A trial study reports a 30% reduction in cardiovascular events using....drum roll please....the Mediterranean Diet. Eating healthy has the added benefit of having no damaging side effects. Think olive oil, nuts, chicken, fish, fruit & vegetables.

Mediterranean Diet Curtails Heart Troubles

By Michael Smith, North American Correspondent, MedPage Today

Published: February 25, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Eating a Mediterranean diet rich in unrefined olive oil or nuts lowered the rate of major cardiovascular events, at least among people at increased risk for heart disease, researchers reported.

In a randomized trial in Spain in high-risk people, those who ate the Mediterranean diet supplemented with extra-virgin olive oil or mixed nuts saw a reduction in the rate of major cardiovascular events by nearly 30% compared with a control group eating a low-fat diet, according to Ramón Estruch, MD, PhD, of the Hospital Clinic in Barcelona, and colleagues.

The results support the use of the Mediterranean diet for "primary prevention" of heart disease, the researchers wrote online in the New England Journal of Medicine.

But they cautioned that participants in the study lived in a Mediterranean country and were already at high risk for cardiovascular events, so it is not clear how well the results will apply to other people.

Nonetheless, the trial's data and safety monitoring board ruled late in 2011 that the benefits were sufficiently clear that the study should be stopped, Estruch and colleagues reported online in the New England Journal of Medicine.

The traditional Mediterranean diet, the researchers noted, is characterized by lots of olive oil, fruit, nuts, vegetables, legumes, and cereals, some fish and poultry, and limited amounts of dairy products, red meat, processed meats, and sweets. As well, the diet includes moderate amounts of wine with meals.

To test the idea that the diet protected against heart disease, the researchers randomly assigned 7,447 people, ages 55 to 80, to one of three diets -- a Mediterranean diet with additional unrefined (or extra-virgin) olive oil, a Mediterranean diet supplemented with mixed nuts (mainly walnuts), or a control diet, which consisted essentially of advice to reduce dietary fat.

The majority of the participants were women (57%) and were free of cardiovascular disease when they started, but either had diabetes or at least three important cardiovascular risk factors, such as smoking, hypertension, or obesity. They received quarterly educational sessions and, depending on group assignment, free extra-virgin olive oil, mixed nuts, or small nonfood gifts

The primary endpoint was a composite of strokes, heart attacks, and cardiovascular death.

After a median follow-up of 4.8 years, 288 participants had a primary endpoint event, including 96 (3.8%) in the olive-oil group, 83 (3.4%) in the mixed-nut group, and 109 (4.4%) in the control group.

In a multivariable analysis, the olive-oil diet led to a 28% reduction in risk, compared with the control diet (hazard ratio 0.72, 95% CI 0.54 to 0.92, P=0.01).

The mixed nut diet led to a similar risk reduction (HR 0.72, 95% CI 0.54 to 0.97, P=0.03).

Results were similar when the two Mediterranean diets were combined and compared with the control diet, they found.

The researchers cautioned that loss to follow-up might have affected the results, although those lost were mainly from the control group and had worse cardiovascular risk profiles than those who remained in the trial.

Although the study suggests benefits for unrefined olive oil and nuts, the key factor was change in the dietary pattern, argued senior author Miguel Angel Martínez-González, MD, PhD, of the University of Navarra in Pamplona, Spain, who presented the data at the International Congress on Vegetarian Nutrition being held in Loma Linda, Calif.

"Our aim was to modify the whole dietary pattern," he told a media conference at the meeting, adding there was good evidence that both the unrefined olive oil and the nuts reduced cardiovascular risk.

But it would be "overly optimistic to think that with a single food you can obtain a very large reduction in risk," he said, adding it's not just a matter of cooking meat and sausage in olive oil or adding walnuts to sweet desserts.

The study is important because it is one of the first to yield gold-standard evidence of the effect of a dietary intervention, commented David Jacobs, PhD, of the University of Minnesota in Rochester, who was not part of the study.

