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WHILE the incidence of stroke and deaths from stroke have been on the decline in the last decade because of better prevention and treatment efforts, experts predict a worldwide stroke epidemic in the next 20-25 years, due largely to a growing aging population, says the December 2012 issue of the Cleveland Clinic Men’s Health Advisor.

Irene Katzan, M.D., director of the Cleveland Clinic Neurological Institute’s Center for Outcomes Research & Evaluation, says, “What we’re seeing now is the calm before the storm. There’s a lot of talk about the need to be very aggressive with primary preventive efforts to try to offset some of this burgeoning burden that’s predicted.”

On average, every 40 seconds someone in the United States has a stroke, adds the health letter.

Call 911 immediately if you experience these stroke warning signs which include:

• Sudden severe headache

• Sudden vision problems in one or both eyes

• Sudden confusion, trouble speaking or understanding

• Sudden numbness or weakness in the face, arm or leg, especially one side of the body

• Sudden trouble walking, loss of coordination

Some stroke risk factors are beyond your control, including:

• Advancing age - Stroke risk doubles for each decade of life after age 55.

• Gender - Stroke is more common in men.

• Race - Stroke risk is greater among African-Americans.

• Family history of stroke

Other stroke risk factors are modifiable, such as:

• High blood pressure (hypertension) - Individuals with high blood pressure (blood pressure above 140/90 mmHg) have more than twice the lifetime risk of stroke as someone with normal blood pressure (less than 120/80 mmHg).

A 2011 analysis found that even individuals with prehypertension - defined as systolic blood pressure (the top number) of 120-139 mmHg and diastolic pressure (lower number) of 80-89 mmHg - have an elevated risk of stroke.

• Diabetes - According to the National Stroke Association, individuals with diabetes are up to four times as likely to have a stroke as non-diabetics.

The potential damage increases, the longer your have diabetes - In a study published in May in the journal Stroke, researchers concluded that compared to diabetes-free patients, individuals with diabetes for less than five years had a 70 percent greater stroke risk, those with the disease five to 10 years had an 80 percent increased risk, and individuals with diabetes for 10 years or more faced triple the risk of stroke.

• Obesity/lifestyle - Obesity, a poor diet and physical inactivity often go hand in hand with each other and with diabetes, hypertension and cholesterol abnormalities, says the health letter.

These factors increase your risk not only of stroke but also cardiovascular disease and an irregular heart rhythm known as atrial fibrillation, both of which are stroke risk factors.

Other lifestyle habits, such as smoking and excessive alcohol consumption, also increase stroke risk. Dr. Kazan recommends yearly cardiovascular evaluation for those with no history of stroke or cardiovascular events and more frequent evaluation for those with a history of stroke or other cardiovascular events.

• Emerging risk factors - These include the newer risk factors, such as:

1) Your mental health may raise your stroke risk - A 2011 study found that depression was associated with a 45 percent greater risk of stroke and 55 percent greater risk of fatal stroke.

A higher likelihood of depression which should prompt a further evaluation with your doctor is indicated if:

a) In the past two weeks, you have felt down, depressed, or hopeless, and

b) in the past two weeks, you have felt little interest or pleasure in doing things.

The effect of depression on stroke risk is becoming more recognized, but people with depression may be reluctant to talk to their doctor about it, says Dr. Katzan.

2) Sleep problems such as obstructive sleep apnea (OSA) have been tied to greater stroke risk.

OSA, characterized by brief interruptions in breathing during sleep, affects an estimated 4 percent of middle-aged men, yet experts estimate that 80 percent of men with OSA are undiagnosed.

According to Dr. Katzan, the three biggest stroke risk factors probably are blood pressure, cholesterol and diabetes and following them is critical, but newer things, such as obstructive sleep apnea and depression, if addressed, will hopefully reduce the risk.

To conclude, the health letter offers these stroke prevention strategies:

• Maintain blood pressure below 120/80 mmHg (130/80 if you have diabetes).

Have your blood pressure tested every two years or more often if it’s consistently above 130/80 mmHg.

• Undergo periodic blood sugar testing; maintain the blood sugar level your physician recommends.

• Aim for an LDL (“bad”) cholesterol goal of less than 100 mg/dL and an HDL (“good”) cholesterol level greater than 40 mg/dL.

• Report any sensation of fluttering or pounding in your chest that may be accompanied by tiredness or dizziness - these could be signs of atrial fibrillation, a stroke risk factor.

• If you feel hopeless, helpless or have any other signs of depression, inform your physician.

• Tell your doctor about sleep problems or if your bed partner notices that you snore loudly or experience interruptions in your breathing during sleep.

• Consume five servings of fruit and vegetables a day while curbing your intake of sodium, processed foods and fatty meats and dairy products.

• Develop an exercise program geared for your physical abilities - build up to at least 30 minutes of moderate-intensity aerobic exercise a day on at least five days a week.

• If you smoke, ask your doctor about ways to quit.

• Limit alcohol consumption to one or two drinks or fewer per day.

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