With the threat of a virtual stroke epidemic on the horizon, North-East GP, Dr Zak Uddin examines a very frightening condition where prevention really is better than cure

EVERY year, the month of May is dedicated to Stroke Awareness, with the aim of supporting those individuals and their families affected by strokes, as well as highlighting practical tips we can all benefit from to hopefully reduce our chance of suffering a stroke.

This is extremely pertinent. Experts are warning of an epidemic, with the number of incidents in the UK predicted to rise by almost fifty per cent over the next 20 years, mainly due to the effects of people living longer.

Research carried out at Kings College London, and examining several European countries, found that this was not limited to the UK, but that we were at the top of the table in terms of increased number of strokes, with the finger firmly pointed at obesity. Being overweight can increase your risk of stroke by more than 60 per cent, and inside Europe, the UK is second only to Hungary with regards to number of people being in the obese category.

With more than 100,000 people a year suffering stroke in the UK, it is one of the most common causes of death. In addition, currently there are in excess of a million survivors. The effects of stroke vary considerably, from minor disabilities to being completely dependent for all aspects of daily living. Stroke is one of the largest healthcare burdens, with an estimated annual cost to the NHS and society of greater than £10 billion.

Stroke, or cerebrovascular accident (CVA), occurs when the blood supply to an area of the brain is interrupted, either by a clot in the blood vessel supplying the territory, or if this blood vessel ruptures. Symptoms, as highlighted by the excellent F.A.S.T campaign, vary depending on the part of the brain affected, and can include facial weakness, noticed as one side of the face drooping, weakness or numbness in one or more limbs, or speech becoming slurred. Stroke is a medical emergency and any one of these symptoms should prompt an immediate 999 call. The treatment for CVA relies on re-establishing blood flow to the affected area, and the quicker this is achieved, the greater the likelihood of recovery.

Treatment following a stroke is centred on rehabilitation and most areas now have dedicated teams including physiotherapists as well as Speech and Language therapists. Doctors look to reduce the survivor’s risk of another stroke by addressing modifiable factors.

So despite age being the biggest risk factors for suffering a stroke, there are still many lifestyle measures we can adopt to reduce an illness where prevention really is better than a cure.

The UK Stroke Association argues that diseases of the heart and blood vessels are not an inevitable result of ageing, and that by addressing conditions which put extra strain on these, potentially nine out of ten strokes could be prevented.

Treatable risk factors for stroke are poorly controlled blood pressure, diabetes, and an irregular heartbeat known as atrial fibrillation, as well as smoking, excess alcohol consumption and obesity. Many of these are interlinked. Raised blood pressure over a prolonged period puts excess strain on blood vessels making them more likely to burst. People with diabetes are two to four times more likely to have a stroke than the background population, as the excess sugar in the bloodstream promotes blood vessel narrowing and eventually blockage. In untreated atrial fibrillation, the disorganised flow of blood in the heart promotes clots to form; which may then travel to the brain and get lodged in a blood vessel there.

With respect to lifestyle choices, obesity raises blood pressure as well as the chance of developing diabetes. Alcohol is calorie rich and excessive consumption is a risk factor for obesity, raised blood pressure and the development of diabetes. Smoking actively damages blood vessel walls, making them more likely to narrow as well as rupture.

In conclusion, although the predictions seem bleak, I would argue that it is anything but. Outside of age, every single risk factor above can be addressed. More than ever there are efforts to improve the care of persons with diabetes, high blood pressure and atrial fibrillation. NHS specialist weight management clinics provide everything from diet and lifestyle advice through to weight reduction surgery. There are clinics for smoking cessation, as well as harmful alcohol use.

The future of stroke prevention relies on doctors and patients working hand in hand to address all of the above. However, if you witness someone who you think is having a stroke, the advice is simple; telephone 999; your action may save a life.