1. Today, October 29, is World Stroke Day. Why are cases increasing?
Dr Rafael Arroyo (RA): Stroke is a very common pathology and its incidence is related to very common cerebrovascular risk factors such as blood pressure, diabetes, tobacco and cholesterol. As you age, your risk increases exponentially. The increase in these risk factors and the increasing aging of the population perfectly explain the increase in stroke cases in our environment.
2. Apart from an aging population, sedentary lifestyles, poor diet, etc., how is Covid-19 affecting us? Did experiencing this affect you?
Dr Jaime González-Valcárcel (JG) Covid-19 patients are at a slightly increased risk of stroke, particularly those with severe infections requiring admission to ICU. In mild cases, the risk is very low, less than 1%. This small increase in risk occurs mainly during the acute phase, the first three weeks after infection.
3. There are rumors again that the COVID-19 vaccine and the flu vaccine may be responsible for the increase in stroke cases. In general, why don’t adverse reactions to vaccines increase stroke cases in older or younger adults?
JG: The AstraZeneca vaccine is associated with a very small risk of rare types of stroke, such as cerebral venous thrombosis, with the risk being less than 1 in 100,000 after the first dose and even lower after successive doses. The rest of the vaccines have nothing to do with brain or cardiovascular events, so from that perspective they shouldn’t worry us, and the same goes for the current COVID-19 vaccines or the flu vaccines, so when faced with clear indications, people have to be patient without a vaccine In case of fear of vaccination.
4. If an older person asked you this question, how would you answer to encourage them to get vaccinated?
RA: The vaccine is intended for high-risk patients to prevent severe symptoms caused by COVID-19, and it is safe from a cerebrovascular perspective, so I would encourage them to follow the current recommendations and get vaccinated.
5. By what percentage does influenza increase the risk of stroke? What about COVID-19?
JG: While the relationship between influenza and stroke risk has been discussed, a recent study showed that influenza vaccination reduces the risk of stroke by 22% to 25%, with this reduction being more significant in high-risk patients. With COVID-19, the risk of stroke is also very low, depending on the severity of the infection. Mild cases are less than 1%, while severe cases can increase to 2-3% when admitted to ICU.
6. A clinical research unit was established at Ruber Juan Bravo University Hospital. One of the trials is preventing relapse. How many participants do you have? The purpose of the paper?
RA: Although advances in treatments in recent decades have allowed us to do a good job of protecting our patients, we always want to do better and minimize the risk of stroke. In this context, we are participating in several international clinical trials in which high-risk patients are included in advanced stroke care centers in Spain and around the world, in order to find new preventive stroke treatments.
7. How many people have strokes, and how many have recurrences?
RA: The annual incidence of stroke in Spain is between 100,000 and 120,000 new cases, and the risk of recurrence five years after the first attack is estimated at 30%.
8. Stroke cases will surge by 35% in 2035. What symptoms should we pay attention to and what should we do?
JG: It is important to recognize the symptoms of stroke and immediately go to a center with a stroke unit to receive appropriate treatment. If you suddenly experience difficulty speaking, loss of vision, strength, or sensitivity on one side of your body, you should suspect a stroke and call emergency services.
9. Do all patients need rehabilitation after a stroke? Under what circumstances is this okay and for how long?
RA: Rehabilitation after stroke is very important, especially for patients with sequelae after the acute phase. These consequences may be due to loss of strength, balance problems, speech or eating disorders. All of these sequelae benefit from rehabilitation. Its duration will depend on the patient’s severity and clinical progression, and in some cases they may benefit from this type of treatment for 6 to 12 months after stroke.
10. Stroke is the leading cause of hospitalization in our country. How many stroke victims die? How many were left with serious consequences? For example, how many people recover 100% and are able to drive again?
JG: Stroke is the leading cause of death in women and the second leading cause in our environment. Stroke mortality ranges from 7% to 15%, depending on the type and severity of stroke. Thanks to advances in acute management, more and more stroke patients are recovering well after stroke. However, stroke remains a leading cause of adult disability, as approximately 30% of patients with severe stroke may be left with severe sequelae.