Stroke Archive

People monitor their cholesterol levels, but they should also watch their triglycerides.

Most people have heard of the two main kinds of cholesterol: the "good" HDL and the "bad" LDL. Doctors focus on controlling LDL, as high levels can lead to a buildup of fatty deposits in the arteries and block blood flow, which can trigger a heart attack or stroke.

A blood test called a lipid profile measures your HDL, LDL, and total cholesterol levels. But within that test is another number you should not ignore: your triglyceride levels.

Research we're watching

Late in 2019, the FDA approved a new use for icosapent ethyl (Vascepa), a drug that is a highly purified form of eicosapentaenoic acid (EPA), an omega-3 fatty acid found in fish.

The drug was originally approved in 2012 for treating people with very high levels of triglycerides, a type of fat in the blood. Now, icosapent ethyl is approved for people with triglyceride levels greater than or equal to 150 milligrams per deciliter who also have an elevated risk of cardiovascular disease despite taking the highest tolerable dose of a cholesterol-lowering statin. A large trial found that the drug decreases the risk of heart attack, stroke, and death from cardiac causes by 26% when compared with a placebo.

There is a lot you can do to lower your chances of having a stroke. Even if you've already had a stroke or TIA ("mini-stroke"), you can take steps to prevent another.

Controlling your weight is an important way to lower stroke risk. Excess pounds strain the entire circulatory system and can lead to other health conditions, including high blood pressure, diabetes, high cholesterol, and obstructive sleep apnea. But losing as little as 5% to 10% of your starting weight can lower your blood pressure and other stroke risk factors.

When it comes to understanding this link, the devil is in the details.

When we talk about LDL cholesterol, it's always described as bad or harmful — and with good reason. High blood levels of this artery-clogging substance boost the risk of heart disease, the nation's leading cause of death. The more you can lower your LDL cholesterol (through diet, exercise, or medications), the lower your risk of a heart attack. For heart attack survivors, national guidelines recommend aiming for an LDL cholesterol level of less than 70 milligrams per deciliter to prevent a second heart attack.

In the past year, however, two studies in the journal Neurology reported a higher risk of hemorrhagic (bleeding) stroke in people with LDL levels of 70 and lower. While that sounds worrisome, a closer look at the findings can put these results into perspective.

Research we're watching

Younger adults who use marijuana appear to face a higher risk of stroke compared with those who don't use the drug, according to a report published Nov. 11, 2019, in the journal Stroke.

Researchers pooled data from a nationally representative survey from the CDC that included nearly 44,000 participants ages 18 to 44. About 14% reported using marijuana within the past month. Young adults who recently used marijuana were 1.8 times more likely to experience a stroke compared with nonusers. The risk was 2.5 times higher among frequent users (more than 10 days a month). Frequent marijuana users who also smoked regular cigarettes had three times the risk for nonusers.

Chronic stress is associated with an increased risk of heart disease, heart attacks, and strokes. These strategies can help you manage it.

People often complain about stress, but it's actually a natural reaction with an essential purpose.

When the body senses danger, it starts its fight-or-flight response. Your nervous system releases hormones like adrenaline and cortisol, which jolt the body into a protective mode. Your heart pounds faster, muscles tighten, blood pressure rises, breathing quickens, and your senses sharpen.

Taking these medications at bedtime rather than in the morning may make them more effective.

Many people take their medications as part of their morning ritual, along with a cup of coffee and the daily newspaper. But for blood pressure drugs, evening may be a better option. Last year, a large study found that taking blood pressure drugs before bed may lower the risk of serious heart-related complications more than taking the drugs in the morning (see "Benefits of bedtime blood pressure dosing").

The concept of chronotherapy, or adjusting medication dosing to a specific time of day, isn't new. There's not a great deal of evidence to support the practice with cardiovascular drugs, but it makes sense, says Dr. Naomi Fisher, director of the Hypertension Specialty Clinic at Harvard-affiliated Brigham and Women's Hospital.

Research we're watching

Treating high blood pressure may do more than prevent heart attacks and strokes. In older adults, intensive blood pressure lowering may also conserve brain function, according to a new study.

Published online Oct. 14, 2019, by the journal Circulation, the study included 199 adults ages 75 and older, all with a systolic blood pressure value (the first number in a reading) of 150 or higher. Their brain scans also showed lesions in the brain's white matter, which contains nerve fibers that send signals from one part of the brain to another. The lesions, which reflect damaged small blood vessels, have been linked to a propensity for thinking and memory problems. About two-thirds of people over age 75 have white matter lesions, as do most people over age 90.

This symptom is common in menopause, but frequent or persistent episodes could be a sign of higher risk for heart attack or stroke.

Researchers have begun to pay more attention to cardiovascular risk factors that are unique to women, such as early menopause (before age 40) and certain pregnancy complications. Recently they turned their attention to a common menopausal symptom that affects up to 85% of women: hot flashes.

Study results presented in September 2019 to the North American Menopause Society from the Study of Women's Health Across the Nation (SWAN) found that women who experience frequent or persistent hot flashes may be more likely than women who don't to experience a heart attack or stroke or other serious cardiovascular problems. (Researchers defined "frequent" hot flashes as having them six or more days in the previous two-week period. Women with "persistent" hot flashes reported those frequent hot flashes at 25% or more of study visits.)

Age, family history, and other risk factors determine if daily aspirin can help prevent a heart attack or stroke.

For many of us, aspirin was the go-to medicine of our youth. Everything from headaches, colds, and general aches and pains were treated with two aspirin and a glass of water.

For decades, aspirin was widely believed to be a safe way to protect healthy adults from heart attacks and strokes. But over the past couple years, new research has questioned this premise and many doctors have already stopped prescribing aspirin for adults at low risk of cardiovascular disease.