Read an Excerpt
Chapter One
A New Paradigm for Stroke Prevention and Treatment
When I first began my medical training in the 1970s, I was immediately drawn to neurology. What could be more fascinating than decoding the mysteries of the human brain? But many people discouraged me from pursuing this field. The brain was simply too complex, they believed, and the nature of brain diseases too opaque, for doctors to be able to help most people. Better to go into cardiology, I was advised, where lifesaving advances were being made in repairing — even transplanting — diseased hearts.
I stuck with neurology because the lure of exploring the uncharted regions of the brain was simply irresistible. The last few decades have been a time of tremendous advancement in our understanding of the way the brain works. The 1990s were rightly dubbed "The decade of the brain," when the advent of new imaging technologies opened a window into the master control room of our consciousness. After centuries of merely guessing how things worked inside our skulls, we now have vivid pictures of neural pathways. We can understand how nerve impulses control various aspects of our physical being, and can even identify the neurological basis for many of our emotions.
In the past few years, breakthroughs in imaging technologies, medications, and surgery — as well as data from population-based epidemiology — have given us dramatic insights into the most prevalent and destructive of brain disorders: stroke. What we've learned flies in the face of many of our most deep-seated assumptions about this dreaded killerand disabler.
For many years, people referred to stroke as "apoplexy," a term derived from a Greek word meaning "to strike down." The word portrays stroke as something sudden, unexpected, unpredictable. An outdated clinical term for stroke, "cerebrovascular accident," carries a similar connotation. These terms no longer apply. In the last few decades — and particularly in the past few years — we have learned what causes and contributes to stroke. We have learned that stroke, though sudden, is neither unexpected nor unpredictable. In fact, in most cases, it represents the end stage of a related disease or condition.
As a researcher who has devoted his career to treating stroke, I find these to be exciting and empowering revelations. If stroke can be predicted, and its causes pinpointed, then it can be prevented. In fact, I believe that up to 80 percent of strokes are preventable. The best news of all is that in the majority of cases, stroke can be prevented through noninvasive changes in lifestyle.
Everyone in health care recognizes that disease prevention saves more money, lives, and suffering than reactive treatment, but up till now, prevention has played only a minor role in stroke medicine. I've written this book to promote a shift toward a new paradigm in stroke treatment: a paradigm of prevention that begins well before old age. Preventing stroke means looking at lifestyle issues and risk factors that begin causing disease in our thirties and forties.
Until we convert our new knowledge about stroke into a coherent prevention program, millions of people are being disabled or killed by a calamity we are failing to avert. The statistics are staggering: Stroke strikes approximately 750,000 Americans every year, killing an estimated 160,000. There are more than 4 million stroke survivors in the United States and almost 30 million direct family members of those survivors. During the course of a lifetime, four out of every five families in the United States will be touched by stroke.
These numbers are tragic, especially since it doesn't have to be this way. We now have the power to prevent most strokes. Prevention is not a passive process. Rather than fearing stroke as an unexpected and inevitable killer and disabler, we need to face it squarely as a predictable medical condition that can be prevented. Each of us needs to take an active role in shaping our medical destiny — first, by assessing our risk level, and second, by taking important steps toward reducing that risk.
Risk assessment has been an imprecise science. We know that certain conditions have increased stroke risk, but we haven't known to what extent and how various risk factors interacted. That has changed. The culmination of four decades of research at Mayo Clinic — along with studies from other medical centers and those we have collaborated on or conducted around the world — has yielded a more complete picture of the numerous variables that increase stroke risk as well as how those variables interact. Our team at Mayo has recently converted this information into a comprehensive method for predicting who is at risk of stroke.
We wanted to make this new risk-assessment tool available to the general public in book form. Armed with the program outlined in this book, any motivated person can create a personalized prevention program.
The Preventive Power of Lifestyle
The newly fleshed-out portrait of the lifestyle and medical factors that can lead to stroke is a powerful preventive weapon. True, this complex picture indicates that no single simple approach can prevent stroke, but it also shows us that stroke is much more deeply rooted in remediable lifestyle risks than has been previously thought. Each of us can have a profound influence on our medical destiny.
I hope this book will give you all the information and advice you need to add years to your life. Rich years, full of family and friends, work and play. It's really up to you. I see a vital role for such lifestyle factors as diet, exercise, and stress reduction in preventing stroke and the conditions that lead to stroke. As more and more lifestyle factors enter into the risk/prevention equation, your role becomes increasingly central. Only you can control such lifestyle risk factors as diet, alcohol consumption, stress, and smoking cessation. Although you will need to work with your doctor to review the various prevention and treatment options at your disposal, the ultimate decision whether or not...
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