"What this study gives us is A-level evidence," Jacobs said during the media conference.

He added that regulators and agencies that establish dietary guidelines will likely take notice of the quality of the evidence.

Although the study was presented a meeting on vegetarian nutrition, the Mediterranean diet is "plant-based" rather than strictly vegetarian, commented conference chairman Joan Sabate, MD, of Loma Linda University.

UPDATE: This article, originally published on Feb. 25 at 6:00 a.m., was updated with new material on Feb. 25 at 2:00 p.m

The study had support from the Instituto de Salud Carlos III. Estruch reported financial links with the Research Foundation on Wine and Nutrition, the Beer and Health Foundation, the European Foundation for Alcohol Research, Cerveceros de España, sanofi-aventis, and Novartis.

Primary source: New England Journal of Medicine
Source reference:
Estruch R, et al "Primary prevention of cardiovascular disease with a Mediterranean diet" N Engl J Med 2013; DOI: 10.1056/NEJMoa1200303.

Is our environment and diet more harmful than we think? An article in Natural Society Newsletter headlines: "Leading Geneticist: Human Intelligence is Slowly Declining." Would you agree with his conclusions?

Leading Geneticist: Human Intelligence is Slowly Declining

by Mike Barrett
February 17th, 2013 | Updated 02/18/2013 at 4:02 am

Would you be surprised to hear that the human race is slowly becoming dumber, and dumber? Despite our advancements over the last tens or even hundreds of years, some ‘experts’ believe that humans are losing cognitive capabilities and becoming more emotionally unstable. One Stanford University researcher and geneticist, Dr. Gerald Crabtree, believes that our intellectual decline as a race has much to do with adverse genetic mutations. But there is more to it than that.



According to Crabtree, our cognitive and emotional capabilities are fueled and determined by the combined effort of thousands of genes. If a mutation occurred in any of of these genes, which is quite likely, then intelligence or emotional stability can be negatively impacted.

“I would wager that if an average citizen from Athens of 1000 BC were to appear suddenly among us, he or she would be among the brightest and most intellectually alive of our colleagues and companions, with a good memory, a broad range of ideas, and a clear-sighted view of important issues. Furthermore, I would guess that he or she would be among the most emotionally stable of our friends and colleagues,” the geneticist began his article in the scientific journal Trends in Genetics.

Further, the geneticist explains that people with specific adverse genetic mutations are more likely than ever to survive and live amongst the ‘strong.’ Darwin’s theory of ‘survival of the fittest’ is less applicable in today’s society, therefore those with better genes will not necessarily dominate in society as they would have in the past.

 Support: 16 Foods that Store for 15 Years

While this hypothesis does have some merit: are genes really the primary reason for the overall cognitive decline of the human race? If humans really are lacking in intelligence more than before, it’s important to recognize other possible causes. Let’s take a look at how our food system plays a role in all of this.
It’s sad, but true; our food system today is contributing to lower intelligence across the board.

The Water Supply, Fluoride is Lowering Your IQ

Researchers from Harvard have found that a substance rampant in the nation’s water supply, fluoride,  is lowering IQ and dumbing down the population. The researchers, who had their findings published in the prominent journal Environmental Health Perspectives, a federal government medical journal stemming from the U.S National Institute of Environmental Health Sciences, concluded that ”our results support the possibility of adverse effects of fluoride exposures on children’s neurodevelopment”.

“In this study we found a significant dose-response relation between fluoride level in serum and children’s IQ…This is the 24th study that has found this association”.

One attorney, Paul Beeber, NYSCOF President, weighs in on the research by saying:

“It’s senseless to keep subjecting our children to this ongoing fluoridation experiment to satisfy the political agenda of special-interest groups. Even if fluoridation reduced cavities, is tooth health more important than brain health? It’s time to put politics aside and stop artificial fluoridation everywhere”.

