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Stroke

Stroke is the most common cardiovascular disorder after heart disease, afflicting about 9.6 million people in Europe and killing an estimated 5.7 million people annually worldwide. In addition, the number of strokes per year is predicted to rise dramatically as the population ages.

© Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

What is stroke?

A stroke occurs when interruption of blood supply or leakage of blood from a blood vessel causes damage to the brain. There are two main types of stroke: haemorrhagic and ischaemic.

A haemorrhagic stroke is caused by a bleed from a blood vessel in the brain. An ischaemic stroke is the more common type, accounting for approximately 85 percent of all strokes, and is caused by a clot narrowing or blocking a blood vessel so that the blood cannot reach the brain, causing brain cells to die due to lack of oxygen. This blood clot may have developed in the brain, or it may have formed somewhere else in the body and travelled to the brain. If the interruption of oxygen supply continues, the affected nerve cells die and the damage can become permanent.

The prevalence of stroke in Europe has been estimated to be nearly ten million. A World Health Organization (WHO) study reported the incidence of stroke in the whole of Europe to be 2 million in 2004. This compares with an estimated incidence of almost 3 million cancer cases in the same year in Europe. Another investigation shows that, for both men and women, the number of individuals experiencing stroke increases substantially with age. However, approximately 25 percent of strokes occur in people aged below 65 years. Data from the WHO also show that stroke incidence is higher in men than in women, across most countries and age ranges.

Additionally, stroke is a major cause of long-term disability worldwide – each year, five million stroke sufferers are left permanently disabled. Thereby, stroke can affect virtually all human functions, making it difficult for many patients to get out of bed, walk short distances and perform basic activities of daily living. As well as impairing speech and physical functioning, stroke can also adversely affect mental health.

Atrial fibrillation (AF) as one of the ‘big five’

AF is the most common sustained heart rhythm abnormality and is a major risk factor for ischaemic stroke and death in the general population. In AF the upper chambers of the heart (known as the atria) tremble irregularly rather than beating regularly and effectively. This may in turn lead to the formation of a blood clot, which can travel to the brain and cause an ischaemic stroke.

Other established risk factors for stroke include high blood pressure, diabetes, heart disease and lifestyle factors, such as smoking, alcohol consumption, poor diet and insufficient physical activity.

The five major modifiable risk factors – the ‘big five’ – that merit targeting in the prevention of stroke have been identified as:

high blood pressure
smoking
lack of physical exercise
diabetes
AF

Owing to its high prevalence, high blood pressure is the leading modifiable risk factor for stroke, accounting for approximately 40 percent of all strokes. AF, by comparison, is estimated to be responsible for approximately 15 percent of all strokes. High blood pressure is therefore responsible for a greater proportion of the global burden of stroke than AF.

However, the risk of having a stroke is higher in an individual with AF than in an individual with high blood pressure: AF confers a fivefold increase in the risk of stroke, compared with an approximately threefold increase in risk with high blood pressure. Moreover, patients with AF are more likely to have a severe stroke and, if they do, they have a 50% likelihood of death within 1 year.

Among the most underlying causes of AF are high blood pressure, narrowing of a valve in the heart, rheumatic heart disease and, to a lesser extent, ischaemic heart disease and diabetes.

Knowing the symptoms means protecting yourself and others

A simple and easily identifiable sign of AF is an irregular pulse. The symptoms may include palpitations, chest pain or discomfort. Besides, shortness of breath, dizziness and fainting may occur. However, AF is commonly without symptoms and therefore frequently not apparent until a person goes to see the doctor with a complication such as ischaemic stroke, a blood clot in the leg or heart failure.

On the contrary, symptoms of stroke are far more evident and can include impaired speech or vision, paralysis, or a dimming of consciousness. In the case of a stroke, the same applies as with a heart attack: a stroke should be treated quickly and preventive measures can be taken to lower the risk.

Prevention is the best protection

Active ingredients exist that inhibit clot formation in AF. Bayer HealthCare is developing such a product and a first clinical trial has delivered successful results.

Advice for patients
Every body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.