University of Virginia Health System

 Study Shows Some Strokes May Be A Family Matter

< May 6, 2003 >Family history was found to be a significant risk factor for two common types of stroke, British researchers report in Stroke: Journal of the American Heart Association.

Researchers say cardiovascular events such as strokes or heart attacks is a significant risk factor for specific kinds of stroke in other members of the family, particularly among younger people.

"Only about half of all strokes can be explained by the traditional risk factors - high blood pressure, smoking, diabetes, cholesterol," says Dr. Paula Jerrard-Dunne, a clinical research fellow at St. George's Hospital Medical School in London and lead author of the study.

"Not all people have these risk factors, and it is hard to explain why some people with risk factors go on to develop a stroke while others do not," Dr. Jerrard-Dunne says. "This means that other factors, such as a genetic predisposition, may also be important."

Experts Say Take Caution and Live Well

"What this study says from a practical standpoint is that if you have a family member who has had a stroke under age 65, you should speak to your own physician about modifiable risk factors and try to be careful about them," says Dr. Larry B. Goldstein, a professor of medicine at Duke University School of Medicine and a spokesman for the American Heart Association.

A number of studies have hinted strongly at a genetic factor in stroke risk, Dr. Goldstein says. This one is valuable because of its careful focus on two specific types of ischemic stroke, which are the kind that happen when a clot blocks a blood vessel. A clot can block a large vessel, causing severe brain damage that can be fatal, or a small blood vessel, causing loss of mental function.

The researchers selected 1,000 people who had suffered ischemic strokes. Their average age was 65. They were given neurological examinations to distinguish between small-vessel and large-vessel stroke, and then they were compared with 800 stroke-free persons matched for age and sex.

The presence of risk factors such as smoking and diabetes, and family histories of heart attack and stroke, were also factored into the equation.

Study Shows Clear Connection

The large-vessel stroke patients were more than twice as likely to have an immediate family member who had suffered a stroke or heart attack at 65 or younger. For small-vessel stroke patients, the risk was slightly lower but still significant. This group was 1.93 times more likely to have the same kind of family history.

Those with large-vessel strokes were almost three times as likely to have a close relative who had suffered stroke at age 65 or younger or a family member who had a heart attack. Those with small-vessel stroke were more than three times as likely to have this family history.

Family history is much more important in young people, experts say, because in older people, the effects of blood pressure, smoking, poor diet, etc. have had a longer time to cause damage to the blood vessels.

For people who have strokes when they are relatively young, experts suspect that there might be an underlying genetic susceptibility which makes them much more sensitive to the effects of risk factors.

While the researchers looked just at stroke, Dr. Jerrard-Dunne says, "There is evidence from a number of studies to suggest that a family history of heart disease is an important risk factor for heart attacks."

Dr. Goldstein says the study is valuable because "it helps direct future research that can lead to a better understanding of the genetic basis for stroke."

Always consult your physician for more information.

Risk factors for stroke that can be changed, treated, or medically managed:

high blood pressure
The most important controllable risk factor for stroke is controlling high blood pressure.

heart disease
Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke.

cigarette smoking
The use of oral contraceptives, especially when combined with cigarette smoking, greatly increases stroke risk.

history of transient ischemic attacks (TIAs)
A person who has had one (or more) TIA is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.

elevated red blood cell count
A moderate increase in the number of red blood cells thickens the blood and makes clots more likely, thus increasing the risk for stroke.

elevated blood cholesterol and lipids
High blood cholesterol and lipids increase the risk for stroke.

lack of exercise, physical inactivity
Lack of exercise and physical inactivity increases the risk for stroke.

obesity
Excess weight increases the risk for stroke.

excessive alcohol use
More than two drinks per day raises blood pressure, and binge drinking can lead to stroke.

drug abuse (certain kinds)
Intravenous drug abuse carries a high risk of stroke from cerebral embolisms (blood clots). Cocaine use has been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them, even among first-time cocaine users, have been fatal.

What are the most common symptoms of stroke?

The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately. Symptoms may include:

• sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
  
  
• sudden confusion or difficulty speaking or understanding
  
  
• sudden problems with vision such as dimness or loss of vision in one or both eyes
  
  
• sudden dizziness or problems with balance or coordination
  
  
• sudden problems with movement or walking
  
  
• sudden, severe headaches with no other known cause

All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away - take action immediately. The symptoms of stroke may resemble other medical conditions or problems.

Always consult your physician for more information before starting an exercise program.

 Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Heart Association

American Stroke Association

Centers for Disease Control and Prevention (CDC)

International Association of Physicians in AIDS Care (IAPAC)

National Association of People With AIDS (NAPWA)

National Heart, Lung, and Blood Institute (NHLBI), part of NIH

National Institute of Allergy and Infectious Diseases (NIAID), part of NIH

National Institute of Neurological Disorders and Stroke (NINDS), part of NIH

National Institutes of Health (NIH)

US Food and Drug Administration (FDA)

For more information on cardiovascular disease and stroke, as well as HIV and AIDS, please visit health information modules on this Web site.

HIV/AIDS Treatment Gains an Important New Drug

Prospects for an AIDS cure loom far in the future, and an effective vaccine is still in early research.

AIDS (acquired immune deficiency syndrome) is caused by the human immunodeficiency virus (HIV), which kills or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers.

But there has been a breakthrough that offers new hope for patients: a newly approved drug called Fuzeon that can serve as an alternative therapy for those who have become immune to the most powerful medications.

"This is a huge advance for patients," says Dr. Robert L. Murphy, an AIDS expert and professor of infectious diseases at Northwestern University. "It's a very good drug. It will work no matter how resistant patients are to the other drugs."

The US Food and Drug Administration (FDA) approved Fuzeon - also known as enfuvirtide, or T-20 - after an extraordinarily quick review. It is manufactured by Hoffmann-La Roche Inc. and Trimeris Inc.

As many as 30 percent of patients who take AIDS drugs may benefit from Fuzeon because their current therapy is no longer effective, Murphy says.

Advances Give Hope to Those with HIV and AIDS

Thanks to powerful medications, AIDS has become a much more manageable health threat than it was just a decade ago, at least in Western countries where drugs are affordable and available.

In the US, the estimated annual number of AIDS-related deaths fell from more than 50,000 in 1995 to fewer than 9,000 in 2001, according to federal health statistics.

However, physicians fear the growing trend of resistance to those medications could drive the death toll higher once again.

"The current drugs are working quite well," says Dr. Warner C. Greene, director of the Gladstone Institute of Virology and Immunology at the University of California at San Francisco.

"Patients are going back to work, living longer, and the quality of their life is immensely improved. But we have to realize there's an increasing amount of drug resistance emerging."

Drug Resistance Poses New Challenges

The problem is that the AIDS virus, like many germs, can change its form to thwart the killing powers of drugs. Researchers suspect the process accelerates, at least in some cases, when patients forget to take their AIDS medications at specific times.

Drug resistance is a fact of life in the AIDS world, says Dr. Robert Grant, an investigator with the Gladstone Institute.

"There are people in the drug development field who say that if a compound doesn't produce drug resistance, it shouldn't be developed further. It means it's not really inhibiting HIV," Dr. Grant says.

Fuzeon Newest Hope

Fuzeon, which experts say is the first major advance in AIDS drug treatment since the mid-1990s, attacks HIV - the virus that causes AIDS - in an entirely new way. And that makes it a valuable alternative to the existing drugs whose power is diminishing, Dr. Murphy says.

Unlike all other AIDS drugs on the market, which try to disable the virus after it has attacked cells, Fuzeon prevents infection in the first place. That's why it's called an "entry-blocker" or "fusion inhibitor." It stops the virus from entering or fusing with cells.

"The real barrier is its production," says Michael Allerton, HIV policy operations director with the Kaiser Permanente Health Plan of Northern California. "It's extremely hard to produce, and that makes the quantity limited and the price extremely high."

Treatment with Fuzeon is estimated to cost about $20,000 a year, and patients will have to take it with other AIDS drugs.

And unlike other AIDS medications, Fuzeon does not come in pills. Patients must inject it.

Dr. Murphy says he does not expect drug resistance to pose a problem for patients who take Fuzeon, at least for a while, because manufacturers are developing similar medications to supplement it.

And while Fuzeon - like other AIDS drugs - can keep the HIV virus at bay, it cannot drive it from the body.

"We are doing much better than we were in terms of chronically controlling the infection, treating it more like diabetes instead of cancer," Dr. Greene says. "But I don't think we're close to a cure. This virus is too devious."

An AIDS vaccine, which would prevent people from getting the disease in the first place, also appears unlikely any time soon. However, experts say a vaccine is much closer than a cure, and several vaccines are in various stages of testing.

"To say it's five years off would be optimistic, even if everything goes well with the vaccines we're testing today," says Dr. Mark Feinberg, an AIDS vaccine researcher at Emory University in Atlanta.

Always consult your physician for more information