Pesticides are Diminishing Intelligence

One study published in the Proceedings of the National Academy of Sciences found that pesticides, which are rampant among the food supply, are creating lasting changes in overall brain structure — changes that have been linked to lower intelligence levels and decreased cognitive function. Specifically, the researchers found that a pesticide known as chlorpyrifos (CPF) has been linked to ”significant abnormalities”. Further, the negative impact was found to occur even at low levels of exposure.

Lead researcher Virginia Rauh, a professor at the Mailman School of Public Health, summarized the findings:

“Toxic exposure during this critical period can have far-reaching effects on brain development and behavioral functioning.”

Processed Foods, High Fructose Corn Syrup Making People ‘Stupid’

Following 14,000 children, British researchers uncovered the connection between processed foods and reduced IQ. After recording the children’s’ diets and analyzing questionnaires submitting by the parents, the researchers found that if children were consuming a processed diet at age 3, IQ decline could begin over the next five years. The study found that by age 8, the children had suffered the IQ decline. On the contrary, children who ate a nutrient-rich diet including fruit and vegetables were found to increase their IQ over the 3 year period. The foods considered nutrient-rich by the researchers were most likely conventional fruits and vegetables.

Interestingly, one particular ingredient ubiquitous in processed foods and sugary beverages across the globe -high fructose corn syrup – has been tied to reduced IQ. The UCLA researchers coming to these findings found that HFCS may be damaging the brain functions of consumers worldwide, sabotaging learning and memory. In fact, the official release goes as far to say that high-fructose corn syrup can make you ‘stupid’.

Gene mutations may have something to do with our ongoing decline in intelligence, but let’s stop to think for a moment what we’re doing to ourselves to make this decline even more prominent.

Read more: http://naturalsociety.com/leading-geneticist-human-intelligence-slowly-declining/#ixzz2LGP8bXH2

Many women I see in practice report their doctors recommend they supplement their diets with calcium for prevention or post-menopausal. Now a new Swedish study indicates that women with a high intake of calcium may have an increased risk of death from cardiovascular and ischemic heart disease, but not from stroke.

Too Much Calcium May Be Harmful for Women

By Michael Smith, North American Correspondent, MedPage Today

Published: February 13, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Women who have a high intake of daily calcium may be at an increased risk of death from all causes, from cardiovascular disease, and from ischemic heart disease, researchers reported.

 

But in a large cohort of Swedish women followed for nearly 2 decades, there was no increase in the risk of stroke in women who took more than 1,400 mg of dietary calcium per day, according to Karl Michaëlsson, MD, of Uppsala University in Uppsala, Sweden, and colleagues.

The findings are seemingly counter-intuitive, Michaëlsson and colleagues wrote online in BMJ, because guidelines have focused on avoiding low levels of calcium.

Indeed, they noted, more than 60% of middle-age and older women in the U.S. regularly take calcium supplements.

But re-analysis of some recent trials observed a higher risk of ischemic heart disease and stroke with calcium supplements, they added, although that was not seen in another study.

To help clarify the issue, they turned to the Swedish Mammography Cohort, a population-based cohort that includes 61,433 women born between 1914 and 1948 with a median follow-up of 19 years.

The primary outcome measures, based on registry data, were time to death from all causes, as well as from cardiovascular disease, ischemic heart disease, and stroke.

The researchers assessed diet by food frequency questionnaires, allowing an estimate of calcium intake, both from diet and supplements. Participants were divided into groups based on calcium intake – less than 600 mg a day, between 600 and 999 mg daily, from 1,000 through 1,399 mg a day, and 1,400 or more mg daily (about five 8-ounce glasses of cow's milk).

All told, 11,944 women died, including 3,862 from cardiovascular disease, 1,932 from ischemic heart disease, and 1,100 from stroke.

