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Preventing further strokes

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Vishal Punwani.

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Video transcript

- If you've never had a stroke you probably don't wanna have a first one. If you had a stroke, chances are pretty good that you don't want to have another one. So, what you can do to help prevent strokes? How can you lower your risk? After all, the vast majority that happen of strokes that happen are preventable. So, let's actually thinks about this in terms of categories. So, there's ways to help prevent stroke by making some lifestyle changes. There's ways to prevent stroke involving taking certain medications, and there are ways involving surgery. So, we'll look at how each of these categories can help you to reduce your risk of stroke. And I won't be covering every possible thing you could do. I'll just cover some of the more important ones for each of our categories here. So with lifestyle, we just gotta start with blood pressure control, so lower blood pressure. Because high blood pressure is the biggest risk factor for stroke because what it does is it causes damage to your blood vessel walls which can eventually lead to a stroke. And in terms of lifestyles, there's a few ways to reduce your blood pressure. For example, daily exercise which will strengthen your cardiovascular system and lower your blood pressure that way. And there's reducing your salt intake because lots of salt in your diet can cause you to retain more water in your blood vessels. And by default, that would increase your blood pressure. And limiting the amount of alcohol you drink because high alcohol intake in known to increase blood pressure. So, if you have a glass of wine with dinner that's not really a problem. It's when you start having more than two standard drinks a day that your stroke risk goes up pretty sharply. And next in our lifestyle column here we have smoking. And really, not smoking is crucial. In fact, smoking and blood pressure control are probably the two most important risk factors for a stroke because for one, smoking damages your blood vessels. And for two, smoking increases your blood pressure. So smoking, no good. Keeping a healthy body weight is important. So, that means that you're being physically active whether that's going for a walk everyday or taking the dog to the beach or maybe playing with the grand kids. Any physical activity that's safe for you to undertake. And diet as well, so eating healthily. Lots of fruit and vegetables, no trans fat, not too much saturated fat and so on. Studies have actually shown time and time again that maintaining a healthy body weight and having a healthy waist circumference is really important in preventing diseases of the arteries and that includes strokes and heart attacks. So, a healthy diet and exercise are really helpful in keeping your cholesterol levels and your blood pressure under control. And then last here, we'll put managing any current medical conditions because some of them can independently increase your risk of stroke. So for example, if you have diabetes then it's super important to keep those blood sugar levels under control whether that's through diet and exercise or those PLUS medications. Because poorly controlled diabetes can cause some imbalances to happen with the lipids in your blood and can damage your arteries which increases your risk of stroke. So, let's hop over to our medications category now. So there's really four broad categories of medication that we'll talk about that you might be taking to prevent or rather lower your risk of having a stroke. So, we've got blood pressure lowering meds. Of course, we'd start with that one. And you know, the plan would be to have your blood pressure controlled by lifestyle measures alone because who likes taking extra pills, right? But if that's not possible then your doctor might prescribe a medication to help lower your blood pressure that way and that will reduce your risk of both ischemic and hemorrhagic strokes. And a group of anti-hypertensives you might have heard of are the ACE inhibitors which work by relaxing your blood vessels and reducing your blood volume. And that in turn lowers your blood pressure. Next, we've got anti-platelet medications like aspirin. And these anti-platelets, they sort of prevent blood clots from forming inappropriately within your blood stream. Because drugs like aspirin stop platelets in your blood from sticking together and forming these little precursors to full-blown blood clots. So, the fewer the precursors, platelet plugs as they're called. These little precursor clots, the fewer blood clots that are able to be created. And of course, the fewer the blood clots you have in your bloodstream, the less likely you are to have one get stuck up in the arteries of your brain, right? Now, anti-coagulants are a similar story to anti-platelets. And you probably heard of the most commonly used anti-coagulant called Warfarin. And how these work is they sort of interfere with and reduce production of certain proteins that are required to form blood clots. So, the result is that any existing clots just can't really grow any bigger because the proteins aren't there that allow that to happen. And also, new clots generally won't form very easily. So, the last major group of medications you might take to reduce your risk of stroke that we'll talk about is the group of lipid-lowering drugs. So, you've probably heard of these as drugs to lower your blood cholesterol. And there's a few different types that each work in a bit of a different way. So, for example one type, the statins they work by preventing your liver for making cholesterol. And you might have heard of a drug called Lipitor. That's actually the most commonly prescribed statin. Another type of lipid-lowering drug is called ezetimibe. And that one works by hanging out in your gut, in your small intestine and then kind of grabbing on to cholesterol that you eat. Not letting you absorb it. So, these lipid-lowering drugs are good for helping you maintain a nice healthy lipid profile within your bloodstream and that lowers your risk of stroke. And I'll just add on to this that sometimes you need medication to manage any ongoing medical conditions that could cause a stroke. So for example, if you have atrial fibrillation which is a condition known to cause clots to form in the atria that sometimes then travel up to brain and cause strokes, it would be really important that you took the necessary medications to manage the atrial fibrillation, right? So that your risk of clot formation in the atria and thus, your risk of stroke would be lowered, right? So here, you'd usually have a combination of drugs to control your hear rhythm or your heart rate plus an anti-coagulant such as Warfarin to make sure that clots don't pop up unexpectedly. So really, the bottom line is that you need to treat ongoing medical conditions that could cause a stroke. Now, for our last major category and that's stroke risk reduction by surgery, by surgical means. So, clots can come from collections of cholesterol from atherosclerotic build up that happens commonly in your carotid arteries, right? So, you get build up of cholesterol and necrotic debris in your arteries here as part of carotid atherosclerosis. And then bits can break off and just travel a short distance up into your brain and get stuck and cause a stroke. Or the build up can just totally block off your carotid artery itself and that would cause a stroke, too. Because it's preventing blood from from heading up into your brain. So, to prevent this from causing a stroke either a first stroke or a subsequent stroke, a surgeon can access this build up and get rid of it. So, there'd be a little incision made here. A little cut in the carotid artery here that has all the atherosclerotic build up. And this whole sort of thick necrotic gunk would be removed and that will reduce the risk of further strokes happening in a pretty big way. So, this procedure is called the carotid endarterectomy. And there's another procedure, I'll talk about that. It helps to lower your stroke risk. And again, it has to do with these carotid plaques. You can just see that these carotid plaques are pretty big risk factor for stroke. So, if you have a significant plaque build up in your carotids, as surgeon might insert a stent. This little mesh expandable tube within the artery, within the carotid to push open the walls and allow more blood flow through it up to the brain. So, it kinda squishes this atherosclerotic plaque against the sides of the artery here and allows you to get better blood flow going through your carotids up to your brain and that lowers your risk for at least ischemic strokes. So there, there's a few ways to try to prevent strokes from happening by some lifestyle changes like blood pressure reduction and quitting smoking and keeping a healthy weight. Some medications like anti-coagulants and anti-platelets and a few surgeries.