'He guides me along the right paths'

He makes me lie down in green pastures, he leads me beside quiet waters, he refreshes my soul. He guides me along the right paths for his name’s sake.

-Psalm 23:2-3

It's been months since this blog has featured a posting based on Scripture. Why?

My life has been increasingly busy - work, home, etc - and the Scripture-based postings require me to think differently. I don't want to just throw out random thoughts to accompany Bible verses. It's been easier lately to just quote a recent article about stroke research or prevention.

I ran across the verses above several weeks ago, waiting for inspiration. I don't know if I have inspiration or not, but I feel compelled to include these verses today, especially the last sentence.

Modifiable stroke risks still rising across all ages, races

Most - not all, but most - strokes are preventable. Experts have been know for years that risk factors include high blood pressure, smoking and high cholesterol. All addressable issues. Yet, as NPR reported not long ago, modifiable stroke risks are still rising across all ages and races:

For years, doctors have been warning us that high cholesterol, cigarette smoking, illegal drug use and diabetes increase our chances of having a potentially fatal stroke.

And yet, most of the stroke patients showing up at hospitals from 2004 to 2014 had one or more of these risk factors. And the numbers of people at risk in this way tended to grow among all age groups and ethnicities in that time period. 

TIAs: Don't call them ministrokes

I've called them ministrokes before, but this article from U.S. News makes me re-think that phrase. It contends that you shouldn't call transient ischemic attacks ministrokes:

Yet, while 35 percent of adults in the U.S. have had symptoms suggestive of a TIA, only 3 percent of them called 911 for help, according to a recent online survey of more than 2,000 people by the American Heart Association and American Stroke Association. That’s a mistake, experts say. If you have symptoms of a stroke or TIA, “don't wait it out,” advises Dr. Dion F. Graybeal, medical director of stroke at the Baylor University Medical Center in Dallas. “Take these symptoms seriously and call 911.” If it’s a real stroke, every minute counts in terms of getting treatment and reducing the risk of permanent disability. And if it’s a TIA, “it’s an opportunity to intervene and hopefully stop a process or condition that could cause a stroke with disability in the future,” Graybeal says.

It’s better to be safe than sorry because if you have stroke-like symptoms, it’s difficult to tell immediately if you’re having a TIA or a full-blown stroke, says Dr. Nieca Goldberg, a cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center in New York City. So it’s important to get to the hospital as soon as possible, There, you will most likely have a CT scan, a CT angiogram, an MRI or an MR angiogram of your brain and the blood vessels in your head to look for a blood clot and evidence of damage to the brain. If damage isn’t apparent and the symptoms have resolved, the episode will be deemed a TIA. But if there is evidence of damage to areas of the brain, the event will be diagnosed as a stroke, even if the symptoms have gone away, Goldstein says.

Stopping aspirin therapy may raise heart attack, stroke risk

Aspirin - cheap and perhaps lifesaving. So read how stopping aspirin therapy may raise heart attack, stroke risk:

Stopping low-dose aspirin therapy without good reason raises the likelihood of heart attack or stroke by nearly 40 percent, a large Swedish study suggests.

Doctors commonly prescribe daily low-dose aspirin after a heart attack to reduce the risk of having a second cardiovascular event. But about one in six patients stop taking their aspirin within three years, the study authors note in Circulation.

Closure of hole in the heart reduces stroke recurrence

A still from the video of my PFO being closed.
Click here to view the video.

If you've read this blog before, you might know that my hole-in-the-heart was closed 10 years ago. Click here to read details.

The hole is called a patent foramen ovale, or PFO. It's an opening between the upper chambers of the heart. We're all born with one, but it's normally closed shortly after birth. For some, though, it remains. For some people, blood clots can pass from one side to the other, getting pumped out to the arteries and eventually in the brain, causing a stroke.

Drug prices especially hit hard in rural America

Which is more valuable - the life of someone who lives in Mountain View, Ark., (population 2,860) or someone who lives just one county over?

