5. How to Reduce Your Risk

Regular Medical Check-ups: Risk factors such as heart disease, high blood pressure and elevated blood cholesterol must be monitored by your physician on a regular basis. These risk factors can be changed or, at a minimum, controlled by proper medical treatment and appropriate diet and lifestyle modifications.

Control Blood Pressure: High blood pressure (hypertension) is the single most important risk factor for brain attack. Even mild hypertension, if not adequately treated, increases brain attack risk. In general, blood pressure should be below 140/90. Elevated blood pressure promotes atherosclerosis and puts abnormal pressure on blood vessel walls, which can cause a rupture at a weak spot.

Hypertension is often called the "silent killer" because there may be no obvious symptoms. It is important to check your blood pressure regularly. Controlling blood pressure, whether by a low-sodium diet, weight control, stress management and/or medication, will reduce your risk of brain attack. Remember: medication to control hypertension is effective only if taken on a regular basis, so it is important to follow your physician's instructions.

Stop Smoking: Studies confirm that smokers have a higher risk of brain attack, regardless of other factors such as age, high blood pressure or heart disease. The risk declines dramatically with a few years of not smoking.

Treat Heart Disease: A variety of heart conditions, including irregular heart rhythms (atrial fibrillation), heart attacks and heart valve disorders, can cause brain attack. Treatment of these disorders can reduce brain attack risk.

Maintain a Healthy Weight: Being overweight strains the heart and blood vessels and is associated with high blood pressure. Obesity also predisposes a person to heart disease and diabetes, both of which increase the risk for brain attack. Keeping your weight at recommended levels for your height and build is a prudent preventive measure.

Exercise Regularly: The percentage of fat in our bodies tends to increase with age. Regular exercise helps keep this increase to a minimum. There appears to be an inverse relationship between exercise and atherosclerosis, i.e., more exercise is linked to lower level of atherosclerosis. If you have not exercised regularly and would like to start an exercise program, or if you have medical problems of family history or serious disease, consult your physician before beginning an exercise program.

Improve Diet: Consumption of foods high in fat, cholesterol and salt increases the risk for brain attack. The following recommendations are among the most important for brain attack prevention. Ask your doctor for more help in identifying dietary culprits and making appropriate substitutions.

Avoid Excess Fat: High intakes of fat, particularly saturated fat, and cholesterol may contribute to atherosclerosis, which is associated with brain attack. Dietary fat and cholesterol may be reduced by limiting fat or oil added in cooking, trimming fat and skin from meats and poultry, using low-fat or nonfat diary products, boiling and baking foods rather than frying, and limiting eggs to no more than three a week.

Avoid Excess Sodium: Excess sodium in the diet is linked to hypertension. Table salt is the primary source of dietary sodium. There is also "hidden" salt in most processed and canned foods. Disodium phosphate, monosodium glutamate, sodium nitrate or any similar compound in the list of ingredients indicate a high sodium content. Try to eat fresh food whenever possible.

Limit Alcohol Intake: Individuals who drink alcoholic beverages (more than two drinks per day) have an increased risk of brain attack. For heavy drinkers, the risk increases further. Healthy young adults are just as susceptible to the risk of brain attack incurred by heavy alcohol consumption as are older persons.

Treat Diabetes: The association between diabetes and increased brain attack risk seems to be related to the circulatory problems caused by diabetes. Good control of diabetes appears to reduce the cardiovascular complications of the disease.

Reduce Stress: Because stress may increase blood pressure, it is linked indirectly to brain attack risk. A one-time stressful event rarely causes a brain attack, but long-term unresolved stress can contribute to high blood pressure. Stress management, including relaxation techniques, biofeedback, exercise and counseling, appear to be useful in the treatment of high blood pressure, thus lowering the risk of brain attack.

Use of Oral Contraceptives: Oral contraceptives, especially those with high estrogen content, appear to increase the risk of blood clots, including clots that cause brain attack, especially in women over age 30. The risk is even higher in women who smoke. Consult your physician for advice regarding alternative methods of birth control if you have brain attack risk factors and are currently using oral contraceptives. Postmenopausal estrogen use does not appear to increase brain attack risk.

Risk Factors That Cannot Be Changed

Age: The chance of having a stroke increases with age. Two-thirds of brain attacks occur in persons over the age of 65.

Gender: For reasons that are not yet clear, brain attack is 25 percent more common in men than in women.

Race: The incidence of brain attack varies among races for reasons that are probably related to genetic factors. Social factors, such as lifestyle and environment, can also play a part. Asians and African Americans have a higher incidence of hypertension than Caucasians, and also a higher rate of brain attack. Furthermore, they are more likely to suffer brain attacks at an earlier age.

Family or Individual History: A history of cerebrovascular disease in a family appears to be a contributing factor to brain attack. While you have no control over your family history, you can take steps to decrease your risk through diet, exercise and other means discussed in this handbook. If you have experienced a brain attack or TIA in the past, you are at increased risk for having a brain attack in the future. Therefore, all the preventive measures discussed in this section are of particular importance.

Brain Rescue intervention for stroke prevention

To prevent stroke occurrence in patients at risk we do a battery of investigations which includes blood and metabolic tests, vascular screening and baseline brain imaging. With the help of these tests we calculate basal metabolic rate, body mass index, percentage occlusion of brain vessels etc. Under this program we offer our patients body fat mobilization therapy, optimizing blood flow therapies, exercises tailored for them, yoga and rejuvenation therapies and appropriate nutritional advice.

The interdisciplinary team includes:

• Consultants: includes the neurologist, Critical care specialist (intensivist), physician, neurosurgeon, interventional neuroradiologist, and neuro-anesthesiologist

• Registered nurses: assess and coordinate patient needs, administer treatment and provide family instruction

• Patient care assistants: provide personal care and hygiene

• Physical, occupational and speech therapists: provide individualized rehabilitation

• Medical social workers: offer support to patient and family, work to coordinate any appropriate community resources

• Care coordination: oversees hospitalization and coordinates with insurance payers; works to insure follow-up arrangements such as home care

• Dietitians: assist with proper design of nutritional caloric intake