ottobock.

"In developed nations, stroke is the most frequent cause of long-term disabilities. Each year 150,000 people in the UK suffer from a stroke; with a dramatic increase expected over the next few years due to current demographic developments and the ageing of the so-called baby boomers." (http://tinyurl.com/cxv878r)

Otto Bock was a man who "founded a company to supply thousands of war veterans with prostheses and orthopaedic products" (http://tinyurl.com/bmxt89e). His company now have a huge range of products aimed at those affected by strokes and aiding in "reintegrating patients into their professional and social environments" (http://tinyurl.com/cxv878r).
 

Statistics from the Otto Bock website state that after suffering a stroke "one quarter of all people are still bound to a wheelchair; two thirds of all people have restriction of the ability to walk. Approximately one-third of all people complain of a total loss of arm functionality, and daily dexterity is significantly impaired in a further 50% of cases" (http://tinyurl.com/cxv878r). These statistics show the huge effects on daily life of a stroke, which is itself a life threatening medical condition.

"Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death" (http://tinyurl.com/3py5b32). Strokes can be caused by a blood clot in the brain which leads to the blood supply being stopped and thus oxygen supply being reduced. This is known as "ischaemic (accounting for over 80% of all cases)" (http://tinyurl.com/3py5b32). The other main cause of a stroke is "haemorrhagic: a weakened blood vessel supplying the brain bursts and causes brain damage" (http://tinyurl.com/3py5b32).

"There is also a related condition known as a 'transient ischaemic attack' (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'" (http://tinyurl.com/3py5b32).

Ischaemic strokes are caused by the build up of deposits, plaques, on the blood vessel walls causing an increased blood pressure, reduced space in the vessel and also stiffening of the walls. These factors later result in a blockage when a plaque breaks off and gets stuck in the blood vessel becoming fully blocked and causing a loss of blood supply and thus oxygen supply to the brain.

The risk of a stroke occurring can however be reduced "through a healthy lifestyle [such as] consuming a healthy diet, taking regular exercise, drinking alcohol in moderation and not smoking. Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke substantially" (http://tinyurl.com/3py5b32).

Treatment of a stroke most often comes in the form of medical drugs for example in the case of ischaemic strokes "using a 'clot-busting' medicine called alteplase, dissolves blood clots. A regular dose of aspirin (an anti-platelet medication) [will also be administered] as this makes the cells in the platelets in the blood, less sticky, reducing the chances of further blood clots occurring" (http://tinyurl.com/d25mo6l). Other drugs are used, known as anticoagulants which also reduce the chances of blood clots by thinning the blood.

Blood cholesterol levels may also be an issue, if the LDL (low-density lipoprotein) cholesterol ('bad cholesterol') count is high then this could be part of the cause of the stroke as they stick to the blood vessel wall and form the plaques (restricting blood flow and reducing the elasticity of the blood vessel walls). "Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol" (http://tinyurl.com/d25mo6l).

In terms of treatment for haemorrhagic strokes "emergency surgery is often needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.

During a craniotomy, a small section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced.

Following a craniotomy, the patient may have to be placed on a ventilator. A ventilator is a machine that assists someone with their breathing. It gives the body time to recover by taking over its normal responsibilities, such as breathing, and it will help control any swelling in the brain.

The patient will also be given medicines, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring." (http://tinyurl.com/d25mo6l).

This type of surgery is extremely dangerous and the risks and benefits to the patient must be assessed before any surgery takes place.

THIS IS A SURGICAL VIDEO
This video shows a procedure not for a craniotomy for stroke but for a tumour. (http://www.youtube.com/watch?v=CoDT9o01L08)

This brochure shows the product range for Otto Bock healthcare and displays the huge innovation in their products. http://www.ottobock.co.uk/cps/rde/xbcr/ob_uk_en/799_Stroke_Product_brochure_A4_FINALJAN.pdf

More information on stroke and the heart can be found at the websites in this post but also on the British Heart Foundation website at http://www.bhf.org.uk/#&panel1-2.





 

Polypill

Student BMJ- The polypill: a magic bullet against cardiovascular disease?(http://student.bmj.com/student/view-article.html?id=sbmj.e6386)

The polypill is "a pill containing a number of medicines that all treat the same condition" (Oxford Dictionary) from 'poly', meaning many.

 

"Cardiovascular disease remains the leading cause of mortality in developed countries, and has been described as a “global epidemic.” In 2003, Wald and Law proposed a new polypill: six drugs combined into one tablet that would work to reduce cardiovascular risk. They proposed the polypill as a way of targeting modifiable cardiovascular risk factors, both for adults with pre-existing cardiovascular disease (secondary prevention) and, more controversially, for adults over 55 years old without cardiovascular disease (primary prevention)."

"Wald and Law argued that over 80% of myocardial infarctions and strokes could be prevented if this strategy was adopted. The polypill would contain six ingredients: three blood pressure lowering drugs (a thiazide diuretic, a β blocker, and an angiotension converting enzyme (ACE) inhibitor), a statin, aspirin, and folic acid. Their idea ignited great debate in the medical community regarding its potential to reduce the global burden of cardiovascular disease" (BMJ reference above).

How well does the pill work?
"By using the right combination of active medicines, the Polypill can reduce the risk of a heart attack or stroke by two thirds. The key objectives of the medicines are to reduce blood pressure and cholesterol."

"In July 2012, the results of a Polypill trial conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.
84 participants took a single Polypill (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the Polypill or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the Polypill period was compared with the levels at the end of the placebo period. The allocation of the placebo or the Polypill is coded, and is only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of the Polypill than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%) on the Polypill, diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively" (https://www.polypill.com/evidence-for-polypill.html).

The two graphs below (https://www.polypill.com/evidence-for-polypill.html) show the effect that the polypill has on diastolic blood pressure and cholesterol respectively both lowering to almost the levl of a 20 year old.

 

Whilst showing a reduction in diastolic blood pressure and LDL (low density lipoproteins) cholesterol in the graphs, this considerably lowers the risk of coronary heart disease and also the risks of stroke (http://tinyurl.com/9ykwvnp and http://tinyurl.com/9uvkr6z).

 

"If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime" (http://www.bbc.co.uk/news/health-18883163).
 

However "The British Heart Foundation called for more research and said pills were not a substitute for a living a healthy life." (http://www.bbc.co.uk/news/health-18883163). This study was also a very small study of just "84" (BBC) over 50 year olds, a much larger study would have to be carried out to provide solid data and evidence to become valid and broadly used.