In the 1970s, Joseph Broderick was a resident at the Mayo Clinic in need of a focus for his fellowship. He decided to give stroke research a try.
Part of the lure was all the unanswered questions, like: Who is most likely to have a stroke? Why do they have it when others seemingly like them don’t? Is stroke getting more or less common? What can be done to prevent it?
Another part of the lure was a landmark study on the frequency of stroke being done in the hospital’s hometown of Rochester, Minnesota. Being part of it meant working for one of the nation’s leading stroke researchers at the time, Jack Whisnant.
By the mid-1980s, Dr. Broderick had worked his way up to being one of the lead authors of a paper that reported a decline and then stabilization in stroke rates in Rochester. Yet, over the decades since, stroke as a cause of death continued to decline across the United States.
A milestone came in 2011, when the Centers for Disease Control and Prevention announced that stroke fell from the No. 3 killer of Americans to No. 4. Alas, that news came with a bit of an asterisk; while stroke rates continued to decline, a change in how the numbers were compiled for chronic respiratory diseases helped push it up to third. So the excitement over stroke dipping to fourth was a bit muted.
Then, on the second-to-last day of 2014, the CDC announced some stunning news. Stroke had dipped to the No. 5 killer of Americans — with no asterisk this time.
“I’m not surprised by the declining numbers,” Dr. Broderick said. “But I am surprised by how quickly it’s happened. Falling two spots in a few years after being No. 3 for a long, long, long time is remarkable.”
At a time when we are flooded with frightening data about our nation’s declining health, this shows that we are taking some steps in the right direction. However, we also must realize our fight is far from done.
Stroke is still the No. 2 killer worldwide — behind only heart disease, which is also the No. 1 killer of Americans. Stroke also remains a leading cause of long-term adult disability. So while many people live a productive life after stroke, the disease takes an enormous toll emotionally, physically and financially on many others.
Dr. Broderick remains a leader in the fight against stroke. He is director of the University of Cincinnati Neuroscience Institute, and serves as chair of the Stroke Council of the American Heart Association and the American Stroke Association. He’s a perfect source to help frame the importance of this latest news, and to give us insight on where the care and treatment of stroke is headed. It is my privilege to turn this space over to him.
The reality is, this overnight sensation was years in the making. It took a long time to draw up the plans, raise the money and then of course to actually build it, from the framework all the way to screwing in every light bulb.
A comparison can be made to the downward trend of stroke deaths. After generations of efforts, the recent statistical change is a tangible reward.
For those of us who’ve devoted our careers to battling this disease, this news is incredibly exciting. The best part? We know we can still do better.
We know we can prevent even more strokes.
We know we can effectively treat stroke, improving the quality of life for survivors.
We also know we can’t do it alone.
As a society, we need to reduce risk factors. Systems changes such as anti-smoking laws and getting food companies to reduce sodium in their products are important steps. People also need to make changes in their own lives, and their doctors need to treat their underlying conditions.
This starts with controlling blood pressure. Aside from aging, which of course can’t be controlled, high blood pressure (also known as hypertension) is the No. 1 leading cause of stroke.
Blood pressure control has changed drastically over the past 50 years. We have seen the marked increase in the use of cholesterol-lowering drugs such as statins, which is another way to prevent stroke. Smoking rates have continued to decrease. Yet we still have plenty of room for improvement. Surely you’ve heard these things before, but they bear repeating:
- Stop smoking. And if you don’t, don’t start.
- Eat healthier. The Mediterranean Diet and the DASH Diet are two excellent ways to eat healthier and lower stroke risk.
- Cut down on sodium.
- Exercise more.
- Take medications as prescribed by your physician if you have an irregular heart rate caused by atrial fibrillation.
We also need to improve awareness of the stroke warning signs. More people need to recognize more quickly when someone is having a stroke. This is critical because we know that when treatment is delayed, brain is lost. The sooner treatment begins, the more likely a patient is to have a good outcome and the less likely you are to die from a stroke. And we do have effective treatments such as tPA and devices to open up occluded blood vessels and medications and devices to fix ruptured brain aneurysms and blood vessels.
Do you know the easy way to remember the symptoms? Think F.A.S.T. If you see (F)ace drooping, (A)rm weakness or (S)peech difficulty, it’s (T)ime to call 9-1-1.
The next layer in our progress against this disease is improving recovery and caring for stroke survivors.
We need to maximize recovery by finding more and better ways to help people who have substantial brain injury from stroke. This is tricky because as we seek to improve their quality of life, we also must do so in a cost-effective manner. I consider this our biggest opportunity for improvement.
I often say the future of stroke research is how we can enhance stroke recovery. We need survivors to become as independent as possible, for their own benefit as well as to reduce the burden this puts on their family and on the rest of society.
Many people fear the consequences of living with stroke more than dying from a stroke — the loss of a career, the inability to drive, needing others to provide basic daily care for you. The physical and emotional cost is incalculable; the financial burden is rough, too. Many stroke patients can have a reasonable quality of life, but the loss of the ability to care for yourself and to be independent is scary. Yet, this is why people need to take stroke so seriously — because it is preventable.
Let’s use a new analogy: a car.
The best way to make it last is by taking care of it. Doing the routine maintenance is important. When other things go wrong, you fix them. Following this formula can help a car make it to 100,000 miles or more without major problems. Eventually a car’s age will catch up to it but by then, it can have traveled a lot of miles.
Like the hoses and belts of a car, a person’s blood vessels wear out over time. Yet, the less strain and the better care you provide for your body and brain at a younger age, the better it can be when it ages.
There’s an accumulative effect of risk factors over time. So everyone — kids and teenagers, as well as older adults — should take these stroke risk factors seriously. Best of all, the steps taken to prevent stroke also help prevent heart disease, and a host of other debilitating and deadly conditions.
So, to me, the news about stroke being No. 5 is exciting, yet not quite worthy of a ribbon-cutting ceremony.
It feels more like halfway point in construction.
What we’ve done so far looks great — it’s a demonstration that success is possible. But there’s still more work to be done by all of us.