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What you don't know about stroke can kill you
By Dawn Brazell | News Center | June 25, 2013
|MUSC neurologist Dr. Bruce Ovbiagele discusses the statistics of stroke and how it is on the rise in the United States.|
With razor-sharp precision, without a hint of hesitation, MUSC neurologist Bruce Ovbiagele drops the statistics.
Stroke care costs are expected to rise 130 percent from 2010 to 2030. During that same time, the occurrence of stroke is expected to rise 20 percent. Almost 4 percent of American adults - nearly one in 25 - will have a stroke. This translates into an additional 3.4 million people with stroke in 2030. Forty percent of stroke survivors experience moderate to severe impairments requiring special care and it is the leading cause of disability.
Ovbiagele, M.D., knows all of this off the top of his head because of what he sees his patients endure, but also because he’s lead study author of “Forecasting the Future of Stroke in the United States,” a policy statement from the American Heart and Stroke associations released in May. The study’s objective was to project future annual costs of care for stroke from 2012 to 2030 and to discuss potential cost reduction strategies.
It’s a wake-up call, he said.
Ovbiagele, professor and chair of MUSC’s Division of Neurology, was invited to conduct the study and hopes that the statement will lead to more public awareness, especially among all levels of policy makers. “We know that strokes are going to rise, so it’s extremely important that policy makers try to start to do things right now to avert this tsunami of strokes and the costs associated with it in the future.”
Currently, there are about 4.4 million stroke survivors in the United States with 750,000 new stroke patients each year. “The population, of course, is aging. Stroke is one condition that rises with age. For every new decade after the age of 55, the risk of stroke doubles. The older one gets, the more likely you are to experience a stroke.”
Women are more likely to experience a stroke and die from it than men, primarily because women tend to live longer, and race ethnic minorities, African-American and Hispanic groups in particular, are disproportionately at risk for stroke than their age-matched white counterparts, he said.
A surprising finding for him is that Americans currently 45-65 years old are expected to have the highest increase in stroke at 5.1 percent. “Our explanation for this is that we know society is changing and the portion of race ethnic minorities are growing, and they are more susceptible to stroke. We also know that, even though we are controlling blood pressure better, we are beginning to have an obesity and diabetes epidemic. That is especially affecting younger and middle-aged people. Being obese and having diabetes are major risk factors for having a stroke.”
Another factor coming into play is that many middle-aged people may not have insurance and get regular health checks and screenings likely to detect such risk factors as high blood pressure.
“We have people in the prime of their lives being at high risk of stroke. That’s the prime segment of society contributing to the economic engine of the country. These folks in middle age are at risk for experiencing stroke and being at risk for dying, and if they don’t, of being disabled.”
The news is not all doom and gloom though. The policy outlines strategies at the federal and state levels to deal with the crisis. Ovbiagele said he empowers his patients to take charge of their own health as much as possible.
Prevention is key – better than cure. It’s highly preventable with up to 80 percent of strokes being preventable. There are certain medical conditions that pose a risk, including hypertension, heart disease, atrial fibrillation, high cholesterol, diabetes and having had a prior stroke or TIA, a transient ischemic attack or "mini-stroke." Other behaviors that factor in are: Smoking, heavy alcohol use, physical inactivity, obesity and an unhealthy diet.
“If you can treat them, you can reduce a person’s chance of stroke substantially. I always tell my patients, the best stroke is the stroke you never had because of the five Ds.”
Stroke’s five Ds are:
Death: Stroke is the fourth leading cause of death with a stroke death happening every three minutes.
Disability: Stroke is the No. 1 cause of disability among adults in the United States. Ninety percent of stroke survivors have lasting effects.
Dementia: It is the second cause of dementia after Alzheimer’s disease.
Depression: Fifty percent of people who have a stroke will suffer from a major depression and it leads to suicide in 7 percent of cases.
Dear as in costly: Total annual costs of stroke are projected to increase to more than $240 billion by 2030, an increase of 130 percent.
