Features May 2013 Issue

Know the Latest in Stroke Prevention and Treatment

New research highlights the dangers of calcified coronary arteries and the benefits of brisk walking after a stroke.

Clogged coronary arteries can not only raise your risk of heart attack, but also put you in danger of a stroke. A recent study, in fact, published in the American Heart Association journal Stroke, found that blockages in the heart’s arteries can raise the odds of you having a stroke even if you’re otherwise considered at low risk for the cerebrovascular event.

CAC scores (seen at the top of each image) are measurements of calcification in the coronary arteries. The calcium can be seen in white. A CAC score of 0 (top left) indicates no calcium, while a CAC score of 1,200 (bottom right) is high and a risk factor for stroke and heart attack.

The study, which involved more than 4,000 patients who had no previous history of strokes or heart attacks, found that those with coronary artery calcium (CAC) density levels of more than 400 were three times more likely to have a stroke than those with levels under 399. A CAC score is determined by getting an image of heart using a CT scanner, and it represents the amount of calcification of the coronary arteries. A score of 1 to 99 is considered mild to moderate, but when the score is above 100, a cardiologist should be consulted to better determine your heart attack and stroke risks.

“Calcified coronary arteries are a marker for atherosclerosis or ‘hardening of the arteries,’ the most common reason for stroke,” explains neurologist Efrain D. Salgado, MD, Director of the Cleveland Clinic Florida Stroke Center and Neurosonology Laboratory. “So the results merely confirm or lend support to what we already suspected.”

Do you need a CAC screening? Dr. Salgado also notes that if you have other established stroke risk factors, such as hypertension, atrial fibrillation or circulation problems, getting CAC screening is probably less important. “We already know exactly what to do to reduce stroke risk under those circumstances,” he says. “The addition of info provided by knowing the CAC, at this point, would not change that.  Although the study provides evidence to support this as another stroke risk factor, it does not tell us what to do about it, and therefore routinely screening everyone or even younger people without or with risk factors cannot be justified unless future studies reveal a specific intervention that will reduce stroke risk in these patients.”

Coronary calcium scans do involve the use of radiation, which is why repeated screenings are discouraged and only individuals who aren’t already at high risk for heart disease or stroke are advised to have them. If you have any questions about your coronary artery health, talk with your doctor about the risks and benefits of tests such as a CAC scan.

Researchers who conducted the Stroke study noted that CAC levels were more accurate predictors of stroke in men and women younger than 65. They also stressed the importance of interdisciplinary efforts to reduce stroke risk and manage risk factors.

The benefits of a good walk Regular exercise is a key component to stroke risk management, and as a separate study in Stroke found, it can also improve the lives of stroke survivors, too. Researchers found that regular, brisk walking after a stroke can help improve fitness, mobility and quality of life. The study looked at 128 stroke survivors, and discovered that among those who performed brisk outdoor walking three times a week for three months experienced several noticeable benefits.

Compared to a group of stroke survivors who received therapeutic massage, but not supervised exercise, the walkers reported a 16.7 percent improvement in quality of life based on physical health and could walk 17.6 percent farther in a six-minute endurance tests. The brisk walkers also achieved a 1.5 percent lower resting heart rate.

Dr. Salgado notes that walking can have a place in the lives of people at risk for stroke and those recovering from stroke.

“A walking exercise program can improve cardiovascular fitness and stamina and have a significant impact in optimally controlling many of the common risk factors for stroke, including hypertension, hyperlipidemia, and diabetes,” he says. “This may in turn reduce medication requirements.”

But he adds that after a stroke, it’s important for patients to understand their limitations and start out in a supervised program.

“Stroke patients should consult with their doctor before engaging in an exercise program,” Dr. Salgado says. “Cardiac disease is common in this patient population and screening for this may be necessary before proceeding with exercise… The important thing is that regardless of whether you are or are not able to walk after a stroke, a regular exercise program tailored to the patients’ circumstances as determined by your doctor and physical therapist can improve strength and stamina while at the same time reducing future stroke risk.”

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