Compared with women whose intake was between 600 and 999 mg day, they found dietary intakes of more than 1,400 mg a day were associated with higher death rates:

• All causes: hazard ratio 1.40 (95% CI 1.17 to 1.67)
• Cardiovascular disease: HR 1.49 (95% CI 1.09 to 2.02)
• Ischemic heart disease: HR 2.14 (95% CI 1.48 to 3.09)

However, higher dietary intakes of more than 1,400 mg per day was not associated with a significantly increased risk for stroke (HR 0.73).

"The increase was moderate with a high dietary calcium intake without supplement use, but the combination of a high dietary calcium intake and calcium tablet use resulted in a more pronounced increase in mortality," the authors stated.

At the same time, levels of calcium below 600 mg a day were associated with an increased risk of all-cause mortality, as well as cardiovascular disease, ischemic heart disease, and stroke.

Diets very low or very high in calcium, might override the normal tight homeostatic control, causing changes in blood levels of calcium, said Michaëlsson and colleagues.

They cautioned that the dietary assessments were prone to limitations that affect both accuracy and precision, and that an observational study cannot show causality. Also, portion sizes were not assessed on an individual basis.

Finally, the results might not apply to people of different ethnic origins or to men.

The study had support from the Swedish Research Council. The journal said the authors declared no conflicts of interest.

From the American Heart Association:

• Guidelines for CVD Prevention in Women

Primary source: BMJ
Source reference:
Michaëlsson K, et al "Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study" BMJ 2013; 346: f228.

Interesting article published in the latest issue of Neurology Now discusses the rise of strokes occurring in younger adults. One should know the warning signs - and what to do - no matter what age you are.

 

Neurology Now:

February-march 2013 - Volume 9 - Issue 1 - p 19–26

doi: 10.1097/01.NNN.0000427282.19003.9c

Features: Young Adult Stroke

Age Is Just a Number: Young adult stroke is one the rise. Here's what you should know

Stephens, Stephani

Illustrations by Brian Stauffer

With another energetic daily workout behind her, Dana Hokin came back to her home in Scarsdale, NY, at 9:45 a.m., showered, and then bent down to retrieve her dropped towel. Suddenly, the vision in her right eye became “squiggly,” then blurry, then totally black. Age 44 at the time, Hokin didn't know exactly what was happening, but she knew it wasn't good.

“I had always been diligent about doctor visits, and I was in great shape,” Hokin remembers of Sept. 22, 2011. She called her husband, Michael, then her mother, Ellen—who suggested it was a detached retina—and then a nearby retinal specialist, Howard Charles, M.D., at the Mt. Kisco Medical Group in Rye, NY. However, acute symptoms such as Hokin's are best treated in an emergency department.

Precious time was passing as Hokin arrived at Dr. Charles' office around 11 a.m. After an examination, he determined Hokin had a blockage in one of the small arteries carrying blood to her retina. The condition—central retinal artery occlusion (CRAO)—is relatively rare, occurring in less than 3.5 per 100,000 people. Sometimes referred to as ocular stroke, CRAO can result in severe or permanent vision loss and increases a person's risk for an ischemic stroke of the brain, which is also caused by a blocked artery.

Dr. Charles knew that the sooner a person with stroke gets treatment, the better the outcome. (See box, “Stroke: The Basics.”) So he arranged for Hokin to be taken to the nearest stroke center, at St. Luke's Hospital in New York, NY.

Once there, Hokin's team included Johanna T. Fifi, M.D., a neuroendovascular surgeon (who specializes in minimally invasive procedures of the brain and spine), and assistant professor at the Albert Einstein College of Medicine in Bronx, NY; and Carolyn Brockington, M.D., director of the Stroke Center at St. Luke's Roosevelt Hospital Center and Beth Israel Medical Center, both in New York, NY. At 3 p.m., their patient underwent a three-hour procedure to dissolve her clot with the drug tissue plasminogen activator (tPA), which is the most promising treatment approved by the U.S. Food & Drug Administration (FDA) for an ischemic stroke. It dissolves blood clots, improving blood flow to prevent further organ or tissue dam­age when administered intravenously within a 3- to 4.5-hour window of time (if given directly into an artery, as in Hokin's case, the window is 8 hours). Although tPA is not FDA-approved for CRAO, Hokin's doctors felt it was the best treatment in her case.

