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Stroke Facts: By The Numbers
Posted by: John S Kiernan
May is American Stroke Month. It’s on the calendar every year, and for good reason. Stroke is the fifth leading cause of death in the U.S. The odds of any of us having one at some point in our lifetime are far too high. And the disease has already cost us way too much.
That’s why taxpayers, pharmaceutical companies and other vested parties have spent billions of dollars researching stroke in recent years. And it’s why the month of May is reserved for building awareness, not to mention soliciting a few donations here and there.
To help contribute to the cause, WalletHub went looking for statistics and factoids to illustrate the gravity of the situation and encourage people to adopt healthier habits. In the following infographic, you call learn about everything from the toll stroke takes on families and the economy to why BE FAST is an acronym to remember.
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For more information about a disease that many people are unfamiliar with, we posed the following questions to a panel of healthcare professionals. You can find their bios and responses below.
What are the signs that someone might be having a stroke? What actions should be taken after calling for help? What steps can someone take today to help reduce the risk of having a stroke? What is driving the projected increase in the number of Americans having a stroke? < >
Pooja Khatri
Professor of Neurology and Director of Acute Stroke Research at University of Cincinnati
Karen L. Saban
Associate Professor and Associate Dean for Research in the Marcella Niehoff School Of Nursing at Loyola University Chicago
Justin A. Sattin
Associate Professor and Residency Program Director in the Department of Neurology and Medical Director of the UWHealth Comprehensive Stroke Program at University of Wisconsin - Madison
Jennifer G Robinson
Professor in the Department of Epidemiology & Medicine and Director of the Prevention Intervention Center at University of Iowa
Holli A. DeVon
Professor of Biobehavioral Health Sciences in the College of Nursing at University of Illinois at Chicago
Gina Lundberg
Clinical Director of the Emory Women's Heart Center and Associate Professor of Medicine in the School of Medicine at Emory University
David C. Seaberg
Professor and Dean of the University of Tennessee College of Medicine Chattanooga
BethAnn McLaughlin
Assistant Professor of Neurology and Assistant Professor of Pharmacology at Vanderbilt University
Bernadette Mazurek Melnyk
Vice President for Health Promotion, Chief Wellness Officer, Dean & Professor in the College of Nursing, and Professor of Pediatrics & Psychiatry in the College of Medicine at Ohio State University
Benjamin Tseng
Assistant Professor and Graduate Research Faculty, Director of the Laboratory of Brain Aging & Neuromotor Behavior, Affiliate Investigator at the Memory Assessment & Research Center at University of Texas at Tyler
Barbara Riegel
Professor and Edith Clemmer Steinbright Chair of Gerontology in the School of Nursing at University of Pennsylvania
Allyson Zazulia
Professor of Neurology & Radiology and Associate Dean for Continuing Medical Education in the School of Medicine at Washington University
Pooja Khatri
Professor of Neurology and Director of Acute Stroke Research at University of Cincinnati
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
We teach the mnemonic of FAST -- F for face (drooped or numb on one side), A for arm (or leg, weak on one side), S for speech (slurred or unable to speak/understand) and T for time (call 9-1-1) immediately because time is brain. Don’t hesitate to call 9-1-1 with a sudden loss of function. Urgent treatments are available up to 24 hours from symptom onset, and the sooner you get treated, the better your chances for recovery.
What steps can someone take today to help reduce the risk of having a stroke?
Exercise (at least 30 min moderate exercise -- i.e., a walk -- at least 3 times per week)
Don’t smoke tobacco, or quit.
Get screened for high blood pressure, diabetes, and high cholesterol.
Try to maintain a healthy weight.
What is driving the projected increase in the number of Americans having a stroke?
The main issue is our aging population. Increased levels of obesity have played a role as well.
