GoogleNews.com, FORBES.com, February 9, 2011, by Marilynn Marchione  —  LOS ANGELES — Doctors are reporting an alarming rise in strokes among young and middle-aged Americans even as the disease declines among older people.

They think the obesity epidemic may be starting to shift the age burden of strokes, which still take their greatest toll on the elderly.

Researchers from the U.S. Centers for Disease Control and Prevention compared a nationwide sample of stroke hospitalizations during 1994 and 1995 to those in 2006 and 2007.

The sharpest rise in stroke hospitalizations was 51 percent among men under 35, including teenage boys. Strokes also rose among females in this age group by 17 percent.

The study was discussed Wednesday at an American Stroke Association conference in Los Angeles.

Stroke is a medical emergency and the third leading cause of death in the US.  It occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops.  Without treatment, cells in the brain, quickly begin to die.  The result can be serious disability or death.  If a loved one is having stroke symptoms, seek emergency medical attention without delay.

Signs of a stroke may include:

Sudden numbness or weakness of the body, especially on one side.

Sudden vision changes in one or both eyes.

Sudden, severe headache with unknown cause.

Sudden problems with dizziness, walking, or balance.

Sudden confusion, difficulty speaking or understanding others.

A transient ischemic (TIA) attack, often called a “mini-stroke,” is more like a close call.  Blood flow is temporarily impaired to part of the brain, causing symptoms similar to an actual stroke.  When the blood flows again, the symptoms disappear.  A TIA is a warning sign that a stroke may happen soon.  It’s critical to see your doctor if you think you’ve had a TIA.  There are therapies to reduce the risk of stroke.

The most common type of stroke is called an ischemic stroke. Nearly nine out of 10 strokes fall into this category.  The culprit is a blood clot that obstructs a blood vessel inside the brain.  The clot may develop on the spot or travel through the blood from elsewhere in the body.

Here is a stroke test, called the F.A.S.T. Test, which helps spot symptoms.  It stands for:

Face – Ask for a smile.  Does one side droop?

Arms – When raised, does one-side drift down?

Speech – Can the person repeat a simple sentence?  Does he or she have trouble or slur words?

Time – Time is critical.  Call 911 immediately if any symptoms are present.

Hemorrhagic strokes are less common but far more likely to be fatal.  They occur when a weakened blood vessel in the brain bursts.  The result is bleeding inside the brain that can be difficult to stop.

The Time Factor

Every second counts when seeking treatment for a stroke.  When deprived of oxygen, brain cells begin dying within minutes.  There are clot-busting drugs that can curb brain damage, but they have to be used within three hours of the initial-stroke symptoms.  Once brain tissue has died, the body parts controlled by that area, won’t work properly.  This is why stroke is a top cause of long-term disability.

For an ischemic stroke, emergency treatment focuses on medicine to restore blood flow.  A clot-busting medication is highly effective at dissolving clots and minimizing long-term damage, but it must be given within three hours of the onset of symptoms.  Hemorrhagic strokes are more difficult to manage.  Treatment usually involves attempting to control high blood pressure, bleeding, and brain swelling.

Diagnosing a Stroke

When someone with stroke symptoms arrives in the ER, the first step is to determine which type of stroke is occurring. There are two main types, and they are not treated the same way. A  CT-scan can help doctors determine whether the symptoms are coming from a blocked blood vessel or a bleeding one. Additional tests may also be used to find the location of a blood clot or bleeding within the brain.

A common cause of stroke is atherosclerosis – hardening of the arteries.  Plaque made of fat, cholesterol, calcium, and other substances bulks up in the arteries, leaving less space for blood to flow.  A blood clot may lodge in this narrow space and cause an ischemic stroke.  Atherosclerosis also makes it easier for a clot to form.  Hemorrhagic strokes often result from uncontrolled high blood pressure that causes a weakened artery to burst.

Risk Factors for Stroke, are chronic conditions, which increase the risk of stroke.  These include:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity

Behavioral risk factors are:

  • Smoking
  • Too little exercise
  • Heavy use of alcohol and salt

Taking steps to control these conditions may reduce the risk of stroke.

