March 25, 2014

Ask the Doctors

I am 50 years old and heard that the calcium in my arteries can be measured to predict my risk of a stroke. I am concerned because of my family history; my father experienced a stroke. Could you advise whether I should have a CT scan of my heart?

A recent article in the journal Stroke* reported that persons with high calcium density in their coronary arteries were more at risk for stroke than those whose coronary artery calcium (CAC) densities were less. The score

of above 400 gave a threefold risk of stroke, while a CAC score less than
100 was mild to moderate. When over 100, a visit to a cardiologist was recommended.

Calcium in the arteries signifies that atherosclerosis is present. Often people have risk factors for stroke already: hypertension, atrial fibrillation, diabetes, or circulatory problems. In that situation, knowing your CAC score would not change much. This means that routine screening for calcium in coronary blood vessels would not be a useful deployment of resources for many people.

If you are worried about a stroke, you need to monitor certain of your habits. A smoker, for instance, should quit smoking. This probably is the single most important thing a person can do to reduce risk. Secondhand smoke should be avoided too, because such fumes are toxic.

Monitor your blood pressure. You should see your doctor and then purchase a home blood pressure monitor. Check your pressure twice a week. Even a mild elevation of blood pressure may indicate a tendency to spikes and the development of hypertension. Your blood glucose levels should be monitored, and a hemoglobin A1C is an excellent test to see whether control has been satisfactory over a period of time.

Irregular heartbeats can have many causes—some inconsequential, but others more important. Your doctor can readily determine whether you have a significant arrhythmia and start you on appropriate therapy.

Preventive strategies are simple and effective. Utilize your doctor’s services to guide you in what might be specific for you. In general, though, we suggest the following:

  • Avoid tobacco and alcohol.
  • Reduce your salt intake.
  • Control your weight.

Exercise is probably the best-known and yet least-utilized preventive strategy. As noted by Ellen White more than a century ago, walking is one of the most beneficial of exercises. We always recommend that you check with your physician before embarking on an exercise program; nevertheless, there are few people who cannot benefit from a graduated program of walking. Begin with a pace you can accommodate easily and for an amount of time that is not overly stressful. The idea is to achieve a goal of walking at least four to five days per week. The eventual goal should be to walk briskly, which is usually about 3.5 to 4.5 miles per hour. One should attempt to walk at a pace that induces a light sweat.

Posture while walking is important. Look straight ahead at the horizon, and keep the lower jaw parallel to the ground and the neck long. Avoid bending forward or leaning backward, and use the muscles of the abdomen and buttocks to aid in balance. The heel should engage the ground first, and then roll through the foot in a smooth action so as to take off with a push from the toes. We also recommend the use of a pedometer.

The well-balanced vegetarian diet of your choice will also provide benefit and protection against stroke.

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.

* Dirk M. Hermann et al., “Coronary Artery Calcification Is an Independent Stroke Predictor in the General Population,” Stroke 44 (2013): 1008-1013.