To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years.

Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed.

Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty.

Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.

The following account shows strategies on preventing stroke.

1. Lower blood pressure
High blood pressure is a huge factor, doubling or even quadrupling your stroke risk if it is not controlled. High blood pressure is the biggest contributor to the risk of stroke in both men and women. Monitoring blood pressure and, if it is elevated, treating it, is probably the biggest difference women can make to their vascular health.

Your ideal goal: Maintain a blood pressure of less than 120/80. But for some, a less aggressive goal (such as 140/90) may be more appropriate.

How to achieve it:
Reduce the salt in your diet to no more than 1,500 milligrams a day (about a half teaspoon).
Avoid high-cholesterol foods, such as burgers, cheese, and ice cream.
Eat 4 to 5 cups of fruits and vegetables every day, one serving of fish two to three times a week, and several daily servings of whole grains and low-fat dairy.
Get more exercise — at least 30 minutes of activity a day, and more, if possible.
Quit smoking, if you smoke.
If needed, take blood pressure medicines.

2. Lose weight
Obesity, as well as the complications linked to it (including high blood pressure and diabetes), raises your odds of having a stroke. If you're overweight, losing as little as 10 pounds can have a real impact on your stroke risk.

Your goal: Keep your body mass index (BMI) at 25 or less.

How to achieve it:
Try to eat no more than 1,500 to 2,000 calories a day (depending on your activity level and your current BMI).
Increase the amount of exercise you do with activities like walking, golfing, or playing tennis, and by making activity part of every single day.

3. Exercise more
Exercise contributes to losing weight and lowering blood pressure, but it also stands on its own as an independent stroke reducer.

Your goal: Exercise at a moderate intensity at least five days a week.

How to achieve it:
Take a walk around your neighborhood every morning after breakfast.

Start a fitness club with friends.
When you exercise, reach the level at which you're breathing hard, but you can still talk.
Take the stairs instead of an elevator when you can.
If you don't have 30 consecutive minutes to exercise, break it up into 10- to 15-minute sessions a few times each day.

4. Drink — in moderation
What you've heard is true. Drinking can make you less likely to have a stroke — up to a point. Studies show that if you have about one drink per day, your risk may be lower. Once you start drinking more than two drinks per day, your risk goes up very sharply.

Your goal: Drink alcohol in moderation.

How to achieve it:
Have one glass of alcohol a day.
Make red wine your first choice, because it contains resveratrol, which is thought to protect the heart and brain.
Watch your portion sizes. A standard-sized drink is a 5-ounce glass of wine, 12-ounce beer, or 1.5-ounce glass of hard liquor.

5. Treat atrial fibrillation
Atrial fibrillation is a form of irregular heartbeat that causes clots to form in the heart. Those clots can then travel to the brain, producing a stroke. Atrial fibrillation carries almost a fivefold risk of stroke, and should be taken seriously.

Your goal: If you have atrial fibrillation, get it treated.

How to achieve it:
If you have symptoms such as heart palpitations or shortness of breath, see your doctor for an exam. You may need to take blood thinners such as high-dose aspirin or warfarin (Coumadin) to reduce your stroke risk from atrial fibrillation. Your doctors can guide you through this treatment.

6. Treat diabetes
Having high blood sugar damages blood vessels over time, making clots more likely to form inside them.

Your goal: Keep your blood sugar under control.

How to achieve it:
Monitor your blood sugar as directed by your doctor.
Use diet, exercise, and medicines to keep your blood sugar within the recommended range.

7. Quit smoking
Smoking accelerates clot formation in a couple of different ways. It thickens your blood, and it increases the amount of plaque buildup in the arteries. Along with a healthy diet and regular exercise, smoking cessation is one of the most powerful lifestyle changes that will help you reduce your stroke risk significantly.

Your goal: Quit smoking.

How to achieve it:
Ask your doctor for advice on the most appropriate way for you to quit.
Use quit-smoking aids, such as nicotine pills or patches, counseling, or medicine.
Don't give up. Most smokers need several tries to quit. See each attempt as bringing you one step closer to successfully beating the habit.n

Compiled by Dr Wrishi Raphael

Source: Mymensingh Medical Journal & Harvard Health