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From the Townsend Letter
November 2015

Anti-Aging Medicine
An Anti-Aging Perspective for Stroke Prevention
by Ronald Klatz, MD, DO, and Robert Goldman, MD, PhD, DO, FAASP
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The fifth leading cause of death in the US and a major cause of adult disability, stroke afflicts approximately 800,000 Americans annually. One American dies from a stroke every 4 minutes, on average.
A stroke or transient ischemic attack (TIA) by age 50 at least triples mortality risk over the subsequent decades. Frank-Erik de Leeuw and colleagues from the Radboud University Nijmegen Medical Centre (Netherlands) assessed long-term outcomes in the prospective Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, which included 959 consecutive patients, aged 18 through 50 years, admitted to a single academic medical center for a first-ever transient ischemic attack (262), ischemic stroke (606), or intracerebral hemorrhage (91) from 1980 through late 2010. In the first 30 days after the event, the fatality rate was 0.4% for TIA, 3.6% for ischemic stroke, and 22% for hemorrhagic stroke, or 4.5% overall. At 1 year, the cumulative mortality rate for 30-day survivors was 1.2% for TIA, 2.4% for ischemic stroke, and 2.9% for intracerebral hemorrhage. While the annual mortality risk after TIA didn't rise significantly, if any, over time, the cumulative mortality of these "mini-strokes" was substantial at 9.2% after 10 years and 24.9% after 20 years. Further, while the smaller number of hemorrhagic stroke patients who survived to 30 days resulted in a more variable annual mortality risk ranging from less than 1% to nearly 3%, their long-term cumulative risk was lower than in the first 30 days, at 10.3% after 10 years and 13.7% after 20 years. The mortality risk over the entire follow-up period compared with an age-, sex-, and year-matched cohort from the no-stroke general population in the Netherlands was consistently elevated after ischemic stroke (26.8% versus 7.6%), though only significantly higher after 10 years post TIA (24.9% versus 8.5%). The study authors warn: "Among adults aged 18 through 50 years, 20-year mortality following acute stroke was relatively high compared with expected mortality."
As well, a stroke can steal 8 years of brain power overnight. Deborah A. Levine and colleagues from the University of Michigan (US) analyzed data collected on 4908 black and white men and women, aged 65 years and older, who were enrolled in the Health and Retirement Study. The team assessed for changes in global cognition – before and after incident stroke. Data analysis revealed that having a stroke ages a person's brain function by almost 8 years, as reflected by slower memory and thinking speeds. The lead investigator urges: "These results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline."
With stroke's potential to gravely compromise quality of life, as well as shorten lifespan, prevention via risk reduction is key. This column reviews recent studies that suggest simple and natural approaches that may help you reduce your stroke risk.

Levine DA, Kabeto M, Langa KM, et al. Does stroke contribute to racial differences in cognitive decline? Stroke. May 21, 2015.
Rutten-Jacobs LC, Arntz RM, Maaijwee NA, et al. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013 Mar 20;309(11):1136–1144.
Stroke [Web page]. US Centers for Disease Control & Prevention. Accessed 28 July 2015.

Purpose in Life Reduces Stroke Risk  
A number of studies have suggested that having a purpose in life – the sense that life has meaning and direction – may reduce a number of adverse health effects. Lei Yu and colleagues from Rush University Medical Center (Illinois, US) studied autopsy results on 453 older adults, who participated in the Rush Memory and Aging Project. All of the participants underwent annual physical and psychological evaluations, including a standard assessment of purpose in life – where purpose in life was judged on a 5-point scale (higher scores indicated a greater purpose), with the average score at 3.5. Participants were followed until they died, at an average age of 90 years. At the study's start, 114 subjects were affected by stroke. At autopsy, 154 individuals had macroscopic infarctions (areas of stroke damage visible to the naked eye) and 128 had "microinfarcts" (areas of damage visible with a microscope). The team observed that for every 1-point increase in the score of purpose in life, the likelihood of having one or more macroscopic infarctions decreased by about 50%. The study authors write: "Purpose in life may affect risk for cerebral infarcts, specifically macroscopic lacunar infarcts.

Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA, Bennett DA. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke. 2015;46:1071–1076.

Protein May Prevent Stroke
People with diets higher in protein, especially from fish, may be less likely to have a stroke. Xinfeng Liu and colleagues from Nanjing University School of Medicine (China) completed a meta-analysis of 7 studies with a total of 254,489 participants who were followed for an average of 14 years. The data revealed that the participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, as compared with those with the lowest amount of protein in their diets. For every additional 20 grams per day of protein consumed, the risk of stroke decreased by 26%. The team advises, however, that the protein of choice be fish and red meat consumption should be limited, in accordance with other published studies associating it with increased stroke risk. The study authors conclude: "These findings suggest that moderate dietary protein intake may lower the risk of stroke."     

Zhang Z, Xu G, Yang F, Zhu W, Liu X. Quantitative analysis of dietary protein intake and stroke risk. Neurology. June 11, 2014.

Cut Stroke Risk with Fruits and Veggies
Fruits and vegetables are rich in key micro- and macronutrients that contribute to healthy blood vessels. Yan Qu and colleagues from Qingdao University (China) completed a meta-analysis of 20 studies published over the last 19 years to assess the effects of fruit and vegetable consumption on risk of stroke globally. The combined studies involved 760,629 men and women who had 16,981 strokes. The data revealed that stroke risk decreases by 32% with every 200 grams (7 oz) of fruit consumed each day and 11% with every 200 grams (7 oz) of vegetables consumed daily. The study authors conclude: "Fruits and vegetables consumption are inversely associated with the risk of stroke."

Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke. 2014 May 8.

Skip the Salt to Slash Stroke Risk
Dutch researchers report that up to 6% of the nation's strokes could be avoided if residents adhere to World Health Organization (WHO) guidelines of a maximum daily salt intake not to exceed 5 grams (equivalent to about 2000 mg of sodium). Marieke A. H. Hendriksen and colleagues from the Dutch National Institute for Public Health & Environment (Netherlands) observe that the average salt intake among Dutch adults is about 83.4 grams per day – markedly higher than the WHO guidelines. The team calculated that up to 6% of strokes and up to 5% of the nation's heart attacks could be avoided if residents complied with the guidelines. The study authors urge: "Substantial health benefits might be achieved when added salt is removed from processed foods and when consumers choose more for low-salt food alternatives."           

Hendriksen MAH, Hoogenveen RT, Hoekstra J, Geleijnse JM, Boshuizen HC, van Raaij JMA. Potential effect of salt reduction in processed foods on health. Am J Clin Nutr. December 11, 2013.

Exercise May Help with Prevention
Finally, keeping active may lower stroke risks. Australian researchers confirm the importance of regular physical activity for stroke prevention. Analyzing data collected in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study involving 30,239 Americans, aged 45 years and over, with follow-up every 6 months for stroke events, Michelle N. McDonnell and colleagues from the University of South Australia found that 33% of the subjects reported a lack of physical activity, which associated with a hazard ratio of 1.2. While there was no significant association between physical activity frequency and risk of stroke by sex groups, there was a trend toward increased risk for men reporting physical activity of 0 to 3 times a week, as compared with those who were active 4 or more-times a week. The study authors warn: "Self-reported low [physical activity] frequency is associated with increased risk of incident stroke."

McDonnell MN, Hillier SL, Hooker SP, Le A, Judd SE, Howard VJ. Physical activity frequency and risk of incident stroke in a national us study of blacks and whites. Stroke. 2013 Jul 18.

To stay updated on the latest breakthroughs in natural approaches that may help you to reduce your risks of stroke, visit the World Health Network (, the official educational website of the A4M and your one-stop resource for authoritative anti-aging information. Be sure to sign up for the free Longevity Magazine e-journal, your weekly health newsletter featuring wellness, prevention, and biotech advancements in longevity.

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