Risk Factors That Can’t Be Controlled:

  • Getting older
  • Family (genetic) history of strokes
  • Gender
  • Race

Stroke Prevention Medications

For people with a high risk of stroke, doctors often recommend medications to lower this risk.  Anti platelet medicines, including aspirin, keep platelets in the blood from sticking together and forming clots.  Anti clotting drugs, such as warfarin, may be needed to help ward off stroke in some patients.  Finally, if you have high blood pressure, your doctor will prescribe medication to lower it.

Stroke Prevention Surgery

In some cases, a stroke results from a narrowed carotid artery  —  the blood vessels that travel up each side of the neck to bring blood to the brain.  People who have had a mild stroke or TIA, due to this problem, may benefit from surgery known as carotid endarterectomy.  This procedure removes plaque from the lining of the carotid arteries and can prevent additional strokes.

Stroke Prevention Without Major Surgery

Doctors can also treat a clogged carotid artery without major surgery in some cases.  The procedure called angioplasty, involves temporarily inserting a catheter into the artery and inflating a tiny balloon to widen the area that is narrowed by plaque.  A metal tube, called a stent, can be inserted and left in place to keep the artery open.

CDC

Centers for Disease Control and Prevention

National Vital Statistics System

Top 10 Causes of Death – US

  1. Diseases of Heart 28.5%
  2. Malignant Neoplasms (cancer) 22.8%
  3. Cerebrovascular Diseases (stroke) 6.7%
  4. Chronic Lower Respiratory Diseases 5.1%
  5. Accidents 4.4%
    • Motor Vehicle Traffic Accidents (41% of all accidents)
    • Poisoning (16% of all accidents)
    • Fall (15% of all accidents)
  6. Diabetes Mellitus 3.0%
  7. Influenza and Pneumonia 2.7%
  8. Alzheimer’s Disease 2.4%
  9. Nephritis, Nephrotic Syndrome and Nephrosis (kidney diseases) 1.7%
  10. Septicemia (blood poisoning) 1.4%

All Others 21.4%


Sex differences

The top two causes for males and females—heart disease and cancer—are the same. Unintentional injuries was third for males and seventh for females. Stroke, CLRD, Diabetes mellitus, and Influenza and pneumonia, which ranked fourth, fifth, sixth, and seventh, respectively, for males, ranked third, fourth, sixth, and eighth for females. Suicide and Chronic liver disease and cirrhosis were ranked 8th and 10th, respectively, for males, but were not ranked among the 10 leading causes for females. Kidney disease ranked ninth for both males and females. Alzheimer ’s disease and Septicemia, ranked 5th and 10th, respectively, for females, were not ranked among the top 10 for males.

Age differences

Leading causes of death varied substantially by age. The leading cause of death for age groups from 1–4 through 25–34 years was unintentional injuries. Assault (homicide) and Intentional self-harm (suicide) were also important causes of death in these age categories. Unintentional injuries, homicide, and suicide combined accounted for 76 percent of deaths for those aged 15–19 years, 73 percent of deaths for those aged 20–24 years, and 53 percent of deaths for those aged 25–34 years. Cancer, heart disease, and Congenital malformations, deformations, and chromosomal abnormalities were also consistently ranked among the leading causes for the younger age groups.

In the older age groups, mortality due to chronic diseases was most prevalent. Cancer and heart disease were the top two causes of death for those aged 45–54 years and the older age groups and consistently accounted for close to one-half of all deaths in these age groups. Other prevalent chronic causes among the older age groups were stroke, CLRD, Diabetes mellitus, Alzheimer ’s disease, kidney disease, and Chronic liver disease and cirrhosis. Unintentional injuries, Influenza and pneumonia, and Septicemia were also important causes of death for those in older age groups.

