Every 45 seconds, someone in the United States has a stroke. A stroke can happen when:
*A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke .
*A blood vessel breaks open, causing blood to leak into the brain. This is a hemmorhagic stroke .
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.The good news is that many fewer Americans now die of strokes than was the case 20 or 30 years ago. Improvement in the control of major risk factors for stroke — smoking, high blood pressure and high cholesterol — is likely responsible for the decline.
Medical researchers have proven that several medications can help prevent heart attacks and other negative effects of coronary artery disease in patients who take them. These medications include aspirin, beta-blockers, lipid-lowering drugs such as statin and angiotensin-converting enzyme inhibitors or ACE inhibitors. Previously, studies have concentrated on physicians and whether they prescribe these drugs for their patients.
Management of stable angina includes eliminating or controlling specific coronary risk factors, implementing lifestyle changes to reduce the risk of coronary artery disease, controlling precipitating factors and prescribing appropriate anti-ischemic medicines. Measures for eliminating or modifying risk factors include control of hypertension and diabetes, a reduction of the cholesterol level, smoking cessation, weight reduction to the patient's ideal body weight, regular exercise and avoidance of strenuous activities that are known to precipitate angina.Doctors often prescribe aspirin, beta blockers and cholesterol lowering statin drugs to patients who suffer heart attacks, these medications have been shown to prevent further heart attacks or other heart trouble.
The goals of drug therapy in the management of chronic stable angina are to eliminate ischemia, abolish or reduce the frequency and severity of anginal attacks, prevent myocardial infarction and potentially improve the patient's long-term survival. Because a pivotal aspect in the pathophysiology of angina is a mismatch of oxygen supply and oxygen demand, drug therapy is directed at decreasing the myocardial oxygen demand and increasing the myocardial oxygen supply. Antianginal agents such as nitrates, calcium channel blockers, beta-adrenergic blockers and aspirin have been shown to decrease cardiac ischemia or prevent myocardial infarction.
In the new paper, U-M Cardiovascular Center researchers report that heart attack and unstable angina patients who were prescribed all those four types of proven medications had a 90 percent lower risk of dying in the six months after they left the hospital than those who received none of the drugs. Even patients who got only two or three of the drugs had a much lower death risk than those who got none.Many studies have already shown that individual drugs in each one of the four classes can help prevent problems in patients with previous heart problems and clogged arteries.
The most important medications for individuals at high risk for heart disease are aspirin, beta blockers, and cholesterol-lowering agents (especially statins). A disturbing 2003 study reported that such medications were underused in women who needed them, including women with the greatest risks for heart attack. (Other medications are also necessary for people with specific risk factors, such as high blood pressure and diabetes.)
Doctors usually prescribed beta-blockers to protect the heart, but it seems the drugs also protect the brain. Researchers found that people who have a stroke are less severely affected if they have been taking beta-blockers.
Beta blockers reduce blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.Examples of beta blockers include:
*Atenolol (Tenormin)
*Metoprolol (Lopressor, Toprol-XL)
*Propranolol (Inderal, Inderal LA)
Dr. Stephen M. Oppenheimer from Baylor College of Medicine, Houston, Texas and Dr. Somchai Laowattana from New Jersey Neuroscience Institute, Edison looked at the severity of stroke in 111 patients.
Among all the prescribed medications these patients had been taking, only beta-blockers were significantly associated with less stroke severity, after other factors were taken into account, the investigators report in the medical journal Neurology.
Taking aspirin or being on a cholesterol-lowering 'statin' drug were not related to stroke severity, the results indicate.
Oppenheimer told Reuters Health that "perhaps beta blockers could have a dual effect" -- by both lowering blood pressure and thereby reducing the likelihood of stroke "and decreasing its severity once it occurs."
However, he concluded, "This requires further investigation in a large follow-up study involving a cohort of several thousand patients."
People who have heart disease and have undergone procedures to alleviate problems involving the coronary arteries should receive certain the lifesaving benefits of these medications that have been proven to extend the lives of people in their circumstances. Programs to insure that physicians are aware of the need to prescribe these drugs are already in place.
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