Cigarette Smoking associated with host of ills
including increased risk of stroke

Stroke can hit like a deadly lightning bolt.

And if the victim survives, the aftermath can be debilitating -- affecting functioning from movement to speech.

While stroke is the third-leading cause of death and the leading cause of adult disability in the United States, it trails behind other major diseases in awareness and recognition of symptoms.

Being informed, however, can protect you from suffering either an ischemic stroke, caused by a blood clot and the most common form of stroke, or the less common hemorrhagic stroke, caused by bleeding in the brain.

Know the factors that may be putting you at risk:

1. Uncontrolled high blood pressure

As for all cardiovascular disease, high blood pressure is a major risk factor for stroke. The American Heart Association estimates that only 45 percent of people with high blood pressure actually have it under control. Female stroke victims, in particular, tend to have uncontrolled blood pressure, and in general, women who suffer have strokes don't seem to be treated as aggressively as men. High blood pressure doesn't have any outward telltale signs, so getting it measured by your healthcare provider is essential to learning if you should make lifestyle changes or take medications to bring it down.

2. Smoking

Puffing on cigarettes is associated with a host of ills. An increased risk of stroke is one of them. When compared to nonsmokers, smokers have double the risk of ischemic stroke. Heavy smokers face an even greater risk: A study of women ages 15 to 49 in an August issue of the journal Stroke found stroke risk was proportional to the number of cigarettes smoked per day. The women who smoked two or more packs a day had nine times the risk of stroke of a nonsmoker.

A study published in Neurology in January found that smokers with a family history of brain aneurysm, abnormal bulging of an artery in the brain, are six times as likely to have a subarachnoid hemorrhage stroke, which is caused by a bleed between the brain and the tissue that covers it. These types of stroke are deadly nearly 40 percent of the time.

3. Family history of stroke

Having a relative who has suffered a stroke increases your chances of having one. Scientists recently moved closer to finding a basis for this genetic component of stroke. In the New England Journal of Medicine in April, researchers identified a chromosomal region and two genetic variants that appear to be associated with ischemic stroke. The researchers are not yet sure what mutation is responsible, but they've determined that having one of these gene variants increases the likelihood of having any type of stroke by 30 percent and of suffering ischemic stroke by 33 percent.

4. Migraines

This severe type of headache may be associated with an increased risk of suffering an ischemic stroke, though the biological reason for this link is still unclear. (One theory is that a common heart defect is behind both some strokes and many migraines.) And some research has also suggested that people who have migraines with aura, or visual disturbances, have a higher risk of stroke than people who have migraines without this symptom.

Additionally, the American College of Obstetricians and Gynecologists recommends that women who experience migraines and are taking birth control pills find another method of contraception. Research has suggested the combination may double or triple the likelihood of stroke. There may be other cardiovascular risks for women over 35 who take the pill as well.

5. "Ministroke"

Transient ischemic attacks, or TIAs, as ministrokes are formally known, can look and feel just like a full-blown stroke, but the symptoms are fleeting. Because the signs are typically short-lived and painless, lasting from one to five minutes, people often don't seek medical attention. But up to 17 percent of people who have a ministroke will have an actual stroke within 90 days, according to the American Heart Association. Because risk for a stroke is highest within the first 30 days, it is essential to quickly diagnose the TIA and work with a doctor to mitigate your stroke risk.

6. History of stroke

Not surprisingly, once you've suffered one, you're primed for another--unless you work with your doctors to reduce your risk factors. But efforts to prevent having a second stroke are lacking, suggests a March study published in Stroke. Lifestyle changes known to reduce the risk of a second attack, such as getting regular exercise, were reported by only 57 percent of the people who'd had a stroke.

Other preventive measures include quitting smoking (66 percent of study subjects reported getting counseling to help them do so), taking aspirin regularly (77 percent), taking medication to control high blood pressure (91 percent), making diet changes if high blood pressure is an issue (62 percent got such dietary counseling), at least annual average blood sugar testing if diabetic (89 percent), getting the flu vaccine (52 percent), and getting the pneumococcal vaccine (53 percent). Some experts have suggested that vaccination against common infections may reduce the risk of stroke; flu epidemics have been associated with higher rates of stroke-related hospitalizations.

7. Too much homocysteine

High blood levels of this amino acid are associated with cardiovascular troubles, including stroke. Genetics and diet each play a role in generating homocysteine.

For example, having high levels of dietary nutrients folic acid and vitamins B6 and B12 is associated with lower levels of homocysteine in the blood.

While it's not yet clear if acting to lower homocysteine will reduce the risk of stroke or heart attacks, the American Heart Association recommends that high-risk patients get hearty amounts of folic acid, B6, and B12 through green leafy vegetables and fortified grains and cereals.

© 2009 U.S. News & World Report DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC

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