Too Many Stroke Patients are Missing an Important Medication


The May 27th online issue of Stroke: Journal of the American Heart Association reported that more than 16% of stroke patients are being discharged without a potentially life-saving medication.  These medications are called statins and they are generally used to reduce levels of the artery clogging cholesterol, LDL.  Common names for the statins are Lipitor, Zocor, and Crestor.

Dr. Bruce Ovbiagle, associate professor of neurology and director at the UCLA Stroke Prevention Program, UCLA Stroke Center and Department of Neurology stated that about one in ten stroke patients experience a second stroke within a week.  If statin therapy is started immediately at the hospital, a second stroke could possibly be prevented.

The good news is that there has been an increase in the number of patients being given prescriptions for the statin medicines between 2005 and 2007.  There has been an increase from 76% to nearly 85% of patients receiving statins.

There did seem to be a disparity in the type of patient and geographic location of the patient receiving the statin prescriptions.  Women had a 13% lower rate of receiving the medication than men and hospitals in the South were 34% less likely to discharge a patient on a statin than hospitals in the West.

If you or someone you know has suffered a stroke, check your medication list and be sure that a statin (Lipitor, Zocor, Crestor, or one of the others) is on the list.  If not, discuss it with your healthcare provider!  There are certain medical conditions that would prevent a person from taking a statin medication.

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Women Unaware of the Warning Signs of a Stroke


On average in this country it takes a woman 45 minutes longer to seek care for a heart attack or stroke. A new online survey may help explain why…

 Only one in four women aged 25 to 75 could name at least 2 symptoms of a stroke.

Women surveyed weren’t aware that women suffer more strokes than men.

One-quarter of the women surveyed were unaware that stroke could happen at any age.

Black and Hispanic women knew fewer facts about stroke than white women.

The main symptoms of a stroke are:

  • Sudden difficulty speaking, understanding speech, or confusion
  • Sudden numbness or weakness in the limbs, particularly on one side
  • Sudden facial drooping or numbness and weakness on one side of the face
  • Sudden balance problems, dizziness or trouble walking
  • Sudden difficulty seeing with one or both eyes
  • Sudden severe headache (the worst headache you’ve ever had in your life)

When someone has a stroke they may only experience one or two of these symptoms or may experience several symptoms depending on the location of the brain being affected.  A stroke is also called a “Brain Attack” so just like a heart attack you need to get to the hospital as quickly as possible in order to prevent permanent damage. If you or someone you know is experiencing any of the above symptoms call 911 and get to the hospital as quickly as possible!

Uncontrolled high blood pressure is one of the leading causes of stroke. Remember high blood pressure is called the silent killer because most people do not have any symptoms when their blood pressure is elevated. The only way to know for sure that your blood pressure is elevated is to get it checked on a regular basis.  Just because you are taking blood pressure medications does not mean your blood pressure is controlled. Goal blood pressure numbers for men and women are less than 120/80. If you do not know your blood pressure – what are you waiting for get it checked today.

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This online-only survey included 2,000 women in the United States, and was undertaken on behalf of HealthyWomen in conjunction with the American College of Emergency Physicians and National Stroke Association.

Carotid Artery Stenting vs Carotid Artery Surgery: Is there a Difference?


If you have a carotid stenosis you could be at an increased risk for a stroke. Carotid artery surgery (carotid endarterectomy) has been the treatment of choice for many years.  Carotid artery stenting is a less invasive option.  But for many years a controversy has existed – which is the better treatment? Carotid Endarterectomy or Carotid Stenting???

The CREST (Carotid Revascularization Endarterectomy Vs Stenting Trial) was devised specifically to answer this question and the results were presented recently at the 2010 International Stroke Conference.  Over 2,500 patients were enrolled in this trial from 117 US and Canadian sites.  So what did the study show???

There was no significant difference in the risk of stroke, heart attack or death during the procedure and no difference in stroke during the 2.5 year follow-up period.

People over 69 years of age had better outcomes with surgery and people younger than 69 had better outcomes with stenting.

There was no difference in outcomes among men and women or symptomatic and asymptomatic patients.

Dr Wesley Moore who was a co-principal investigator in this study stated that stroke rates were lower with carotid surgery but when heart attacks were added to the adverse outcomes the results of the two procedures became similar.

What must be remembered is that only the most experienced physicians and hospitals were included in this study.  So in order to receive the same benefits and low rate of adverse outcomes with either procedure you need to make sure you undergo a procedure at a hospital with a physician who is well experienced.

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50-year-old cholesterol medication makes a comeback?


 A recent cholesterol trial called ARBITER 6-HALTS was discussed at the American Heart Association national meeting and published in the New England Journal of Medicine last month. Three hundred and sixty three men and women with known heart disease or vascular disease were enrolled in this study. All of the patients LDL (bad) cholesterol levels were < 100 mg/dl (goal LDL in this high risk group is < 70) so the LDL was good but could be better. Their HDL (good) cholesterol levels were acceptable but a little low (< 50 mg/dl). When HDL levels are low patients are not receiving adequate protection against heart disease and stroke. Half of the patients received treatment with ezetimibe (Zetia) in addition to a statin treatment to further lower LDL levels. The remaining patients received extended-release niacin in addition to a statin to improve HDL levels. So this study set out to see which treatment would be more beneficial – further lowering of LDL (bad) cholesterol or raising HDL (good) cholesterol in a high-risk group of patients.

After 14 months of treatment cholesterol results improved in both patients receiving ezetimibe and patients receiving niacin. The interesting finding was the niacin patients had a reversal of plaque inside the blood vessels in the neck; this was measured by a test called carotid IMT. The patients in the ezetimibe (Zetia) group surprisingly did not experience the same benefit. This was a small study but clearly suggests that niacin, which is a 50-year-old medication, may be more beneficial than some of the newer medications like ezetimibe. Remember all of these patients were also receiving a statin medication for cholesterol management. Unfortunately many patients are unable to tolerate high doses of niacin due to the side effects. Niacin is an inexpensive medication and available over the counter but we recommend you talk with your health care provider before starting niacin treatment.

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Free Video on Blood Thinner Pills from AHRQ


People often worry about how routine medicines like blood thinner pills will affect their lifestyles. With a few simple steps, taking a blood thinner can be safe and easy. In fact, more than 2 million people take blood thinners every day to keep them from developing dangerous blood clots. Staying Active and Healthy with Blood Thinners is a 10-minute video offered by the Agency for Healthcare Research and Quality that shows how small changes in daily routines can help people take blood thinners safely.

 What is a blood thinner? What does it do? Why it is helpful? These questions are answered in this video, which features easy-to-understand explanations of how blood thinners work and why it’s important to take them correctly. It also introduces BEST, an easy way to remember how to fit blood thinner medication into daily life.

Be Careful
Eat Right
Stick to a Routine
Test Regularly

 The Agency for Healthcare Research and Quality offers a free booklet and a video about blood thinner medicines. Staying Active and Healthy with Blood Thinners, a 10-minute video, features easy-to-understand explanations of how blood thinners work and why it’s important to take them correctly. Blood Thinner Pills: Your Guide to Using Them Safely, a 24-page booklet, explains how these pills can help prevent dangerous blood clots from forming and what to expect when taking these medicines.

 How to Order a Copy of the Video

Copies of this video on DVD can be ordered from the AHRQ Publication Clearinghouse by calling 800-358-9295 or sending an E-mail to
Ask for AHRQ Publication Number 09-0086-DVD.