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Dr. Miller: You have had a stroke. How did that happen, and how to prevent that from happening again in the future? I am here today with Dr. Dana DeWitt. She is a professor in neurology and a stroke specialist at the 人妻中出视频 of Utah, the . Tell us a little bit about why people have strokes. You have had a stroke. What causes a stroke?
What Causes a Stroke?
Dr. DeWitt: There are different causes of stroke, and it's important that when you have a stroke, to be evaluated by someone who helps determine why it happened. A stroke can occur from a clot coming from the heart, it can occur from a clot coming from one of the arteries in your neck, or it can occur because you either have a blood vessel in the brain break, or a small blood vessel in the brain close off.
Dr. Miller: But the results are many times the same. Is that right?
Dr. DeWitt: Yes.
Dr. Miller: Debilitating problems.
Dr. DeWitt: Debilitating problems, focal deficits, often they don't recover.
Risk Factors of Stroke
Dr. Miller: So, Dana, tell me a little bit about the causes behind those embolic, those pieces of tissue that break off or vessels that bruise. What are the main things that cause that to happen? Lifestyle things that might cause another stroke in a patient?
Smoking, High Blood Pressure, and Heart Conditions
Dr. DeWitt: So, we know that smoking is one of the major causes of hardening of the arteries and high blood pressure. It's a major risk factor for stroke.
We know that high blood pressure is also a big risk factor for stroke. High blood pressure can cause blood vessels in the brain to thicken; it can be one of the causes for atherosclerosis as well, and can also cause heart disease.
And then we know that cardiac conditions, people who have had heart attacks, whose heart doesn't pump normally, and then there is the irregular heartbeat called atrial fibrillation, which carries a high risk of stroke. And that's when a certain part of the heart called the atrium actually becomes a little stretched and fibrillates, and a clog can form in the heart.
Age
Dr. Miller: What about age? Is age related to stroke?
Dr. DeWitt: Well, we know that as people get older, the risk of stroke is greater. We also see in young people on occasion, sometimes that can be due to hyper-coagulable or clotting problems, or something called dissection in blood vessels, or tears in blood vessels, but the major strokes occur in older patients
Gender
Dr. Miller: Men and women about the same?
Dr. DeWitt: There is a high risk of stroke in men. And again, the cause of stroke in women is a little different, except if the woman was a smoker and had hypertension and high cholesterol for years, then her risk is the same.
Transient Ischemic Attacks
Dr. Miller: So now I am assuming that if you had a stroke, your risk of having another stroke is higher, higher than the average population risk. Is that true?
Dr. DeWitt: It is. Evaluating those patients is why that's so important. There is also something called a TIA, which is really transient ischemic, which is a stroke-like event, presumed caused by the same thing that causes a stroke, but it clears quickly, and patients are also at risk for stroke within a short period of time. So it's an important thing for a doctor to evaluate your blood pressure. If you are a smoker, you need to stop smoking. You need to know what your cholesterol is and treat your cholesterol, and you need to have your heart evaluated to see if you might have atrial fibrillation or some other cardiac risk.
Atrial Fibrillation
Dr. Miller: It's true. I think that many people who have atrial fibrillation may not know that.
Dr. DeWitt: That's very true. Atrial fibrillation, we are finding more and more about it, but it may be that atrial fibrillation actually isn't seen at the time that the stroke occurs. It may actually be found later, and there are now methods, 30-day monitors, or what we call loop recorders, which are implantable recorders that watch over a heart for a long period of time to see if atrial fibrillation occurs. Heart ultrasound, called an echocardiogram can sometimes tell us if the heart is abnormal in a way that can put the patient at risk for atrial fibrillation. It's very important because the treatment is...
Dr. Miller: And do those work better to reduce the risk of stroke in the future than aspirin?
Dr. DeWitt: Yes. For atrial fibrillation, absolutely. So it is important to know whether that occurs and whether that needs to be treated in that way.
Diabetes
Dr. Miller: Let me ask you a couple of other questions. How about diabetes? Is there a risk of stroke associated with diabetes?
Dr. DeWitt: There is a risk of stroke with diabetes. Diabetes is part of the blood vessels and can promote more atherosclerosis. It also causes damage to very small blood vessels, which can cause small deep strokes. We know that patients with diabetes sometimes get damage to the arteries and their retina, in their eyes, and also in their kidneys. So the same process can happen in the brain and cause strokes.
Dr. Miller: How about just obesity in general? People who are not in very good shape, are overweight, they are not working out much.
Dr. DeWitt: That carries a risk as well. Metabolic syndrome, we know, is a kind of pre diabetic condition, but patients who are obese are also more prone to high blood pressure. They are more prone to high cholesterol, and this carries the risk of stroke.
Stroke Prevention Starts with Risk Factor Awareness
Dr. Miller: It sounds to me like high blood pressure, diabetes, possible cardiac functions, if your heart is pumping well or not, and an abnormal rhythm in the heart could all contribute to a second stroke. So, what would you say to the person out there who has had a stroke or had a family member with a stroke? Do you think that many of them know their risk factors, or should they really be aggressive in trying to find out if those problems we just mentioned are high-risk factors?
Dr. DeWitt: I think that's extremely important. We talk about primary stroke prevention versus secondary stroke prevention. One is to know your risk factors so that the stroke never happens, and you treat them aggressively. The other is, once you have a stroke, know why the stroke occurred so that you can prevent another one by again, controlling those risk factors. And again, those risk factors really are high blood pressure, smoking, high cholesterol, diabetes, and then obesity and inactivity carry another risk. Mainly because they promote the other problems.
updated: May 20, 2025
originally published: July 15, 2014
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