Preventing stroke: Yes to folic acid; no to heavy drinking
CNN Medical Unit
DALLAS, Texas (CNN) -- For the first time, researchers find that diets high in folic acid can prevent a disabling stroke -- but consuming two alcoholic drinks a day can increase more than tenfold the chances of having a devastating type of stroke that mainly affects younger adults.
Although stroke is the third leading killer in the United States, behind heart disease and cancer, only 1 percent of people surveyed are worried about it.
The survey conducted by the American Stroke Association also found only 15 percent of people can identify the most important thing they can do to prevent a stroke, which is to stop smoking.
In addition to not smoking, reducing your chances of a stroke may be as simple as eating a bowl of fortified cereal every day.
People who ate at least 300 micrograms (mcg) of folate per day had a 20 percent lower chance of stroke than those who consumed half that amount, according to a 20-year study. The study also found high folate diets reduced the chances of cardiovascular disease by 13 percent.
"It seems to me we have pretty good data now to support 300 to 400 microgram dose of folic acid for everyone," said Dr. Scott Kasner who wrote an editorial to the study and is in the department of neurology at the Comprehensive Stroke Center, University of Pennsylvania Medical Center. "We're pretty much getting it now since fortification is mandated now as long as you're getting enough grains and pastas."
Because of the evidence that folic acid consumption during pregnancy reduces the risk of neural tube defects in the fetus, the U.S. Food and Drug Administration mandated the addition of folic acid in flour, rice, pasta, cornmeal and related products in 1998. The mechanism by which folate reduces neural tube defects and how it reduces stroke and heart disease is different.
"The question we still don't have answered is in people who've already had a stroke or heart attack, is if they need to take more folic acid, like 500 micrograms, to prevent a second incident," said Kasner.
Another way to reduce the burden of stroke is to get heavy drinkers to cut down, according to a second study in the journal Stroke.
Heavy alcohol use, defined as two drinks or more a day, appears to increase a type of bleeding stroke that accounts for about one in 10 strokes.
This type of stroke, called a subarachnoid hemorrhage (SAH), is highest among 20- to 50-year-olds and is most prevalent in women. A SAH is also deadly -- about 40 percent of victims die within a month of the stroke.
Dr. Brett Kissela, who led the study, said the biggest risk factor for an SAH is smoking, followed by high blood pressure and then heavy drinking.
"People should avoid heavy alcohol use," said Kissela, who is in the department of neurology at the University of Cincinnati.
Kissela also found heredity plays an important role in who suffers an SAH.
"If you have a family member who's had a SAH, that means you're at increased risk and should avoid smoking, heavy drinking and high blood pressure," Kissela said.
Kissela said some data suggest one drink a day may actually reduce the risk of stroke, although no one knows why.
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