Flying and strokes
Last week a friend of ours went to Europe for a meeting, which meant he flew out Monday night, had a meeting Tuesday, and was to return on Tuesday night or Wednesday. On Thursday we tried calling him and got an obviously-European ring. When this happened on Friday we sent him a text message asking where he was. He responded that he was in a hospital in Vienna recovering from a stroke.
When we spoke to him later he said that A) he had apparently completely recovered physically, and B) that many European business acquaintances of an age had told him that before they get on a plane they always take blood thinners to prevent strokes while flying, and C) the doctors had told him not to fly for a while, so that he planned to come back by boat.
We had never heard about this, and even though we are much younger than our friend – at least six months younger in the case of the oldest of the editors – it seemed like a good idea to check this out. We certainly know that people who sit on airplanes in one position for too long are at increased risk of developing blood clots (deep vein thrombosis, or DVT). This is why airlines on long flights show videos on exercising in your seat and getting up and walking around – videos which most passengers ignore, as best as we can see. If a clot is going to break loose because of reduced activity (and possibly other factors which have not yet been identified) on a flight, there is no reason to assume that in some cases the clots won’t end up in the brain, causing a stroke.
Virchow’s Triad postulates three circumstances associated with an increased chance of a blood clot:
• increased coagulability of the blood
• damage to the walls of the blood vessel
• things slowing down the blood flow
If the prime culprits during air travel are reduced activity and dehydration (increased coagulability of the blood and a slowing down of the blood flow), then air travelers should increase their activity and their hydration. When we travel by air (domestically we tend to travel by train, but you can’t get to Uzbekistan from here via train), we get up and walk around roughly every half hour, and we tend to drink a LOT of water or juice (not caffeinated drinks or alcohol, which dehydrate you) while flying, as aircraft have very low humidity which tend to dehydrate you, and which therefore thickens the blood.
In addition, we also take roughly two grams of Omega 3 a day, in the form of the Res-Q 1250 (http://tinyurl.com/2qg6na) that we discussed in the February 2008 issue of ÆGIS. A study released in the January 17, 2001 issue of the Journal of the American Medical Association suggests that fatty fish and omega-3 polyunsaturated fatty acid, such as that found in Res-Q 1250, may be as effective as daily aspirin therapy at reducing the risk of thrombotic stroke, but without the side effects of aspirin therapy. Several epidemiological studies have tested the effects of omega-3 fatty acid intake on stroke risk, and suggest benefits are likely on ischemic or thrombotic stroke risk, which is what concerns us here, although not on hemorrhagic stroke. We take three capsules just before bed, and three on an empty stomach in the morning.
There are various factors that increase your risk for stroke. The American Heart Association lists the following non-controllable factors (http://www.americanheart.org/presenter.jhtml?identifier=4716): • Age — The chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes. • Heredity (family history) and race — Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.
• Sex (gender) — Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
• Prior stroke, TIA or heart attack — The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are “warning strokes” that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. Recognizing and treating TIAs can reduce your risk of a major stroke. If you’ve had a heart attack, you’re at higher risk of having a stroke, too.
They also list the following factors over which you have some control:
• High blood pressure — High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
• Cigarette smoking — In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
• Diabetes mellitus — Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke.
• Carotid or other artery disease — The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
• Atrial fibrillation — This heart rhythm disorder raises the risk for stroke. The heart’s upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
• Other heart disease — People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
• Sickle cell disease (also called sickle cell anemia) — This is a genetic disorder that mainly affects African-American and Hispanic children. “Sickled” red blood cells are less able to carry oxygen to the body’s tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
• High blood cholesterol — People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
• Poor diet — Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
• Physical inactivity and obesity — Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days. Finally, they list factors for which there is not yet solid documentation:
• Geographic location — Strokes are more common in the southeastern United States than in other areas. These are the so-called “stroke belt” states.
• Socioeconomic factors — There’s some evidence that strokes are more common among low-income people than among more affluent people.
• Alcohol abuse — Alcohol abuse can lead to multiple medical complications, including stroke. For those who consume alcohol, a recommendation of no more than two drinks per day for men and no more than one drink per day for non-pregnant women best reflects the state of the science for alcohol and stroke risk.
• Drug abuse — Drug addiction is often a chronic relapsing disorder associated with a number of societal and health-related problems. Drugs that are abused, including cocaine, amphetamines and heroin, have been associated with an increased risk of stroke.
By addressing controllable factors, by increasing our intake of Omega-3 to about a gram in the morning and a gram at night (three RSQ 1250 first thing in the morning and three just before bed) or by taking a baby aspirin just before bed (you don’t want to do both aspirin therapy and Omega-3 for fear of making your blood too thin), by exercising, and, more to the point by increasing our activity and hydration while flying, we like to think we will be able to reduce the risk of DVTs and strokes while flying.