Catalyst for Change

In 2008, Ronald Stewart, M. D., was one of several people advocating for designated stroke centers in San Antonio, TX, where he lives and works. A designated stroke center is a hospital that specializes in stroke care. Dr. Stewart chaired both the surgery department at the University of Texas Health Science Center at San Antonio and the Southwest Texas Regional Advisory Council, which oversees care for patients with traumatic injuries, heart attacks, and strokes across 22 south Texas counties. He still holds both positions.

Back in 2008, at yet another meeting held on the topic of designated stroke centers, Dr. Stewart once quipped, “You know what? I have atrial fibrillation [the most common cause of irregular heart beat and a risk factor for stroke]. I could have a stroke and need you guys someday.”

He did.

And he did.

He was 53 years old and sitting at his home computer on December 21, 2011, when he experienced a type of ischemic stroke caused by multiple clots in the brain—in his case, on the left side of his brain. His arm involuntarily shot straight up as he struggled to make sense to his daughter Elizabeth. Fortunately, within a matter of minutes, he was able to tell her he'd had a stroke, needed an aspirin, and needed to go to the university hospital. She called 911.

By then, thanks in part to his efforts, that facility had implemented a designated stroke center, as had nine other San Antonio hospitals. He was treated by the team of his colleague and friend, Robin L. Brey, M. D., chair of the department of neurology at the University of Texas Health Science Center, Fellow of the AAN, and editor-in-chief of Neurology Now. She quickly diagnosed his stroke and administered tissue plasminogen activator (tPA), which dissolves blood clots, improving blood flow to prevent further organ or tissue damage when administered intravenously within a 3 to 4.5-hour window of time. Having recovered fully, Dr. Stewart is now eager to share his wisdom.

“Patients who have atrial fibrillation should take an anticoagulant or blood thinner. I should have been on something more than aspirin, as my doctors had recommended,” he says somewhat sheepishly.

“And if you think you're having a stroke, don't say, ‘This will get better,’ because it won't. Call 911 and go to the hospital, not to a doctor's office or a clinic. Take an ambulance so you don't waste time in the waiting room—the quicker you get stroke treatment, the better your chances,” Dr. Stewart says.

“If symptoms include sudden alterations in consciousness and neurologic function, don't hesitate to think stroke,” says Dr. Stewart. “Lots of younger people who have periodic atrial fibrillation may or may not be diagnosed. It's more common than most people believe.”

Dr. Stewart is back to full speed in his career and his life—and happy to talk, walk, and work again. “As best I can tell, I've made a complete recovery. I am very blessed and very grateful,” he says.

NUMBERS ON THE RISE

The clot, which remained for more than five hours, destroyed 80 percent of Hokin's vision, leaving 20 percent blurred.

“You're so young to have had a stroke,” Hokin remembers one doctor telling her. In fact, many well-known people have had strokes at a relatively young age: actor Kevin Sorbo (see our article on him at http://bit.ly/osbflE); actress Sharon Stone; Sen. Mark Kirk (R-Ill.); Beau Biden, son of U. S. Vice President Joseph Biden; Tedy Bruschi, former linebacker for the New England Patriots (see our story on Bruschi at http://bit.ly/136pE7P); and singer/songwriter Bret Michaels; to name a few.

Stroke symptoms such as dizziness or headache can be confusing—mimicking signs of other conditions, including brain tumor, multiple sclerosis, spinal cord injury, or serious infection. Stroke can also masquerade as vertigo, alcohol intoxication, inner ear disorder, or migraine headache. (See box, “Warning Signs of Stroke.”)