Not all strokes can be prevented, so the other key message is teaching the public the signs of a stroke. When he explains it to patients, he takes it from the head down, noting that virtually all stroke patients have at least one of these five symptoms. There are:
· Head – A very severe headache – like the worst of your life
· Eyes – A change in vision, either double or blurred vision
· Mouth – difficulty speaking or slurred speech
· Limbs – Numbness or paralysis in an arm or leg on one side
· Legs – Difficulty walking as if a person were drunk
“The key is sudden onset. What separates stroke from virtually everything else is that it’s like a bolt out of the blue. One minute you’re totally fine, the next minute something changes. It’s always drastic. That blood vessel suddenly gets blocked or that blood vessel suddenly breaks and you have symptoms immediately. If you have one of those symptoms that comes out of the blue, you should call 911 immediately.”
On this, Ovbiagele is adamant.
If a person has had a stroke, then prompt treatment is the next best course, particularly since a clot-busting medication called tPA, if administered within a 4.5 – hour window following a stroke, can work wonders and potentially reverse the damaging effects of stroke, he said.
“Even though we’ve had tPA for 16 years and know it works, less than 5 percent who’ve experienced a stroke actually are receiving tPA. That’s why it’s so important that the public recognize what the symptoms of a stroke are and get them to the hospital in time. The best way is to call 911,” he said. “We have a saying in stroke. Time is brain. We know as time goes by in stroke, brain cells are dying. Once brain cells die, unfortunately they don’t come back so the longer it takes to get to a hospital and get the treatment, the more likely that damage is going to be severe.”
In rural areas, telemedicine is making inroads, which is extremely important, he said, explaining how MUSC’s REACH (remote evaluation of acute ischemic stroke), a web-based outreach initiative has linked up to 13 hospitals in outlying areas and has made a huge difference. “Stroke neurologists are very adept at handling stroke and administering tPA. The idea is to have an expert hospital or hub to use telemedicine and help colleagues confirm stroke and guide them in the treatment. It has done a phenomenal job at increasing the administration of tPA,” he said, adding that tPA was given 150 times last year through the program.
Another risk factor relates to a geographical health disparity. There’s the stroke belt in the South, but the buckle of the belt is South Carolina, North Carolina and Georgia. People born in these three states are four times more likely to experience a stroke, he said. If you are born in this region, and even if you move away, you still carry that high risk of stroke with you, an area of interest to researchers.
Sunil J. Patel, M.D., professor and chair of the Division of Neurosurgery, said MUSC is fortunate to have Ovbiagele here. Ovbiagele, who joined MUSC 10 months ago, completed dual internships in psychiatry and internal medicine. In 2011, he joined the faculty of the University of California San Diego as professor of Neurosciences and was appointed director of the San Diego Veteran Affairs Medical Center Stroke Program.
“He is one of the top nationally renowned clinical stroke researchers and brings to us leadership in stroke epidemiology,” said Patel. “I could not think of a better stroke expert to help lead a stroke program in the country's stroke belt. South Carolina has one of the highest rates of stroke deaths and Dr. Ovbiagele will definitely help change that statistic.”
Ovbiagele said it all starts with awareness. The policy statement helps, and on a more personal level, there are small, progressive lifestyle changes people can make that can significantly reduce their risk of having a stroke. See Life’s Simple 7 campaign by the American Heart and Stroke associations. Ovbiagele said it’s important to know the risk factors and to work in partnership with health providers to reduce those risks.
It’s a partnership of the patient with the provider to make incremental progress, he said. “Your life is in your hands. There are lifestyle things that can go a long way to reducing that risk of stroke. It’s about living a healthy lifestyle.”
DID YOU KNOW?Stroke occurs when part of the brain gets injured because it doesn’t get enough blood supply. This can be because of a blockage in a blood vessel or a vessel that has broken open causing bleeding into the brain.