Every year, nearly 149,000 Americans die from stroke, the third leading cause of death. But there is good news: The mortality rate has been dropping sharply, and researchers may be on the brink of a revolution in prevention and therapy.
Every year, nearly 149,000 Americans die from stroke. But there is good news: The mortality rate has been dropping sharply, and researchers may be on the brink of a revolution in prevention and therapy.
he old man sits alone in his wheelchair, watching his beloved Kansas City Royals struggle through another televised spring training game, or simply staring out the window at the squirrels emerging from their winter doldrums.
At 77 years of age, he is an enigma. His right side is paralyzed and virtually useless. His speech is limited to yeses and noes that often don't seem to make sense. But his eyes burn with a pride that reflects the intelligence that was once there--and may still be.
What is he thinking about in his mental prison? Does he relive the AAU basketball games he played as a young man or the years he worked on the Union Pacific Railroad during World War II? Is he once more whiling away the early-morning hours in his vegetable garden, or is he remembering the spring days he spent fishing for crappie in nearby Pony Express Lake? Or are his thoughts a jumble of confusion and fear, sadness and regret? We don't know. Perhaps science will never know the answer to such questions. That is what makes stroke--a sudden interruption of blood flow that causes brain cells to die--so devastating to its victims and their families.
My father had a stroke on July 17, 1985. At 5:30 in the morning, he arose, exhaled sharply and collapsed to the floor. In the briefest of seconds, a black wall descended across his mind, muting his communication with the outside world, severing control of the right side of his body, and irrevocably changing the lives of his family.
His--our--experience is not uncommon. Every year, about a half-million Americans have a stroke and nearly 149,000 die from it, making stroke the third leading cause of death behind heart disease and cancer.
In 1987, the most recent year for which figures are available, there were more than 2 million stroke survivors alive, according to the American Heart Assn. In 1989, the cost of caring for these survivors was an estimated $11.2 billion, plus another $2.3 billion for lost productivity.
But there is good news mixed in with these grim statistics. According to the AHA, the death rate for stroke has been dropping sharply. In the 1940s and 1950s, U.S. stroke mortality declined at a rate of about 1% a year. Since 1973, however, the death rate has dropped by an average of 5.5% a year.
In 1950, 89 of every 100,000 people in the United States died from stroke. By 1987, according to the AHA, the rate had shrunk to 30 per 100,000. These decreases are generally attributed to efforts to lower the risk factors for stroke and to modest improvements in therapy for individuals who have suffered a stroke.
More important, researchers may be on the brink of a revolution in approaches to stroke prevention and therapy. At present, there is little that can be done on a routine basis for stroke victims. "We can put you in bed and tuck you in but, in truth, we don't have any effective therapy," says Dr. Roger Simon, a neurologist at UC San Francisco Medical Center. "But very shortly, we probably will."
In the past two years, neurologists have begun conducting clinical trials with a number of new drugs and therapies that can reduce the risk of having a stroke, minimize the damage to brain cells during a stroke and--if given early enough--reverse the conditions that produced it in the first place, such as by dissolving the blood clots that impede the flow of life-giving blood to the brain.
These techniques will be of no use to people such as my father, for whom it is too late. Rather, they are meant to be used before a stroke occurs or within one to eight hours after a stroke--a period researchers are coming to call the "window of opportunity" because of the possibility of intervention.
"We're working with things that weren't even conceived of as recently as 1984," says Simon. "There's an enormous amount of excitement." Echos Dr. Michael A. Sloan, a neurologist at the University of Maryland Medical Center in Baltimore: "This is a promising time, a very exciting time to be in clinical stroke work. We can't say which of the new drugs will work out best, but the therapeutic knowledge of the past is dead."
Strokes occur when a blood vessel bringing oxygen and nutrients to the brain either becomes clogged by a blood clot or bursts open. In either case, the area of the brain served by the blood vessel no longer receives the flow of blood it needs. Deprived of oxygen, the brain cells in the area die.