Race differences

The four major race groups share six of the leading causes. Heart disease and cancer rank first and second, respectively, for the white, black, and American Indian populations. For the Asian or Pacific Islander (API) population, cancer was the leading cause of death, with heart disease second. Stroke ranks third for the white, black, and API populations but ranks fifth for the American Indian population. CLRD, unintentional injuries, and Diabetes mellitus also ranked among the 10 leading causes of death for each race group. CLRD ranks fourth for the white population, seventh for the American Indian and API populations, and eighth for the black population. Unintentional injuries ranks fifth for the white and black populations, third for the American Indian population, and fourth for the API population. Diabetes mellitus ranks fourth for the black and American Indian populations, fifth for the API population, and sixth for the white population. Influenza and pneumonia ranks sixth for the API population, seventh for the white population, and ninth for the American Indian population, but this category is not ranked in the leading 10 causes of death for the black population. Suicide ranks 8th for the American Indian and API populations and 10th for the white population, but it is not ranked in the top 10 for the black population. Kidney disease ranks ninth for the white, black, and API populations, but it is not in the top 10 for the American Indian population. Homicide was among the 10 leading causes for only two race groups: the black and the American Indian populations, ranking 6th and 10th, respectively. Likewise Septicemia ranks 10th for the black population and also for the API population, but it is not among the 10 leading causes for the white and American Indian populations.

For three race groups, at least 1of the 10 leading causes is unique to that group. For the American Indian population, Chronic liver disease and cirrhosis ranks sixth but is not ranked in the top 10 for the other 3race groups. HIV disease ranks seventh for the black population, and Alzheimer ’s disease ranks eighth for the white population but these causes were not ranked among the top 10 for the other race groups.

Hispanic origin

Heart disease and cancer ranks first and second for both the Hispanic and non-Hispanic populations. Unintentional injuries ranks third for the Hispanic population, higher than both the non-Hispanic white and the non-Hispanic black populations (fifth). The fourth-ranked cause for Hispanics is stroke, which ranks third for the non-Hispanic populations. Diabetes mellitus ranks fifth for the Hispanic population, but ranks eighth for the non-Hispanic white population and fourth for the non-Hispanic black population. Chronic liver disease and cirrhosis, ranks sixth for the Hispanic population, but this category is not ranked among the 10 leading causes for the other race-origin populations. Homicide ranks seventh for the Hispanic population and sixth for the non-Hispanic black population, but this category is not ranked among the 10 leading causes for the non-Hispanic white population. The only other leading cause shared by all three groups is CLRD, which ranks much lower for the Hispanic (eighth) and non-Hispanic black (seventh) populations than for the non-Hispanic white (fourth) population. Influenza and pneumonia also ranks much lower for the Hispanic population (ninth) than for the non-Hispanic white population (sixth); it was not among the 10 leading causes for the non-Hispanic black population. The 10thranked cause for the Hispanic population is perinatal conditions. The high ranking of perinatal conditions is primarily a reflection of the relatively young age distribution of the Hispanic population. HIV disease (ranks 8th for the non-Hispanic black population), Alzheimer’s disease and suicide (ranks 7th and 10th, respectively, for the non-Hispanic white population), and kidney disease (ranks 9th for both the non-Hispanic white and black populations) do not rank among the 10 leading causes of death for Hispanics. Septicemia ranks 10th for the non-Hispanic black population but did not appear among the top 10 for the other groups.

Leading causes of infant death

The leading causes of infant death were Congenital malformations, deformations, and chromosomal abnormalities (congenital malformations), which accounted for one-fifth of all infant deaths. Disorders related to short gestation and low birth weight, not elsewhere classified, was ranked 2nd and followed by Sudden infant death syndrome (SIDS) (3rd); Newborn affected by maternal complications of pregnancy (4th); Newborn affected by complications of placenta, cord and membranes (5th); unintentional injuries (6th); Respiratory distress of newborn (7th); Bacterial sepsis of newborn (8th); Diseases of the circulatory system (9th); and Intrauterine hypoxia and birth asphyxia (10th). In all, the 10 leading causes of infant death accounted for 68 percent of all infant deaths.

Neonatal and postneonatal mortality

Stark differences were evident when comparing leading causes of death in the neonatal (less than 28 days after birth) and postneonatal (between 28 days and 11 months after birth) periods. Disorders related to short gestation and low birth weight, not elsewhere classified was the leading cause of neonatal death. In contrast, SIDS is the leading cause in the post neonatal period. Congenital malformations, although top-ranked for infant mortality overall, ranks second for both neonates and post neonates. The remaining leading causes of neonatal death are characterized by conditions occurring in the perinatal period. In the post neonatal period, the remaining leading causes are characterized more by conditions prevalent among the general population, including unintentional injuries (third), Septicemia (fifth), homicide (seventh), and Influenza and pneumonia (ninth).

Data Source: National Center for Health Statistics
National Vital Statistics