Karen L. Saban
Associate Professor and Associate Dean for Research in the Marcella Niehoff School Of Nursing at Loyola University Chicago
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
The American Stroke Association recommends using the acronym, “FAST” to remember the signs of a stroke:
F: Face drooping;
A: Arm weakness;
S: Speech difficulty;
T: Time to call 911.
If a person has any of the above symptoms, 911 should be called immediately. Do not wait to see if the symptoms get better. Studies demonstrate that patients who arrive to the emergency room within 3 hours of their first symptoms have less disability following the stroke than those who delay treatment (Fang, Keenan, Ayala, Dai, Merritt & Denny, 2008). When calling 911, the caller should indicate that they think it could be a stroke. It is also helpful to note, when possible, the time that the symptoms started.
What steps can someone take today to help reduce the risk of having a stroke?
According to the American Stroke Association, 80% of strokes are preventable. The American Stroke Association outlines several steps you can take to prevent a stroke:
Make sure that you have your blood pressure checked regularly. High blood pressure (also known as hypertension) is the most significant controllable risk factor for stroke.
If you smoke, quit. Smokers have a three times greater risk for stroke than non-smokers.
If you have diabetes, keep your blood sugar (blood glucose) levels well controlled.
Try to get a total of 30 minutes of activity every day.
Avoid food that is high in saturated fat, trans fat, and salt. Make sure that you eat at least 5 servings of fruits and vegetables every day. Some evidence suggests that following a Mediterranean-style diet that is higher in nuts and olive oils is associated with a decreased stroke risk.
Maintain a normal weight which is defined as a Body Mass Index (BMI) between 18.5 to 24.9. You can calculate your BMI using the National Institutes of Health (NIH) calculator.
Have your cholesterol levels checked regularly. The American Heart Association recommends that individuals over 20 years of age have their cholesterol levels checked every 4 to 6 years. Those with cardiovascular (heart) disease or who are at high risk for heart disease may need to get their cholesterol levels checked more often.
If you have carotid artery disease or peripheral artery disease, make sure that you carefully follow your clinician’s advice for treatment. Carotid artery disease is a narrowing of the blood vessels in your neck leading to your brain and peripheral artery disease is narrowing of the blood vessels in your arms or legs. People with carotid artery or peripheral artery disease have a higher risk for stroke.
Atrial fibrillation or afib, is an abnormal heart rhythm that can increase your risk for stroke by causing clots to travel to the brain and result in a stroke. Treatment for atrial fibrillation can reduce your risk for a stroke.
Sleep apnea increases your risk for stroke. Studies are ongoing to see if treating sleep apnea with continuous positive airway pressure may decrease risk for stroke.
Women who experience migraine with aura and who smoke and use contraceptives have a 3 fold increased risk of stroke than women who do not.
Mental health can play a significant role in stroke risk. Studies have shown that those with higher levels of anxiety and depression are at increased risk of stroke.
What is driving the projected increase in the number of Americans having a stroke?
Stroke is the 5th leading cause of death in the U.S., with someone in the U.S. experiencing a stroke every 40 seconds. The good news is that over the past 10 years, the death rate from stroke has fallen almost 35%. Despite this downward trend in stroke mortality, some have projected that the number of deaths from stroke could increase by 50% by the year 2030. In addition, it is projected that stroke disparities among non-Hispanic black and non-Hispanic whites will continue to increase through 2030.
Higher rates of obesity, decreased physical activity, and high-sodium, high-fat diets most likely contribute to the projected increased rates of stroke. In addition, high levels of stress -- particularly that experienced by socioeconomically vulnerable persons -- may also be contributing a greater occurrence of stroke.
Justin A. Sattin
Associate Professor and Residency Program Director in the Department of Neurology and Medical Director of the UWHealth Comprehensive Stroke Program at University of Wisconsin - Madison
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
Signs of stroke can be remembered with the acronym BE FAST:
Balance: Sudden loss of balance;
Eyes: Sudden loss of vision in one or both eyes;
Face: Ask them to smile -- does the face look uneven?
