Health
90% of strokes are avoidable with a few lifestyle changes!
Cleveland Clinic Expert Shares Six Simple Steps to Prevent Vast Majority of Strokes
December 5, 2023 – According to the World Stroke Organization (WSO), stroke is the leading cause of disability worldwide. The WSO says one in four people will have a stroke in their lifetimes, and each year over 12 million people worldwide have strokes. However, it adds that 90% of strokes are preventable by addressing a small number of risk factors that are responsible for most strokes. In The Bahamas, on average 224 people (or 9.56%) die annually from strokes.
Here, Andrew Russman, DO, Medical Director of Cleveland Clinic’s Comprehensive Stroke Center and a vascular
neurology specialist, offers advice on how to reduce stroke risk by better managing existing health conditions and also through implementing lifestyle changes. “These tips are interrelated as most of the lifestyle changes mentioned also play a role in improving management of hypertension, high cholesterol and diabetes, which all increase stroke risk,” Dr. Russman points out.
- Reduce hypertension
Uncontrolled hypertension – that is, blood pressure that is consistently above 130/80 – is the single most important modifiable risk factor in stroke worldwide, says Dr. Russman.
Aside from medication, an important step in reducing blood pressure is to reduce salt intake, which Dr. Russman says is good advice even if you don’t have high blood pressure. “We recommend consuming no more than 2g of salt per day. I advise my patients to check food labels and nutritional websites for sodium levels as their intake is usually far higher than they realize,” he adds.
- Be wary of diabetes
It is important to be tested for diabetes, and if diagnosed, to manage the condition wells, says Dr. Russman. He explains that diabetes causes narrowing of small, medium and large blood vessels in the body, including vessels of the eyes, kidney, heart and brain. Owing to this, diabetes can contribute to a variety of vascular, cardiovascular and cerebrovascular problems including stroke. In addition, for patients who have survived a stroke, the risk of having a second is three times higher in those patients whose diabetes is not controlled.
Dr. Russman says that as part of their treatment plan, people with diabetes should have their condition monitored through HbA1C tests, which provide a three-month snapshot of their blood sugar control. “We recommend that these individuals aim for an HbA1C result of 7.0 or less. Taking prescribed medication correctly, watching their diet, exercising regularly, and following their healthcare provider’s recommendations will help them achieve this.”
- Address atrial fibrillation
The WSO says atrial fibrillation is associated with one in four strokes, and Dr. Russman says these strokes tend to be more severe and disabling than strokes associated with other risk factors.
“Atrial fibrillation is a heart rhythm condition characterized by very rapid heartbeats that don’t allow the top left chamber of the heart – the left atrium – to contract normally. Instead, it fibrillates and flutters so blood is not ejected normally from the chamber,” he says. “Anytime blood is stagnant for too long, it can form a blood clot that can travel elsewhere in the body. This clot could cause a stroke by blocking a blood vessel in the brain, depriving that part of the brain of the oxygen and nutrients it needs.”
Dr. Russman says atrial fibrillation is the most common acquired heart rhythm disorder in older adults, and its associated risk is strongly related to age. “The older you are, the more at risk you are of acquiring the condition, but also the higher the risk of stroke associated with the condition,” he says. “It is estimated that up to half of all patients with a heart rhythm condition are not aware of it. However, once diagnosed, atrial fibrillation can be treated with a blood-thinning medication. These do carry some risks, but the benefits far outweigh these in the vast majority of patients.”
- Manage cholesterol levels
In addition to reducing high levels of low-density lipoprotein (LDL) or ‘bad’ cholesterol through diet, for example, by avoiding saturated fat, individuals might be prescribed statin medications that reduce future risk of heart attacks and strokes. Dr. Russman says these medications, particularly rosuvastatin and atorvastatin, may benefit patients
beyond simply reducing cholesterol levels in that they also appear to reduce inflammation and stabilize plaque build-up in blood vessels.