One out of seven patients with stroke between the ages of 16 and 50 was misdiagnosed according to a 2011 study conducted by the department of neurology and stroke program at Wayne State University/Detroit Medical Center, according to program director and study co-author Seemant Chaturvedi, M.D., professor of neurology and Fellow of both the American Academy of Neurology (AAN) and the American Heart Association.

“One out of seven is not a trivial number when you consider that more than 50,000 young people have a stroke each year,” Dr. Chaturvedi says.

Early use of magnetic resonance imaging (MRI) can improve diagnostic accuracy in young adults with stroke, as can having a neurologist see the patient in the emergency department.

HOW YOUNG IS YOUNG?

So just who is a “young adult”? Experts agree it can be a controversial issue.

Dr. Chaturvedi defines the term as between the ages of 18 and 50. “That number has been commonly used in previous studies,” he says.

Others define the upper limit as between ages 45 or 50 years, according to Aneesh B. Singhal, M.D., of Massachusetts General Hospital's department of neurology and stroke service. “The vast majority say age 45, a few say 49, one or two say 55, but 45 is the standard,” says Dr. Singhal. “It is a ‘moving target,’ an arbitrary definition that depends upon the research you're doing. We really should emphasize that stroke can affect people of all ages including newborns, children, adolescents, young adults, and middle-aged individuals—not just the old and very old.”

True, nearly three-quarters of all strokes do occur in people over the age of 65, and stroke risk more than doubles each decade after the age of 55. But evidence continues to mount that strokes really don't just occur in the elderly, in spite of what many people think.

“It's possible that the increases in stroke among the young result from better detection, due to advances in brain imaging such as MRI,” says Dr. Singhal. But he also refers to studies such as the 2012 study from the University of Cincinnati College of Medicine in Ohio led by Brett M. Kissela, M.D., M.S., and Fellow of the AAN: According to the study, rates of modifiable stroke risk factors such as hypertension, diabetes, obesity, and cigarette smoking increased significantly between 1993 and 2005, as did rates of first stroke, among patients age 20 to 54.

“The data are particularly relevant given the U.S. and global epidemics of obesity and diabetes,” says Dr. Singhal.

Warning Signs of Stroke

Stroke strikes fast. You should, too. Call 9-1-1 if you experience any of these signs:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

* Sudden confusion, trouble speaking or understanding

* Sudden trouble seeing in one or both eyes

* Sudden trouble walking, dizziness, loss of balance or coordination

* Sudden, severe headache with no known cause

Call 911 immediately if you or someone you are with shows signs of having a stroke. Do not try to drive yourself to the hospital.

Stroke can happen with just one of these symptoms, and the symptoms can vary. In addition, the symptoms can either start slowly or come on quickly.

STROKE CAUSE AND EFFECT

For stroke in general, doctors determine a cause in about two-thirds of cases. “The cause of stroke in young adults is much more ‘wide spectrum,’ with a high frequency of causes that, overall, are considered uncommon,” says Dr. Singhal.

Dr. Singhal co-authored an October 2012 study that found newer diagnostic tests—such as CT angiography, genetic studies, and newer blood tests—can detect the cause in the vast majority of young adult stroke patients. It also found that vascular risk factors are common and that early treatment with clot-busting agents can be safe.

The most common collective cause among patients younger than age 45 is disease of the arteries in the brain, according to Dr. Singhal. Atherosclerosis is prevalent in approximately 10 percent of young patients with stroke and can result from high blood pressure, high cholesterol, smoking, or physical inactivity, he notes.

Younger patients who have diabetes, HIV/AIDS, tuberculosis, the autoimmune disease lupus, or migraines are also at increased risk for stroke. Migraine with aura—visual sensory disturbances that precede or accompany the migraine—increases a woman's risk of stroke two-fold to three-fold, Dr. Singhal says. The risk is 12-fold to 16-fold higher for women with migraine with aura who also smoke and take oral contraceptive pills.