Arms: Ask them to lift their arms -- does one arm drift down?
Speech: Ask them to repeat a phrase -- does their speech sound strange?
Time: Time is brain -- time to call 911!
After calling 911, the most important things are:
Mark the time that it started or, if known, when the person was last seen in their usual state of health. All stroke treatments depend on the time of onset or last known well.
Don’t give the victim anything to eat or drink -- including no aspirin (as with a heart attack). The victim might inhale the food / drink / medicine and choke or get pneumonia.
For family members, it’s helpful to gather the victim’s medications and any documentation of their medical problems for EMS to bring to the hospital.
Stroke prevention starts with good living: A healthful diet, regular exercise, and not smoking. The most important treatable risk factor for stroke is high blood pressure (hypertension). Seeing the doctor from time to time for a blood pressure check and taking blood pressure medications when prescribed is extremely important. If a person has diabetes or dyslipidemia (high cholesterol), keeping these under control is also extremely important.
The number of strokes is rising because the biggest risk factor is age -- we have an aging population here in the U.S. However, the proportion of people who have a stroke that die from it is actually going down. They’re surviving the stroke, but too often with disabilities such as paralysis on one side of the body, inability to speak, inability to eat, inability to walk, etc. That’s why preventing stroke in the first place is so important and why one must call 911 right away if stroke symptoms do develop. Again, time is brain; all stroke treatments are critically time dependent and the longer people wait to get help, the more likely they are to end up disabled after a stroke. Large numbers of stroke survivors with lifelong disability are a huge strain on patients, families and society.
Jennifer G Robinson
Professor in the Department of Epidemiology & Medicine and Director of the Prevention Intervention Center at University of Iowa
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
See the American Heart Association/American Stroke Association website -- they cover this quite well.
What steps can someone take today to help reduce the risk of having a stroke?
Throughout the lifespan, a healthy diet, regular physical activity and weight control are foundation of stroke prevention. Treating high blood pressure makes a big difference -- systolic blood pressure (the top number) should be 190 mg/dl).
Holli A. DeVon
Professor of Biobehavioral Health Sciences in the College of Nursing at University of Illinois at Chicago
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
Numbness or weakness of face, arm or leg (especially on one side).
Confusion or trouble speaking or understanding.
Visual problem in one or both eyes.
Difficulty walking, loss of balance, or loss of coordination.
Dizziness.
Severe headache.
The key point is that these signs and symptoms come on suddenly.
The American Stroke Association has an initiative called Act F.A.S.T., to encourage individuals to call 911 if they see a person with any of these signs: F -- this stands for facial droop. One side of the face droops so if you ask a person to smile, only one side of their face rises. A -- is for arm, which is weak. If you ask the individual to raise both of their arms, one will drift down. S -- is for garbled or difficult speech. T -- is for “time to call 911.”
Another important point is that someone who is having a stroke will likely not be able to recognize it or help themselves, so it is critical for bystanders to call 911 immediately. If an individual gets to a stroke center (even virtually with telehealth modalities) they can receive immediate treatment which can prevent the death of brain cells and preserve brain function. This was not possible 20 years ago.
What steps can someone take today to help reduce the risk of having a stroke?
Everyone can employ risk factor reduction strategies and the sooner, the better. These are common risk factors for stroke (and other conditions such as heart disease and cancer):
High blood pressure, smoking, diabetes, diet, physical activity, obesity, high cholesterol, obstructive sleep apnea, carotid artery disease, peripheral artery disease, atrial fibrillation, sickle cell
disease, other heart disease. As you can see, many of these problems are related to each other. For example, obesity is a risk factor for obstructive sleep apnea.
If I could emphasize a couple of things, they would be:
If you smoke, quit. If you don’t smoke, don’t start.
Get your blood pressure, blood sugar, and cholesterol checked on a regular basis.
What is driving the projected increase in the number of Americans having a stroke?