- Stop smoking
“Any type of smoking is associated with increased risk of cardiovascular disease and stroke, and is strongly associated with accelerated hardening of the arteries and narrowing of blood vessels in the brain, heart and elsewhere,” says Dr. Russman. “We therefore strongly recommend everyone completely stop any form of nicotine ingestion to significantly reduce their long-term risk for a multitude of diseases.”
- Adopt a healthy lifestyle
Dr. Russman recommends following an eating plan that is low in saturated fats and sodium, and to avoid alcohol and excessive caffeine consumption. Regular physical activity is also important as it can reduce the risk of stroke directly, but also indirectly as it helps to lower high blood pressure and blood sugar levels. Exercise can also help to reduce stress, as can other activities such as meditation or deep breathing, which is important as stress causes the body to release chemicals that can increase blood pressure, affect hormones and raise blood sugar levels, says Dr. Russman.
Caribbean News
Belize, Jamaica and St. Vincent and the Grenadines eliminate mother-to-child transmission of HIV and Syphilis
Grand Turk, Turks and Caicos Islands – 11th May 2024: On Thursday, 9th May 2024, results of testing for two suspected measles cases were received from the Caribbean Public Health Agency, confirming that both cases were positive for measles. These represent the first cases of measles in the TCI since 1991.
The public health team has been responding since initial reports of the suspected cases, carrying out contact tracing, isolation, public education and outreach in anticipation of yesterday’s results. No additional suspected cases have been identified at this time. All unvaccinated contacts of the confirmed cases have been vaccinated. Additional vaccination efforts will be conducted throughout the TCI. 
The public health team has been receiving technical support from its key stakeholders including the Caribbean Public Health Agency (CARPHA), UK Health Security Agency (UKHSA) and Pan American Health Organisation (PAHO).
Measles is a highly infectious disease caused by a virus that spreads easily between people. Symptoms typically start between 10 and 12 days after catching the infection. The signs and symptoms of measles are:
- A high fever
- Runny or blocked nose
- Cough
- Red, sore, watery eyes
Small greyish-white spots with a bluish-white center inside the mouth, cheek, and throat may appear a few days later. A rash usually appears 2-4 days after the cold-like symptoms start. The rash starts on the face and behind the ears before spreading to the rest of the body.
Measles is spread through close contact with someone with measles. This could be through droplets in the air which are generated by the coughs and sneezes of infected persons or by touching things that someone with measles has coughed or sneezed on.
Measles spreads easily within households and in other places where people mix closely together. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected. The period when a person is infectious and can spread the virus is within 7 to 10 days of exposure but can be up to 14 days.
Most measles-related deaths are caused by complications associated with the disease and serious complications are more common in children under the age of 5, or adults over the age of 30 and individuals whose immune systems have been weakened. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Women infected while pregnant are also at risk of severe complications, and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.
Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.
No specific antiviral treatment exists for measles virus.
Severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
A number of measles outbreaks have been detected globally and regionally. While the TCI has high vaccination coverage in the measles, mumps and rubella vaccine (MMR) (>95%), unvaccinated persons can still acquire measles through contact with an infectious person. 
Having the MMR vaccine is the best way to prevent measles. The vaccine is safe and effective in providing long term protection against measles, mumps and rubella. Vaccines are offered free of cost to all children at government-operated primary care facilities across the TCI.
The Ministry of Health and Human Services encourages parents to ensure that their children’s vaccines are up to date. If you are unsure if you or your child has had 2 doses of the MMR vaccine, please visit your health care provider. If you have missed a dose, you can still be vaccinated at any age.
The public is being advised to remain vigilant and report any fever with rash or fever followed by rash to their doctor/health care provider as soon as possible.
The Ministry of Health and Human Services is grateful for the support of its stakeholders, including CARPHA, who provided the results of testing in such a prompt manner.
The Ministry of Health and Human Services will continue heightened surveillance for fever and rash and take necessary actions to mitigate against further cases.
For additional information please call 649-338-5469 or visit the Ministry of Health and Human Services Facebook page at https://www.facebook.com/tciministryofhealth/.
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