Stroke Risk Factors - Are You at Risk?
- Danielle
- Jun 18, 2019
- 6 min read
Updated: Jun 28, 2019
My first experience with stroke was about ten years ago. I vividly remember walking into the Emergency Department and seeing my grandpa on a hospital bed unable to form a sentence. It was terrifying. As a clinical pharmacist I routinely come across people who have suffered from a stroke, and every time it is devastating. These experiences make me passionate about stroke prevention and I am fortunate that in my position I am able to help patients understand the importance of stroke prevention. We will further explore stroke risk factors by looking at the ecological model and its various levels.
Ecological Model
“A multilevel approach to population health is predicated on the understanding that exposures at many levels of organization work together to produce health outcomes” (Galea, 2015). Such an approach forces us to look at the many factors in play that influence health behaviours that can lead to illness and can give insight into why diseases may be more prevalent in specific populations (Galea, 2015). This analysis allows a thorough understanding of a health issue, which in turn allows programs and prevention strategies to be put in place to help improve the health within the population. It is important to note that the more factors you can target within a health program or strategy and the more health determinants that are included in a health program, the more likely it is to be a success (Rural Health Information Hub, 2019).
The ecological model can be defined as “the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people’s interactions with their physical and sociocultural environments” (Rural Health Information Hub, 2019). This model can be broken down into several factors that influence health, with five main factors being:
1. Interpersonal/Individual
2. Intrapersonal
3. Institutional and Organizational
4. Community
5. Public Policy
Taken together, these factors can help explain health behaviours of both an individual and ultimately a population in regards to particular health issues. When we understand all of the dimensions that influence a health behaviour we can better develop programs and initiatives to help improve health of individuals. The video below further explains the ecological model.
Individual Factors
There are several individual factors that affect the risk of stroke in an individual, these are either modifiable or non-modifiable. Modifiable risk factors include diet, physical activity, smoking/tobacco and alcohol, all of which can be controlled by an individual and directly affect their risk of stroke. The cornerstone of these factors is that the individual must have knowledge of these factors, as well as the correct attitude in order to be able to reduce their risk of stroke. Initiating healthy eating and introducing physical activity are steps that individuals can take to reduce their risk of stroke (National Stroke Association, 2019). The risk of stroke is tripled for people who smoke and/or use tobacco, therefore it is crucial for individuals to work towards becoming a non-smoker. Similarly the use of alcohol increases the risk of stroke as it can lead to hypertension, therefore alcohol should be limited. Additionally, stress is another modifiable risk factor that can increase stroke risk in an individual therefore it is important for individuals to learn how to identify and properly manage stress (Heart and Stroke Foundation of Canada, 2018). Identifying risk factors that are more detrimental to an individual’s stroke risk can be a good way to improve overall outcomes (Heart and Stroke Foundation of Canada, 2018).
Building off of these modifiable risk factors, hypertension, hyperlipidemia, atrial fibrillation and diabetes all lead to increased risk of stroke, with hypertension being the factor that has the most impact on stroke. Some of these factors have a genetic component to them and are considered modifiable, however the heredity factor of stroke is unfortunately non-modifiable (Boehme, Esenwa, Elkind, 2017). Looking into the non-modifiable individual factors that affect stroke risk include increasing age, being male (in older age) and being African American, Hispanic/Latino American or American Indian (Boehme, Esenwa, Elkind, 2017). This video and the image below further illustrate individual risk factors for stroke.
Interpersonal Factors
Applying the information from individual factors, we can see that family, friends and peers have the potential to impact how individual attitudes, beliefs and knowledge are shaped. If an individual grew up in a household where healthy eating habits were instilled in them, they are less likely to develop many diseases, including diabetes, hypertension and hyperlipidemia. It has been shown that “by eating well at age 15, young people developed the habit of good nutrition, and it carried on into their 20s and beyond” (Glazier& Ko, 2017). Likewise, it has been found that if children participate in a high amount of physical activity from age 9 through 18 that they would be likely to continue this into adulthood. Both of these instances illustrate that the foundation of eating habits and exercise begin to form when we are young, and show that the health of the population truly begins to form in childhood (Telama et al, 2005).