Birth control pills have been the subject of much discussion and research; they remain generally ill-advised for women who smoke. They can also raise stroke risk for women over 35 and those with high blood pressure, diabetes, or high cholesterol. Pregnancy also raises stroke risk for women.

Dr. Singhal offers this advice. “Clinical guidelines recommend against using oral contraceptives in women who have had a stroke—which is all about secondary prevention. Most experts agree that women with migraine should take progesterone-only contraceptives.”

Stroke: The Basics

There are two types of stroke: ischemic and hemorrhagic. Ischemic stroke is caused by blockage of a blood vessel supplying the brain. Hemorrhagic stroke is caused by bleeding into or around the brain.

How common is stroke?

* About 795,000 Americans each year experience a new or recurrent stroke. On average, a stroke occurs every 40 seconds in the United States.

* Stroke kills more than 137,000 people a year—approximately 1 of every 18 deaths. It's the fourth-highest cause of death in the United States.

* About 40 percent of stroke deaths occur in men, and 60 percent in women.

What are the risk factors for stroke?

Risk factors that can be treated, changed, or controlled include high blood pressure, cigarette smoking, diabetes, carotid or other artery disease, peripheral artery disease, atrial fibrillation (irregular heartbeat), heart failure, sickle cell anemia, high cholesterol, poor diet, physical inactivity, and obesity.

* Prior stroke, transient ischemic attack (TIA), or heart attack: The risk of stroke for someone who has already had one is many times that of a person who has not. A TIA produces stroke-like symptoms but no lasting damage; it is also a predictor of stroke. And if you have had a heart attack, you are at higher risk of having a stroke.

* Age: The chance of having a stroke approximately doubles for each decade of life after age 55.

* Sex: Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.

* Race: African-Americans have a much higher risk of death from a stroke than whites do, partly because African-Americans have higher risks of high blood pressure, diabetes, and obesity.

* Family history: Stroke risk is greater if a parent, grandparent, sister, or brother has had a stroke. Rarely, strokes may be symptoms of genetic disorders like cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

What treatments are available?

* Prevention: The best treatment for stroke is prevention. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as high blood pressure, atrial fibrillation, and diabetes.

* Acute stroke therapies immediately after a stroke: These try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics and thrombolytics.

* Post-stroke rehabilitation: This helps a patient prevent or overcome disabilities that can result from stroke damage.

What research is being done?

The National Institute of Neurological Disorders and Stroke (ninds.nih.gov) conducts stroke research and clinical trials at its laboratories and clinics at the National Institutes of Health (NIH) and through grants to major medical institutions. Some of the topics of current stroke research include: how stroke risk factors contribute to stroke; how stroke damages the brain; the genetics of stroke; and ways to help the brain repair itself after stroke to restore important cognitive functions. New advances in imaging and rehabilitation have shown that the brain can compensate for some function lost as a result of stroke.

LOOKING FORWARD

Dana Hokin has relearned necessary daily life skills and is grateful for the little things. “You don't know how much you can't handle,” she says, recalling how she felt somewhat “helpless” immediately after her stroke. The road back to normalcy presents a few bumps along with new insights, like learning to drive a car again—and smashing the rear-view window along the way.

“I deal with my vision loss every day,” she says. “But I have a lifeline to an amazing husband and two wonderful kids and my friends. ‘Stuff happens’ to everyone, and this is my thing. I'm grateful it wasn't worse, and I am moving on and not dwelling on my stroke,” Hokin says.

“Not everybody has a devastating stroke,” says Dr. Chaturvedi. “A lot of young people have made a good recovery. We are continually optimistic about the increasing number of excellent diagnostic tools for stroke.”

“The good news is that some of the possible contributing factors to these strokes can be modified with lifestyle changes, such as diet and exercise,” said Dr. Kissela in a prepared statement. “However, given the increase in stroke among those younger than 55, younger adults should see a doctor regularly to monitor their overall health and risk for stroke and heart disease.”

©2013 American Academy of Neurology