Johnralph

Like close cousins, heart disease and stroke share a common lineage. Both emerge from a mix of nature (genes), nurture (upbringing and environment), and personal choice (smoking, exercise, etc). For most of us, personal choice largely determines whether a stroke lies ahead. Guidelines on the prevention of stroke suggest that a healthy lifestyle can cut the risk of having one by 80%. No drug, device, or other intervention can come close to doing that.

The term "stroke" conjures up a frightening bolt out of the blue. It certainly feels that way when it happens. But the sudden onset belies a stroke's decades-long development due to slow but steady damage to blood vessels, the growth of artery-clogging plaque, or the development of atrial fibrillation. This long gestation means it is often possible to avoid a stroke by fighting arterial corrosion.

Two types of stroke

A stroke occurs when blood stops flowing to part of the brain. Cut off from their supply of oxygen, brain cells begin dying within minutes. Sometimes the damage is fatal — stroke is the fourth leading cause of death in the United States, accounting for almost 135,000 deaths each year. Most of the time, stroke isn't a killer. The American Heart Association estimates that there are more than six million stroke survivors in the United States. Although some have no physical or mental reminders of the attack, many have long-lasting speech loss, paralysis, or other problems. In fact, stroke is a leading cause of disability — nearly one in three survivors is permanently disabled, and many more need long-term care.

Ischemic strokes occur when a blood clot or other debris blocks a blood vessel in the brain or one leading to it. These account for more than 80% of strokes. The rest are hemorrhagic strokes. These occur when a blood vessel in the brain bursts. The bleeding (hemorrhaging) deprives downstream brain cells of oxygenated blood and can also damage cells by increasing pressure inside the brain.

Though ischemic and hemorrhagic strokes require different treatments once they appear, efforts to prevent them are very similar.

Different types of stroke

There are two main types of stroke. Ischemic strokes are more common and occur when a blood clot blocks an artery in the brain. In some cases, the clot develops in the vessel itself (thrombotic stroke). In other cases, the clot forms in the heart or in an artery that carries blood to the brain; the clot breaks off and travels to the brain, where it lodges in a small artery (embolic stroke). Hemorrhagic strokes occur when an artery in the brain ruptures, releasing blood into the brain tissue.

Three types of risk

You can change some, but not all, of the factors that increase your odds of having a stroke (see "Risk factors for stroke").

Nonmodifiable risk factors include your age, gender, genes, birth weight, and race or ethnicity.

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