That's the question from a good NPR piece about how high drug prices hit rural hospitals extra hard, a story beginning with the story of a stroke patient coming in to a small, rural hospital needing an expensive drug:

For example, Langston's 25-bed hospital pays $8,010 for a single dose of Activase — up nearly 200 percent from $2,708 a decade ago. Yet, just 36 miles down the road, a bigger regional hospital gets an 80 percent discount on the same drug. White River Medical Center, a 235-bed facility in Batesville, Ark., buys Activase for about $1,600 per dose.

White River participates in a federal drug discount program Congress approved in the early 1990s. The program offers significant price breaks on thousands of drugs to hospitals that primarily serve low-income patients. One federal report found the average discount ranged from 20 to 50 percent, though as illustrated with Activase, it can be much higher.

After years of decline, South sees rise in stroke deaths

Even though the South is also know as the Stroke Belt, we've seen a decline in stroke deaths - until now. In the most recent numbers, stroke deaths are rising in the South:

In its monthly Vital Signs report, the Centers for Disease Control and Prevention reported that stroke deaths are on the rise in the South in recent years after decades of decline, and rates are stagnant in other states. While stroke deaths have declined more than 76 percent since 1968 among adults 35 and older, and 38 percent since 2000, that decline has roughly leveled off or even increased in most states since 2013, according to the report. That includes an overall 4 percent increase in the South, with a 3 percent increase in Georgia and a whopping 10.8 percent increase in Florida.

“This is an important wake-up call,” said Dr. Brenda Fitzgerald, director of the CDC and a former Commissioner of the Georgia Department of Public Health. It is particularly alarming among those ages 35-64, which made up a third of the more than 32,000 “excess stroke deaths,” those who died from stroke who might not have had the death rates continued their decline.

Meth could up stroke risk in younger users

Methamphetamine's dangers are well known - and now, it looks like that the drug could up stroke risk in younger users:

With use of the stimulant increasing, particularly in more potent forms, doctors in many countries are seeing more meth-related disease and harms, the Australian study authors said. This is especially true among younger people, who are the major users of the drug.

"It is likely that methamphetamine abuse is making a disproportionate contribution to the increased incidence of stroke among young people observed over recent years," said researchers led by Julia Lappin. She's with the National Drug and Alcohol Research Center at the University of New South Wales in Sydney.

These strokes can lead to disabilities or death, she and her colleagues pointed out.

(Photo from MedlinePlus)

Men are seeing a decline in stroke risk - but women?

You might have seen postings about the disturbing numbers about younger people having strokes. Now, while stroke risk is declining among some groups, a recent study suggests that stroke risk is declining in men but not women:

The incidence of stroke has declined in recent years, but only in men.

Researchers studied stroke incidence in four periods from 1993 to 2010 in five counties in Ohio and Kentucky. There were 7,710 strokes all together, 57.2 percent of them in women. ...

No one knows why there has been no improvement in women, but the lead author, Dr. Tracy E. Madsen, an assistant professor of emergency medicine at Brown, said that some risk factors have a stronger effect in women than in men. Risk factors for stroke include high blood pressure, heart disease, diabetes and smoking.

Where did your stroke happen? Geography might impact treatment

Photo from David Kessler via Flickr

Last week, the posting was about people born in the "stroke belt" region.

So for a related item, a look at cholesterol-treating drugs seem less likely to be prescribed in the stroke belt, with no statin prescribed for half of stroke survivors:

But inside the so-called Stroke Belt region, seniors were 47% less likely to be discharged on a statin, and men were 31% less likely to get a prescription for the lipid-lowering drugs than women. Neither association was seen outside the Stroke Belt.

"All survivors of ischemic stroke should be evaluated to determine whether they could benefit from a statin, regardless of the patient's age, race, sex, or geographic residence," lead author Karen Albright, PhD, DO, MPH, of the Birmingham VA Medical Center, said in a press release.