There are several theories for the increase in stroke (especially in young people). Some are positive and some are negative:
Positive:
Some people gained access to care under the Affordable Healthcare Act. This means they received care (a diagnosis) when they would not have before.
Diagnostics (both blood tests and imaging such as MRI) has improved so some people who would not have been accurately diagnosed in prior years are now being properly diagnosed.
Negative:
Rates of obesity and type 2 diabetes are on the rise. Two serious risk factors.
Atrial fibrillation (irregular heart rhythm) is on the rise.
The aging of the baby boomers means more acute and chronic disease such as stroke.
Poor lifestyle choices such as sedentary lifestyle and poor diet (high calorie lacking in nutritional value).
Some useful websites -- American Stroke Association (stroke facts); video about stroke; stroke warning signs (act FAST); other stroke resources.
Gina Lundberg
Clinical Director of the Emory Women's Heart Center and Associate Professor of Medicine in the School of Medicine at Emory University
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
We use the term FAST to teach people the signs of stroke.
F is for face. If the face is drooping or asymmetric, then that could be a sign of a stroke. Also facial weakness.
A is for arms which may be weak in strength or feeling numb or tingling.
S is for speech. The speech may be garbled or the patient may not comprehend speech or be making sense.
And T is for time. Getting to the hospital quickly is extremely important. Always call 911 for immediate transport to a hospital, hopefully a certified stroke unit.
These types of symptoms that resolve quickly are called a transient ischemic attack or TIA. They also need medical attention quickly.
What steps can someone take today to help reduce the risk of having a stroke?
Blood pressure and abnormal heart rhythms are strongly related to stroke. Maintaining a good blood pressure can be done through normal body weight, normal sodium intake, and routine exercise. Abnormal heart rhythms such as atrial fibrillation are strongly related to stroke. Atrial fibrillation is from high blood pressure, diabetes, blocked arteries, sleep apnea, and thyroid problems. See your doctor routinely and know your blood pressure, blood glucose, and cholesterol numbers. Eat a heart healthy diet and get moderate exercise five days a week.
What is driving the projected increase in the number of Americans having a stroke?
High blood pressure is a major driver of stroke. As we get older, our blood pressure naturally gets higher. The arteries get stiffer and the kidney function declines. All these things contribute to high blood pressure as we age. See your doctor regularly and have your risk for heart disease evaluated. Stroke is the number one cause of disability in the USA and number five cause of death. Also, stroke affects more women than men.
David C. Seaberg
Professor and Dean of the University of Tennessee College of Medicine Chattanooga
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
If you or someone you know is possibly having a stroke:
Call 911;
Note time of onset of symptoms (time of symptoms helps direct treatment);
Lie down but do not let them fall asleep;
Perform CPR if necessary.
Do not:
Give aspirin;
Give them food or drink;
Drive yourself to the ED or have the stroke patient talk you out of calling EMS.
Thing you can do to prevent stroke:
Keep your blood pressure under control;
Lose weight;
Exercise;
Stop smoking;
Drink alcohol only in moderation;
Treat atrial fibrillation and/or diabetes;
Take an aspirin a day after the age of 50.
Stroke rates have declined overall in the U.S. population and is due to the control of the above prevention factors. There seems to be an increase in strokes in younger people and it is unknown what the
cause may be. Prevention, as noted above, is the key.
BethAnn McLaughlin
Assistant Professor of Neurology and Assistant Professor of Pharmacology at Vanderbilt University
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
The American Heart Association has developed a handy acronym called FAST to help people know if they are having a stroke. FAST stands for: Facial drooping, Arm weakness, Speech difficulties and Time to call 9-1-1. While some strokes are described as “the worst headache of your life,” the majority of strokes don’t hurt and people think they are overly tired or “can sleep it off.” If you see any of the FAST signs, it’s time to go call 9-1-1.
What steps can someone take today to help reduce the risk of having a stroke?
