Stroke experts call for alertness to risk factors

Ten years ago, health authorities called for a sweeping change in the way Americans view stroke, asking them to learn stroke symptoms and to treat those signs as an emergency -- much like a heart attack.

A new study shows that many Americans have gotten the message. More people now recognize a stroke and are prepared to act. But people still are not very knowledgeable about the risk factors that can lead to a stroke.

The study, published last week in the Journal of the American Medical Assn., compared results of telephone surveys taken in 1995 and 2000 in Cincinnati. While 57% of people could correctly name one stroke warning sign in 1995, 70% were able to do so five years later. More than 2,100 people were surveyed in 2000 and 1,880 in 1995.

Strokes affect about 600,000 Americans a year, according to the American Heart Assn., killing about 167,000 people. Although strokes are a leading cause of long-term disability, neurological damage can be dramatically limited by administering a drug called tissue plasminogen activator, or TPA, within hours of a stroke.

“TPA had been approved in 1996, and that got a lot of press,” said Dr. Alexander T. Schneider, assistant professor of neurology at the University of Cincinnati and lead author of the study. “Still, 30% of people don’t know any stroke warning signs. We’ve come a long way, but we’ve got a long way to go about educating people about stroke.”

Stroke symptoms occur suddenly. They include:

Numbness or weakness of the face, arm or leg, especially on one side of the body.

Confusion or trouble speaking or understanding speech.

Trouble seeing in one or both eyes.

Trouble walking, dizziness or loss of balance or coordination.

Severe headache with no known cause.

Schneider and his colleagues are trying to promote a pneumonic device, FAST, to help people recall stroke warning signs. FAST stands for: Facial weakness or numbness, Arm weakness or numbness, Speech difficulty, Time to call 911.

Only one warning symptom needs to be present to signal a possible stroke, Schneider said.

“Stroke is often painless,” he added. “So it doesn’t scare us as much. That throws off people in terms of recognizing the seriousness of it.”

Everyone should learn the symptoms of stroke because it’s often family, friends or co-workers who recognize a problem. The person having the stroke may be impaired by it to the extent that he or she doesn’t recognize what has happened.

The response to a stroke probably would improve further if more people understood they are at high risk, Schneider said. The 2000 survey showed 72% of people could name at least one stroke risk factor, a slight improvement over the 1995 figure of 68%.

The study also showed that people with the highest incidence of stroke -- those age 75 or older, blacks and men -- were the least knowledgeable about warnings signs and risk factors.

The major risk factors for stroke include hypertension, smoking, heart disease, diabetes, previous stroke or transient ischemic attack (or the so-called mini-stroke), heavy alcohol use and high cholesterol.

“The risk factors for stroke are the risk factors for heart disease,” Schneider said. “But 28% of people can’t name one risk factor. There is still a huge lack of knowledge.”