Basic cause of strokes
The interesting feature about 28-year-old Ryan Armaoui’s stroke and his valiant efforts to recover his speech (Sunday, May 26), would have been more instructive to readers if the stroke causation details had also been explained.
Strokes are caused by either blockage or rupture of a blood vessel within the brain. Vessel rupture (usually due to very high blood pressure) producing a significant haemorrhage within the brain is usually fatal.
Most strokes are caused by blood clots blocking a brain vessel and are not fatal but, on the size of the blood clot and the size of vessel blocked will depend the extent of the resulting disability.
With very early diagnosis and swift referral to hospital, interventional radiologists may now successfully remove the bigger clots and achieve a complete recovery from the stroke disability. Tiny clots may produce a visual, speech or limb movement impairment for only a few minutes – these are called transient ischaemic attacks (TIAs) in medical jargon. It is crucial that these brief episodes are correctly diagnosed for what they are (transient slight strokes due to tiny blood clots in brain or eye vessels) because they may be a warning of a much bigger stroke to follow.
Blood clots are the fundamental cause of most cardiovascular disease (heart attacks and strokes), which remains the commonest cause of morbidity and mortality. Most blood clots form where the normally very smooth and slippery inner lining of blood vessels (like the non-stick lining of frying pans) has been damaged.
Diabetes and smoking are major causes of this damage to blood vessels, but it is now realised that depression and mental disease, including chronic stress, anxiety and anger, together with uncontrolled high blood pressure and a poor diet lacking vitamin C, folic acid and magnesium, may also be responsible for this subtle blood vessel damage. Some inflammatory (such as autoimmune) diseases and infective organisms may also cause it.
Living in poverty is another reason for chronic stress and anxiety leading to blood vessel damage and clots – UK statistics show people in impoverished regions in northern England may live almost 20 years less than people in the rich south. Italy reveals a similar pattern of higher longevity in the richer north.
Clots may form because of increased density and coagulability of the blood without the requirement of blood vessel wall damage. This may result as a side effect of some pharmaceutical drugs or because of an inherited clotting defect. The anti-inflammatory painkiller aspirin thins the blood (that’s why it’s used to prevent clots), but some other more powerful anti-inflammatory drugs and painkillers may increase the tendency for blood clotting (long-term use of corticosteroids is one example).
Perhaps the two most important inherited increased blood clotting defects are Hughes (antiphospholipid) syndrome and high blood lipoprotein [Lp(a)]. These are not looked for in routine blood tests and may therefore be missed. They should be suspected if there a family history of stroke or heart attacks at a relatively young age.
The prevalence of Hughes syndrome is uncertain – UK statistics quote somewhere between 1 in 1000 to 1 in 500 of the population, and 1 in 5 of populations are thought to have an inherited high Lp(a), so they are not rare. A high Lp(a) cannot be lowered with statins (cholesterol-lowering drugs), and both conditions would need a blood-thinning (anti-clotting) medication.
Regarding strokes at such a young age, as with Armaoui, there have been rare cases reported in northern European countries following a big alcoholic binge – the large amount of alcohol thins the blood and, when the blood alcohol level falls, there is reactive increase in blood coagulability which might form blood clots. Armaoui is likely to have a permanent blood clotting problem needing treatment for life.
How come “cholesterol” hasn’t been included in this discussion? The “high fat diet-high blood cholesterol-high cardiovascular disease risk” theory has been the conventional medical wisdom for several decades and is backed by a trillion-dollar industry of pharmaceutical drugs and laboratory cholesterol tests. Opposing it risks, at best, ridicule and, at worst, a big spanner in one’s medical career.
In spite of those risks, several research trials have shown that low density lipoprotein (LDL) cholesterol (“bad cholesterol” and the darling of the statin pharmaceutical industry) has nothing to do with cardiovascular disease and, more importantly, the reverse is true – the more LDL is lowered, the more cardiovascular disease risk and less lifespan is to be expected. Furthermore, all the chemical studies of blood vessel narrowings (atheromatous plaques) have not found any LDL (as the conventional wisdom claim) within them but only the residues of blood clots.
It therefore appears that the basic cause of strokes and heart attacks is a blood clotting and not a blood cholesterol problem. The prevention and treatment should therefore be to safely thin the blood.
What irritates the “cholesterolstatin” bandwagon even further is the fact that at least two natural food supplements (which cannot be patented), fish oil (omega-3) and nattokinase (a Japanese fermented soya blood clotdissolving product) are not only effective but safer blood thinners than pharmaceutical ones.
The “cholesterol con”, as it has been described, requires a future more detailed feature. More people now expect to understand and have a say in the management of their medical conditions and therefore have a right to have a peep into the greatest controversy of modern medicine.
“Living in poverty is another reason for chronic stress leading to blood vessel damage and clots
Albert Cilia-Vincenti is a former scientific delegate to the European Medicines Agency, a London University medical school tenured teacher, a HM Coroner’s Pathologist in Central London and Central Hampshire, and deputy dean Malta Medical School.