This is an excellent question. We know after decades of research that stroke is largely a matter of prevention. While some risk factors, such as your age can’t be changed, others absolutely can. Checking your blood pressure and getting treated if it’s over 140/90 provides huge benefits. We also have some tremendous tools to help folks quit smoking, manage their diabetes more effectively and it’s incredibly important that even if you have FAST symptoms, like facial droop, arm weakness and speech difficulties that are getting better, you call 9-1-1 immediately. Even if these symptoms get better on their own, the fact that you have had them is a huge warning sign you are at high risk of having a full blown stroke in the near future.
What is driving the projected increase in the number of Americans having a stroke?
We really don’t understand all the genetic and environmental factors that play a role in stroke, but certainly, as a country we need to be doing much better self care when it comes to diet and exercise.
That’s no easy feat, but even small things like losing 10% of your body weight can have a big impact.
There are all kinds of options out there that primary care physicians, endocrinologists, cardiologists and neurologists are spending time developing personal goals and plans with their patients to live longer and healthier lives. If you aren’t getting heard about your stroke risk concerns, you need to find a new physician.
Bernadette Mazurek Melnyk
Vice President for Health Promotion, Chief Wellness Officer, Dean & Professor in the College of Nursing, and Professor of Pediatrics & Psychiatry in the College of Medicine at Ohio State University
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
If experiencing any of these symptoms, call 911 as getting to the hospital quickly is so important. People should not have someone drive them to the hospital. If someone is having the most common type of stroke, “ischemic stroke,” and is within 3 hours of their symptoms starting, they can be given a clot busting medicine, which works very effectively, and often promotes full recovery.
Signs of stroke include:
Sudden onset of numbness or weakness in the face, arm, or leg, especially on one side of the body.
Sudden onset of confusion, trouble speaking, or difficulty understanding speech.
Sudden onset of trouble seeing in one or both eyes.
Sudden onset of trouble walking, dizziness, loss of balance, or lack of coordination.
Sudden onset of severe headache with no known cause.
What steps can someone take today to help reduce the risk of having a stroke?
People should reduce risk factors that can be changed:
High blood pressure;
High cholesterol;
Tobacco smoke; Regular and Social Smoking;
Marijuana use;
Overweight/Obesity;
Diabetes;
Physical inactivity;
Unhealthy eating;
Depression;
Stress.
Behaviors are the #1 killer of Americans; 80% of chronic diseases including stroke and other cardiovascular diseases can be prevented with just a few healthy lifestyle behaviors, including engaging in physical activity for 30 minutes 5 days a week; eating at least 5 fruits and vegetables per day, not smoking, drinking alcohol in moderation, and reducing their stress. It is a simple formula, but not easy as changing behavior is what I call character-building.
What is driving the projected increase in the number of Americans having a stroke?
Stroke rates have doubled in younger people, ages 35 to 44, over the past 20 years due to increased rates of obesity, high BP, and diabetes (the majority of these cases can be prevented with healthy lifestyle behaviors).
Benjamin Tseng
Assistant Professor and Graduate Research Faculty, Director of the Laboratory of Brain Aging & Neuromotor Behavior, Affiliate Investigator at the Memory Assessment & Research Center at University of Texas at Tyler
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
First of all, there are different types of stroke we need to understand. It can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). A TIA (transient ischemic attack), or "mini stroke," is caused by a temporary clot.
Use the letters in "FAST" to spot stroke signs and cal 911 as recommended by the American Heart Association and American Stroke Association.
Face dropping;
Arm weakness;
Slurred speech;
Time to call 911.
In addition to FAST, other symptoms to look out for:
Sudden numbness or weakness of face, arm, or leg, especially on one side of the body;
Sudden confusion, trouble speaking or understanding speech;
Sudden trouble seeing in one or both eyes;
Sudden trouble walking, dizziness, loss of balance or coordination;
Sudden severe headache with no known cause.
What steps can someone take today to help reduce the risk of having a stroke?
