Heart attack-stroke connection & tips to reduce your risk

Someone in the U.S. has a stroke every 40 seconds, and one person dies from heart disease every 33 seconds, according to the Centers for Disease Control and Prevention.

Why mention heart disease and stroke together? Because they are closely connected.

“Certain heart conditions can increase a person’s risk for stroke,” said Maen Nusair, MD, cardiologist with Endeavor Health. “Moreover, coronary artery disease and stroke share many of the same risk factors.”

Why does coronary artery disease put someone at a higher risk of stroke?

Coronary artery disease and stroke share a number of risk factors, such as high blood pressure, diabetes, obesity and high cholesterol. The risk factors promote plaque buildup in arteries which are blood vessels that carry oxygen and nutrients to organs. Plaque buildup can compromise blood flow in these arteries, and when this compromise affects the arteries which supply the heart muscle that can result in a heart attack. If it affects the arteries which supply the brain, that can result in a stroke.

Some heart conditions, such as atrial fibrillation, which is a specific type of heart rhythm disturbance, can result in clot formation inside the structure in the heart. This clot can break free, travel through the blood stream to the brain and cause a stroke. In addition, some defects in the heart such as patent foramen ovale and trial septal defects can allow the passage of clots through the heart and these clots can go to the brain and cause strokes.

What interventions can help lower stroke risk for people with heart disease?

In patients with coronary artery disease, aggressively controlling the risk factors which led to disease development can not only decrease risks of heart attacks but also decrease risk of stroke.

In patients with atrial fibrillation, careful evaluation and consultation with a cardiologist allows implementation of interventions that can considerably decrease the risk of stroke caused by this condition. Certain blood thinners can be used to achieve that goal. In patients for whom blood thinners are not advised, a minimally invasive procedure called Left Atrial Appendage Closure can be performed. It confers a high level of protection from stroke, similar to blood thinners, with much lower bleeding risk.

Patients who have a patent foramen ovale and have a history of stroke require careful assessment and when appropriate a minimally invasive procedure to close this defect can be performed.

Carefully removing plaque and opening arteries helps lower the risk of stroke. Treatment options include:

• A carotid endarterectomy is the “gold standard” for removing plaque from the carotid artery, though it carries a higher risk for heart complications and nerve damage.
• Trans-femoral carotid stenting is another way to open the artery, though it carries an increased risk of stroke. As the plaque is disturbed by the stent, bits of it can break off and follow the flow of blood to the brain.
• A third option, transcarotid artery revascularization (TCAR), is a minimally-invasive procedure that allows for stenting of the carotid artery while a device reverses the blood flow and filters it back into the patient’s body through the femoral vein in the thigh, avoiding the risk of plaque traveling to the brain. Once the stent is in place, the TCAR device is removed and blood flow returns to normal. With TCAR there is a minimal risk of stroke, nerve damage or cardiac complications.

Is there anything else people can do to lower their risk of stroke or heart disease?

“It’s easier to adopt healthy lifestyle habits that help prevent disease than it is to have to address cardiovascular disease,” Dr. Nusair said. “Try to make a point of incorporating these lifestyle factors, even if you have to do it gradually.”

1. Get to know your family’s heart health history. Having a first-degree relative (parent, sibling or child) who either developed heart disease before age 55 or died at an early age of sudden cardiac arrest can increase your risk as much as having high cholesterol or diabetes. Try to learn about the heart health of cousins, aunts and uncles, and grandparents too if possible. The more information you have, the better.
2. Ease into exercise. Exercise makes your heart stronger, making it easier for your heart to pump blood through your body. It also lowers your blood pressure and “bad” cholesterol levels (see below), two factors that contribute to heart disease. Staying active also helps regulate your weight and the American Heart Association (AHA) recommends adults do 150 minutes of “moderately intensive” aerobic exercise each week. If you aren’t active now, talk to your physician about safely starting an exercise routine.
3. Quit smoking (and if you don’t smoke, don’t start). Smoking is linked to heart disease, a higher risk of stroke, lung cancer and other chronic diseases. The AHA reports almost a third of coronary heart disease deaths are due to smoking and breathing secondhand smoke. Nicotine can raise your blood pressure, cause a racing heartbeat and narrowing of your arteries. Talk to your physician about how to quit.
4. Watch your blood pressure. Keeping tabs on your blood pressure and cholesterol levels is one of the smartest things you can do to keep your heart healthy. High blood pressure has no symptoms, so unless you monitor it you wouldn’t know if it’s high. Cholesterol also causes no symptoms. There are two types of cholesterol: LDL, the fatty cholesterol that clogs arteries, and HDL, the cholesterol that helps get rid of LDL. Talk to your physician about your blood pressure and cholesterol and how to keep them in a healthy range.
5. See your doctor. Keeping regular checkups with your primary care physician is not only heart-smart, it’s good for your overall wellbeing and health. Annual checkups create a record of your health over time, so your doctor can see if your blood pressure or cholesterol levels change, for example. Your doctor can also recommend lifestyle changes and even medication, if needed, to help keep your cardiovascular system healthy.
6. Lean toward a heart-healthy diet. Sticking with a healthier diet, which allows some indulgence but is mostly healthy overall, will also help keep arteries clear and flexible, which keeps your heart healthier. You’ll also have more energy and will likely maintain a healthier weight.