Institutional and Organizational Factors
In British Columbia the Healthy Families BC Policy Framework exists and one of the focus points surrounds chronic disease prevention. It is alarming to know that “up to 80% of heart disease, stroke and type 2 diabetes, and over 30% of cancers, can be prevented by eliminating tobacco, unhealthy diet, physical inactivity and the harmful use of alcohol” (Ministry of Health, 2014). One of the main focus points is to improve healthy eating amongst British Columbians and specific targets have been set to monitor this progress; for example, increasing “the proportion of British Columbians (age 12+) who consume at least 5 servings of fruit and vegetables per day: 44% (2009/10) to 55% (2023)” (Ministry of Health, 2014). Similar benchmark goals have been set for physical activity, tobacco control, healthy early childhood development and alcohol use. The Heart and Stroke Foundation of Canada is currently involved in a wellness program called Activate which aims to help prevent hypertension in individuals who have risk factors for developing this disease. This revolutionary program aims to decrease the number of people that may suffer from stroke by targeting hypertension and it will be interesting to see the results from phase two of this prevention strategy program.
Community Factors
Looking at community factors, we see how a community can impact one’s risk for stroke. Something as simple as living in the suburbs puts you at an increased risk for obesity, as you are more likely to use a car instead of walking and obesity can subsequently put you at an increased risk for stroke. Additionally the presence of sidewalks increases the chance of individuals walking and thus improving their physical activity, therefore the design of a community can impact the health of a community (Lear, 2018). Furthermore, if the design of the community has retail mixed with residential there is an increase in the amount of walking, the presence of green space increases well-being and promotes physical activity, and the more healthy food-outlets there are the better the health of the community. It has been found that such factors tend to exist in more affluent communities, therefore this adds another element to risk of stroke (Lear, 2018). All of these aforementioned factors decrease the risk of obesity and diabetes, and therefore may decrease the risk of stroke.
Public Policy Factors
There are several public policies that can have an effect on reducing risk of stroke. The Tobacco and Vapour Products Control Act and Regulation was established by the Ministry of Health of BC and health authorities in British Columbia implement the parameters within the Act and Regulations. The image below is of a sign that is commonly seen throughout the Vancouver, BC area in order to help reduce exposure to second hand smoke.
Taxes on tobacco exist through the Tobacco Tax Act which is regulated by the Ministry of Finance of BC. This taxation policy has been shown to be an effective strategy in decreasing the levels of tobacco use (BC Government, 2019). In legislation enacted by the federal government of Canada, partially hydrogenated oils (PHOs) were forbidden to be used in foods in 2018. Additionally, there are regulations in BC to reduce the amount of trans fat products in vending machines and food and beverage sales in schools (BC Government, 2019). Taken together, all of these policies work towards establishing a healthier population and also have the effect of decreasing stroke risk through affecting modifiable risk factors.
Conclusion
As can be seen there are several different factors that affect the risk of stroke in both individuals and a population. It is important to examine all levels of these factors in order to implement successful programs and achieve better health. Using the ecological model allows many different facets to be examined and ultimately exposes the many contributing factors to stroke.
References
American Heart Association News. (2019 March). Environment, culture, social determinants play big role in heart health. Retrieved from: https://www.heart.org/en/news/2019/03/21/environment-culture-other-social-determinants-play-big-role-in-heart-health
BC Government. (2019). Healthy eating trans fat. Retrieved from: https://www2.gov.bc.ca/gov/content/health/managing-your-health/healthy-eating/trans-fat
BC Government. (2019). Tobacco and vapour products. Retrieved from: https://www2.gov.bc.ca/gov/content/health/keeping-bc-healthy-safe/tobacco-vapour/legislation
Boehme, A, Esenwa, C, Elkind, M. (2017 Feb 3). 120(3): 472-495. Stroke risk factors, genetics, and prevention. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321635/
Heart and Stroke Foundation of Canada. (2018). Lifestyle risk factors. Retrieved from: https://www.heartandstroke.ca/heart/risk-and-prevention/lifestyle-risk-factors
Glazier, E, Ko, E (2017 Jan 24). Eating habits now will affect how kids eat as adults. Retrieved from: https://oklahoman.com/article/5535051/eating-habits-now-will-affect-how-kids-eat-as-adults
Lear, S. (2018 Jan). How your community impacts the health of your heart. Retrieved from: https://theconversation.com/how-your-community-impacts-the-health-of-your-heart-90529
National Stroke Association. (2019) Lifestyle factors. Retrieved from: https://www.stroke.org/understand-stroke/preventing-a-stroke/lifestyle-risk-factors/
Telama R, Yang X, Viikari J, Valimaki I, Wanne O, Raitakari O. (2005 Apr). Physical activity from childhood to adulthood: a 21-year tracking study. 28(3): 267-73. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/15766614
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