In general, anything good for your heart is also good for you brain and blood vessels;
Regular physical activity;
Lower your blood pressure;
Lower your blood cholesterol;
Reduce diets with high saturated fat and trans fat;
Quit smoking.
What is driving the projected increase in the number of Americans having a stroke?
First of all, we need to objectively accept the fact that modern medicine has increased our life expectancy substantially. In another word, people are living much longer than they used to, which may
lead to higher prevalence of stroke (since more cases are being reported and documented).
Secondly, modern lifestyle with limited physical activity and sedentary lifestyle may contribute to higher stroke rate in America. Relatively speaking, Americans drive a lot more and walk a lot less than our Asian and European counterparts. This leads to obesity and hypertension and increase stroke risks.
Barbara Riegel
Professor and Edith Clemmer Steinbright Chair of Gerontology in the School of Nursing at University of Pennsylvania
What steps can someone take today to help reduce the risk of having a stroke?
The American Heart Association has published a wonderful, practical approach to staying healthy and preventing cardiac and vascular diseases such as stroke: Life’s Simple 7. The 7 behaviors advocated begin with the basic principle of knowing your numbers -- have your blood pressure, cholesterol, blood sugar, and body weight measured.
Another important basic principle is that “something is better than nothing.” I personally made a pact with my husband to exercise together for 10 minutes each day. That was 3 years ago and we’re still exercising every morning. The message is to pick something little and stick with it.
Allyson Zazulia
Professor of Neurology & Radiology and Associate Dean for Continuing Medical Education in the School of Medicine at Washington University
What are the signs that someone might be having a stroke? What actions should be taken after calling for help?
The key characteristic of a stroke is that symptoms come on suddenly. Some of the most common signs of stroke are sudden weakness or numbness of the face, arm, or leg, especially on one side of the body, sudden difficulty speaking or understanding, sudden loss of vision in one or both eyes, sudden trouble walking or incoordination, and sudden severe headache.
One useful tool to spot stroke signs and take action is to use the letters in “FAST,” where F stands for face drooping, A for arm weakness, S for speech difficulty, and T for time to call 9-1-1. When you call, say, “I think this is a stroke.” While waiting for help to arrive, collect a list of other medical conditions the person has and a list of medications being taken (or put all the pill bottles in a bag and bring it with you to the Emergency Department). It is also very important to note the time that the symptoms began.
Do not drive yourself or a family member who is having stroke symptoms to the Emergency Department! Patients with stroke who arrive by ambulance are more likely to be treated with a clot-busting medication or clot-retrieving procedure faster than those arriving by car, and every minute counts when it comes to saving brain cells.
What steps can someone take today to help reduce the risk of having a stroke?
The strongest modifiable risk factors for stroke include high blood pressure (greater than 140/90), diabetes, heart disease (especially the irregular heart rhythm, atrial fibrillation), smoking, and high cholesterol. The first step would be to understand what your personal risk for stroke is using such tools as the National Stroke Association’s Stroke Risk Scorecard and discussing any elevated risks with your doctor.
Up to 80% of strokes are thought to be preventable through a combination of lifestyle changes (getting regular exercise, eating a healthy diet, and not smoking) and control of risk factors. Make sure to have your blood pressure checked regularly, find out if you have high cholesterol, report any episodes of skipped or irregular heartbeats, treat circulation problems like blocked arteries in the heart, and seek treatment if you have any episodes that could represent a TIA.
What is driving the projected increase in the number of Americans having a stroke?
The major driver of the projected increase in the number of Americans having a stroke is the aging of our population. The rate of stroke goes up with age due to the increased presence of stroke risk factors in older individuals. For example, the occurrence of the irregular heart rhythm atrial fibrillation, which is one of the most powerful stroke risk factors, increases dramatically over the age of 60. So as more Americans enter their 60’s and 70’s, the incidence of atrial fibrillation is expected to increase.
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