety and not just depression when dealing with CVD, according to Rebecca Thurston, PhD, associate professor of psychiatry at the University of Pittsburgh and co-author of the study. “These findings encourage practitioners to assess and treat anxiety, as well as to reconsider popular notions such as ‘worried well’ — this worrying may not make us so well,” she said in the release.

Efforts to curb stroke mortality show big payoff, study says

Stroke deaths in the U.S. have declined dramatically in recent decades due to improved treatment and prevention, according to a scientific statement by the American Heart Association/American Stroke Association. The association commissioned the paper, published Dec. 5 as an online article in the journal Stroke, to discuss the reasons that stroke dropped from the third- to fourth-leading cause of death.

“The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” Daniel T. Lackland, DrPH, chairman of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C., said in a news release. Public health efforts including lowering blood pressure and hypertension control, which started in the 1970s, have contributed greatly to the change, Lackland said. Smoking cessation programs, improved control of diabetes and abnormal cholesterol levels, and better, faster treatment also have prevented strokes. Improvement in acute stroke care and treatment is associated with lower death rates.

“Although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages,” Lackland said in the release. “We need to keep doing what works and to better target these programs to groups at higher risk.”

Older men who walk daily might lower their stroke risk

Older men who walked at least one to two hours each day compared with less than a half-hour per day had a reduced risk of stroke in a large population-based study. The findings were published Nov. 14 on the website of the American Heart Association journal Stroke.

The study included 3,435 British men ages 60-80 who did not have cardiovascular disease or heart failure. Data came from a larger British Regional Heart Study, sampled from one primary care center in each of 24 towns across Britain. In 1998-2000, participants completed questionnaires about various aspects of their walking and other physical activities. Nurses also conducted a range of traditional health tests such as blood pressure and measured novel risk factors such as inflammatory markers.

Researchers asked the study participants the distance walked each week and usual walking pace. Researchers followed the men for the next 10 years and monitored them for new cases of stroke. During the follow-up, 195 first strokes occurred in the study group.

The researchers found men who walked eight to 14 hours per week had about one-third lower risk of stroke than men who spent zero to three hours walking each week. The risk was about two-thirds lower for men who walked more than 22 hours a week. Of the 3,435 men, 42% walked for more than eight hours per week and 9% walked for more than 22 hours a week.

Men who walked zero to three hours per week had 80 strokes per 10,000 person years, according to the study, and men who walked eight to 14 hours per week had 55 strokes per 10,000 person years.

“The total time spent walking was more consistently protective against stroke than walking pace; overall it seemed that accumulating more time walking was most beneficial,” Barbara Jefferis, PhD, study first author and senior research associate in the Department of Primary Care & Population Health, University College London, U.K., said in a news release.

To see what else is trending in stroke, visit www.Nurse.com/Stroke.


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