By Phil Collis – Community Stroke Specialist

A stroke is a brain attack. It happens when the blood supply to part of your brain is cut off. It can be caused by a blockage in one of the blood vessels leading to the brain or by a bleed in the brain.

Blood carries essential nutrients and oxygen to your brain. Without blood your brain cells can be damaged or die.

Strokes affect people in different ways depending on the part of the brain that is affected, how widespread the damage is and how healthy you were before the stroke. A stroke can affect the way your body functions as well as your thought processes and how you feel and communicate.

The BEFAST test can help you to recognize the symptoms of a stroke. These symptoms usually come on suddenly. Other symptoms include sudden weakness or numbness on one side of the body, sudden confusion, dizziness or unsteadiness.

A transient ischaemic attack or TIA is similar to a stroke but the symptoms are temporary – usually lasting from a few minutes up to 24 hours. A TIA is serious and should not be ignored. If you experience any of the symptoms described above you must call 911, as there is no way of telling whether you are having a TIA or a stroke when the symptoms first start.

Why am I more likely to have a stroke if I am black?

Studies show that if you are black and of African or Caribbean origin you are twice

As likely to have a stroke, and at a younger age, than white people. The reasons for

This are complex and not completely understood.

What we do know is if you are black and of African or Caribbean origin you are more

Likely to develop high blood pressure or diabetes or have sickle cell disease,

Which are all risk factors for stroke.

Some of the lifestyle factors that increase your risk of developing some of these medical conditions, and therefore of having a stroke, are also known to affect some African and Caribbean people more than the rest of the UK population. These include carrying weight around your waist and smoking.

What factors will increase my risk of stroke?

High Blood Pressure

High blood pressure is the most important risk factor, contributing to around 53% of all strokes. In the UK high blood pressure is more common among black Caribbean people than any other ethnic group.

Blood pressure is the measure of how strongly your blood presses against the walls of your arteries when it is pumped around your body. If this pressure is too high it puts a strain on your arteries and heart, which can cause health problems and lead to a stroke or heart attack.

High blood pressure (known as hypertension) develops when your blood pressure is consistently too high (140/90mmHg or higher).

High blood pressure puts a strain on all the blood vessels in your body, including the ones leading to your brain. This makes a blockage more likely to develop or a blood vessel in the brain to weaken and bleed, both of which could cause a stroke.

What can I do about high blood pressure?

High blood pressure does not have any symptoms so the only way to know if you have it is to have your blood pressure measured regularly.

Everyone over 40 should get their blood pressure checked at least once every five years, but as you’re more likely to have high blood pressure if you are black African or black Caribbean, you should get it checked more often, ideally once a year. This can be done by your GP or nurse, or you can check it yourself with a home testing kit.

Leading a healthy lifestyle can help to reduce your risk of high blood pressure. You can read more about this further on in this factsheet.

Diabetes

Diabetes is up to three times more common among black African and black Caribbean people compared to the rest of the UK population.

Diabetes is a condition caused by too much sugar (known as glucose) in the blood. This is why people with diabetes may say they’ve “got sugar”. There are two main types of diabetes:

• Type 1 develops when the body stops producing insulin, a hormone that helps your body to use up the glucose in your bloodstream. This type of diabetes usually begins in childhood or adolescence.

• Type 2 diabetes develops when your body does not produce enough insulin or

When your body does not react to it in the right way. This type of diabetes is much

More common and tends to develop gradually, usually in adulthood.

Having diabetes doubles your risk of stroke. This is because high levels of glucose in the blood can damage your blood vessels, making them harder and narrower and more likely to become blocked. If this happens in a blood vessel leading to the brain it could cause a stroke.

How can I manage diabetes?

It is important that you get checked by a GP or other health professional, especially if you have other major risk factors for developing the condition i.e.

You are over 40 years of age.

There is a history of diabetes in your family.

You are overweight or obese (check your BMI).

You have had diabetes during pregnancy.

If you have diabetes, you must have regular checkups with your GP or at a diabetes clinic to make sure your blood glucose and blood pressure stay at healthy levels.

Although there is no cure, diabetes can often be managed by making changes to your lifestyle i.e. altering your diet, doing more exercise.

Sickle Cell Disease

Sickle cell disease is a disorder that affects red blood cells. Blood cells are normally round and flexible, but in people with sickle cell disease they become stiff and sickle shaped. This can lead them to block blood vessels, often causing pain. This is known as a ‘sickle cell crises’. If sickle cells block the blood supply to the brain this can lead to stroke. Research shows that around 24% of people with sickle cell disease will have a stroke by the age of 45.

In the UK around 10,000 people have sickle cell disease and it predominantly affects people of African, Caribbean, Asian and Mediterranean origin. Sickle Cell disorders can be detected with a blood test. (All newborn babies in the UK are checked for sickle cell disease). Although Sickle Cell Disease cannot be cured, treatment can reduce its symptoms and the complications that result from it, like stroke. Specialist health professionals can help you manage the condition by providing regular checks to monitor your risk.

If you are diagnosed with Sickle Cell it is likely that you will have a TCD (Transcranial Doppler Scan) every year from the age of 3. This type of scan uses ultrasound to measure the flow of blood through the brain and can indicate whether a blockage may be forming. If the scan shows that you are at a high risk of stroke. Your doctor or health professional may recommend that that you have more regular scans or a blood transfusion, which can significantly reduce your risk. Some things are known to trigger a sickle cell crisis and can be avoided. These include very hot or very cold temperatures, stress and smoking cannabis.

Atrial Fibrillation (A/F)

This is a term used for people who have a type of irregular heartbeat that can cause blood clots to form in the heart. If these clots move up into the brain it can lead to stroke. Some studies have shown that people of African origin are less likely to have A/F, however if you do have A/F it is probable that you are likely to have other possible risk factors (i.e. High blood pressure and diabetes) Which will very possibly increase your risk of stroke. Your doctor or health professional can test whether you have A/F by checking your pulse and performing an Electrocardiogram (ECG) – a simple and painless test that records the rhythm and electrical activity of your heart. If you have A/F you can be treated with blood thinning medication such as Warfarin or drugs called novel oral anticoagulants which can reduce your risk of stroke by 50 – 70%.

Managing your lifestyle can help reduce your risk of stroke. Risk factors that you cannot control include your age, gender, ethnic background and family history of stroke.

Making lifestyle changes can significantly reduce your risk of stroke.

Smoking- doubles your risk of stroke: the more you smoke the greater your risk – smoking damages artery walls and makes blood more likely to clot.

Alcohol – regularly drinking large amounts of alcohol greatly increases your risk of stroke. ‘Binge’ drinking in particular is dangerous as it can cause blood pressure to rise very quickly.

Weight – Some studies have shown that women of African origin are more likely to carry weight around their waist which makes them more likely to have high blood pressure, diabetes or other health problems.

Diet - Eating a healthy balanced diet can help to lower blood pressure and control diabetes. Cholesterolis a fatty substance that can be absorbed from foods.

Salt – be aware that salt intake can have a significant effect on controlling blood pressure. Many of today’s foods already contain significant amounts of salt. Salt fish a favorite of African and Caribbean communities should be eaten in moderation, oily fish are a more suitable alternative.

Plenty of fresh fruit and vegetables in a balanced diet improve overall health and wellbeing.

Check out your own Stroke risk using this useful score card for you and your family.