Beau Biden Hospitalized with mild stroke

Vice President Joe Biden’s son, Beau, was hospitalized today after suffering what was described as a “mild stroke.” The 41 year old, who is the Attorney General of Delaware, was initially hospitalized at Christiana Hospital in Newark, N.J., but transferred to Thomas Jefferson Hospital in Philadelphia today. According to the Associated Press, Dr. Timothy Gardner of Christiana Hospital says that Biden is “in good spirits and talking with his family at the hospital. He is fully alert, in stable condition and has full motor and speech skills.” Biden is expected to make a full recovery.

In an interview given to ABC News,  Dr. Aneesh Singhal, associate professor of neurology at Harvard Medical School reported that an “estimated 10 to 15 percent of strokes — most of them ischemic or due to blood clots, rather than hemorrhaging — occur in those under 45. ” (For a discussion of ischemic vs. hemorrhagic strokes see our story on Garrison Keillor.)

The good news for Biden is that strokes can be treated and “recovery rates in the young are much better than when you are older,” says  Dr. Singhal, “but up to half of all patients still have symptoms and a third are unable to return to work. The psychological impact, the social and emotional changes after a stroke are much bigger in the younger population. Risk factors for young adults include a personal and familial history of migraines, smoking and, in women, oral contraceptives, with women who have all three risk factors at a 16 times greater chance of having a stroke.”

Stroke in younger people can be related to cardiac and blood vessel abnormalities, substance abuse, birth control pills or autoimmune diseases such as lupus. Drugs, such as cocaine, ecstasy, amphetamines can cause arterial narrowing which can precipitate stroke. Arterial dissection — when arteries tear due to a minor trauma — as well as congenital heart disease can also be causes. Patients with sickle-cell disease also have a higher incidence of stroke.

Since stroke is caused by blockage or rupture of a blood vessel, it should be no surprise that similar risk factors contribute to both stroke and cardiovascular disease. These include hypertension, smoking, diabetes, high cholesterol, and lack of physical activity. It is possible to dramatically reduce these risks through healthier lifestyle choices or medications (such as blood pressure-lowering drugs).

Modifiable Risk Factors for Stroke

Risk factor How much it affects stroke risk Why it affects stroke risk What you can do
Hypertension  Hypertension causes a two-to four-fold increase in the risk of stroke before age 80. After age 80, the impact of hypertension declines and other risk factors become more important. Hypertension promotes atherosclerosis and causes mechanical damage to the walls of blood vessels. Blood pressure medications, such as thiazide diuretics and angiotensin-converting enzyme (aCe) inhibitors, can reduce the risk of stroke by 30 to 40 percent. Early treatment is essential. Among older people with normal blood pressure, prior mid-life hypertension increases stroke risk up to 92 percent. Guidelines from the Centers for Disease Control and Prevention recommend a target blood pressure of less than 140/90 mm Hg.
Cigarette smoking  Smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke. Smoking promotes atherosclerosis and aneurysm formation, and stimulates blood clotting factors. Stroke risk decreases significantly two years after quitting smoking and is at the level of nonsmokers by five years.
Diabetes  In terms of stroke and cardiovascular disease risk, having diabetes is the equivalent of aging 15 years. In diabetes, glucose is not efficiently taken up by the body’s cells and accumulates in the blood instead, where it can damage the vascular system. Hypertension is common among diabetics and accounts for much of their increased stroke risk. Blood pressure medications, dietary changes, and weight loss can lower stroke risk. Controlling blood sugar appears to reduce the risk of recurrent stroke.
Physical inactivity and obesity  Waist-to-hip ratio equal to or above the median (mid-value for the population) increases the risk of ischemic stroke three-fold. Obesity is associated with hypertension, diabetes, and heart disease. While no clinical studies have tested the effects of exercise or weight loss on stroke risk, both tend to reduce hypertension and boost cardiovascular health.
Atrial fibrillation (AF)  AF affects less than one percent of people under age 60, but is more prevalent in older people. It is responsible for one in four strokes after age 80, and is associated with high mortality and disability. AF refers to irregular contraction of the atrium – the chamber where blood enters the heart. AF can lead to blood stagnation and increased clotting. Warfarin, a blood-thinning medication, can reduce the risk of stroke in people with AF. People under age 60 with AF and no other stroke risk factors may benefit from aspirin. Importantly, pacemakers have no effect on the risk of stroke associated with AF.
Cholesterol imbalance  High-density lipoprotein (HDL) cholesterol is generally considered protective against ischemic stroke. Low-density lipoprotein (LDL) cholesterol, when present in excess, is considered harmful. LDL and HDL are needed to carry cholesterol (a fatty substance) through the blood (made up mostly of water), and deliver it to cells. Because LDL delivers cholesterol to cells throughout the body, excess LDL can cause cholesterol to build up in blood vessels, leading to atherosclerosis. HDL sends cholesterol to the liver to be eliminated. Clinical trials have shown that cholesterol-lowering drugs known as statins reduce the risk of stroke. However, some studies point to only a weak association between stroke and cholesterol, and there is speculation that statins reduce stroke risk by acting through some unknown mechanism

For more information:

Cerebrovascular Disease
Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.


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