October 11, 2013
News Review From Harvard Medical School – Impact of Stroke Can Be Severe
All strokes -- even "mini-strokes" – not only shorten peoples' lives, but also can significantly worsen quality of life, a new study finds. Researchers followed 748 people who had a stroke and 440 people who had a transient ischemic attack (TIA) or "mini-stroke." TIAs don't last as long as full-blown strokes and tend to have few lasting effects. People were followed for 5 years. Researchers measured their quality of life after stroke with questionnaires. The results show that a stroke, on average, costs a person 1.71 out of 5 years of perfect health due to an earlier death. And stroke costs another 1.08 years due to reduced quality of life. When the researchers combined the two measures, people who have a stroke lose 2.79 years, on average, of "quality-adjusted life years." The more severe the stroke, the greater the loss. TIAs resulted in a loss of 1.68 quality-adjusted life years. The researchers say that preventing stroke is the best way to reduce the toll it takes. The journal Neurology published the study online. HealthDay wrote about it October 9.
By Howard LeWine, M.D.
Harvard Medical School
What Is The Doctor's Reaction?
Strokes worsen quality of life. And the larger the stroke, the more a person's quality of life suffers. It’s no surprise that even small strokes cause some disability. And large ones almost always are major life-changers.
The unexpected finding in this study relates to TIAs, short for transient ischemic attack. These are also known as mini-strokes.
Typical symptoms of a TIA include the sudden onset of:
- Weakness in an arm, hand or leg
- Numbness on one side of the body
- Loss of vision, particularly in one eye
- Difficulty speaking
- Inability to understand what someone is saying
- Dizziness or loss of balance
Most TIAs last about 5 to 15 minutes. The symptoms may linger for a few hours. But there is no permanent damage. You wouldn’t suspect that having a TIA would affect quality of life over the following few years. But it does. And for some people, the impact is significant.
This study was not designed to look at the factors responsible for diminished quality of life after a TIA. But here are some likely reasons:
- Anxiety about having a stroke, especially for the first few weeks after the event. That’s when the risk of a full-blown stroke is highest.
- Likely needing to take more medications or perhaps needing blood vessel surgery to prevent a stroke
- Overall, feeling less confident about your general health and longevity
What Changes Can I Make Now?
You should always seek immediate medical attention if you have symptoms of TIA, even if the symptoms go away in just a few minutes. The greatest risk for having a stroke is in the first few days after a TIA.
A TIA means that you have had a temporary blockage of blood flow to part of the brain. The cause could be a narrowing in one of the arteries in your neck. Or it could be that small blood clots have formed in your heart and traveled to the brain. While there are several other causes, these are the two most common reasons for TIAs.
Here's how you can lower your risk of ever having a TIA or stroke:
- Keep your blood pressure in the normal range (less than 140/90). This is the most important step.
- Lower your blood cholesterol level if it is high.
- Maintain a normal weight.
- Don't smoke.
- Eat at least five servings of fruits and vegetables daily.
- Stay physically active and schedule at least 30 minutes per day for dedicated exercise.
- If you have atrial fibrillation (an abnormal heart rhythm), you and your doctor need to choose a drug that prevents clots from forming in the heart.
If you have already had a TIA, you might simply need a daily aspirin to prevent another TIA or stroke. Or, you may need to take a different type of anti-clotting medicine. For a severely narrowed artery that causes a TIA, you may need surgery or angioplasty to open the artery.
What Can I Expect Looking To The Future?
Doctors, of course, focus on the immediate medical decisions after a person has a TIA. We reassure the patient that he or she didn’t have a stroke. Too often we assume that this is sufficient. But now we learn from this study that the person’s quality of life has been impacted more than we expected.
So, in the future, I will spend more time letting the patient know how stressful having a TIA can be. And I will detail the specific steps that will greatly decrease the risk of it happening again.