Reducing stroke mortality
by David Dunaief
May 14, 2019 | 6978 views | 0 0 comments | 601 601 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
May is National Stroke Awareness Month, with a focus on raising awareness of stroke risk factors and prevention. Stroke remains one of the top five causes of mortality and morbidity in the United States.

As a result, a wealth of studies inform us on the roles of medications and lifestyle in managing risk. Of particular importance are changes in medication guidelines that balance the risks and benefits of different stroke prevention regimens.

Medications with beneficial effects

Two medications have shown positive impacts on reducing stroke risk: statins and valsartan. Statins are used to lower cholesterol and inflammation, and valsartan is used to treat high blood pressure.

Statins do have side effects, such as increased risks of diabetes, cognitive impairment and muscle pain. However, used in the right setting, statins are very effective.

In a study presented at the 2012 American Academy of Neurology conference, patients who were on a statin to treat high cholesterol had an almost sixfold reduction in mortality when experiencing a stroke, compared to those with high cholesterol who were not on therapy.

There was also significant mortality reduction in those on a statin without high cholesterol, but with diabetes or heart disease. The authors surmise that this result might be from an anti-inflammatory effect of the statins.

Valsartan iworks on the kidney to reduce blood pressure. However, in the post-hoc analysis that looked back at the completed Kyoto Heart Study data, valsartan used as an add-on to other blood pressure medications showed a 41 percent reduction in the risk of stroke and other cardiovascular events for patients who have coronary artery disease.

It is important to recognize that high blood pressure and high cholesterol are two of the most significant risk factors for stroke. Fortunately, statins can reduce cholesterol, and valsartan may be a valuable add-on to prevent stroke in those patients with coronary artery disease.

Medication combination: negative impact

There are two anti-platelet medications that are sometimes given together in the hopes of reducing stroke recurrence — aspirin and Plavix (clopidogrel). The assumption is that these medications together will work better than either alone.

However, in a randomized controlled trial, this combination not only didn’t demonstrate efficacy improvement but significantly increased the risk of major bleed and death.

Major bleeding risk was 2.1 percent with the combination versus 1.1 percent with aspirin alone, an almost twofold increase. In addition, there was a 50 percent increased risk of all-cause death with the combination, compared to aspirin alone.

Patients were given 325 mg of aspirin and either a placebo or 75 mg of Plavix. The study was halted due to these deleterious effects. The American Heart Association recommends monotherapy for the prevention of recurrent stroke. If you are on this combination of drugs, please consult your physician.

Lifestyle modifications

A prospective study of 20,000 participants showed that consuming white fleshy fruits (apples, pears, bananas) and vegetables (cauliflower, mushrooms) decreased ischemic stroke risk by 52 percent.

Additionally, the Nurses’ Health Study showed that foods with flavanones, found mainly in citrus fruits, decreased the risk of ischemic stroke by 19 percent.

The authors suggest that the reasons for the reduction may have to do with the ability of flavanones to reduce inflammation and/or improve blood vessel function. I mention both of these trials together because of the importance of fruits in prevention of clot-based stroke.

Fortunately, there are many options to help reduce the risk or the recurrence of a stroke. Ideally, the best option would involve lifestyle modifications. Some patients may need to take statins, even with lifestyle modifications. However, statins’ side effect profile is dose-related. Therefore, if you need to take a statin, lifestyle changes may help lower your dose and avoid harsh side effects.

For further information, visit or consult your personal physician.
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