Better Health & Living
Women’s Surprise Stroke Risk
Don't ignore these 5 warning signs
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When Nicolle Ferguson, 51, of Southampton, Pennsylvania, can’t find time to exercise, she remembers a phone call from her great-uncle 40 years ago. “He told us our great-grandmother had a stroke,” she says. “My great-grandmother was very fit all of her life—she worked as a hotel maid and essentially exercised all day, five days a week. But after retirement, I guess things changed. She survived her stroke but was frail for the rest of her life.”
The memory prods Ferguson to lift weights while watching TV at night, to invite her daughter along on after-school walks, and to make time for swimming laps—no matter what. “More than weight loss, avoiding scary things like a stroke or a heart attack really motivates me now that I’m past 50,” she says. “The bonus is, I’m getting firmer, and I’m more relaxed!”
It’s an enlightened plan. Stroke is the third leading cause of death for American women (heart disease and cancer claim first and second place), yet women themselves ranked it a distant 10th among health conditions they feared most in a national survey conducted by the Society for Women’s Health Research. The truth: About 420,000 women have debilitating or deadly “brain attacks” each year. Compared to men, women are less likely to survive a stroke, and if they do, they’re more likely to be severely disabled. And while most strokes happen to women older than 65, one in four occurs in younger women.
Midlife women face a special risk. A UCLA study found that women ages 45 to 54 had twice the chance of having a stroke as compared to men of the same age. Neurologist Amytis Towfighi, MD, the study’s lead researcher, suspects the reason is that women and their doctors simply hadn’t been taking their biggest risks seriously at all.
“Women’s blood pressure levels were rising 8 to 10 points every decade during the study, while men’s rose 4 to 5 points,” Dr. Towfighi says. “Women’s cholesterol levels increased by 10 to 12 points every 10 years, while men’s rose 5 points or less. And women’s blood sugar levels rose slightly more than men’s. Doctors and the public underestimate a woman’s risk for stroke at midlife.”
Like a Heart Attack in the Brain
A stroke happens when parts of the brain are deprived of oxygen, resulting in the destruction of brain cells vital for speech, movement, thought, and all the processes that keep us alive. About 80 percent of strokes are caused by a clot blocking a blood vessel in the brain—an ischemic stroke. The rest are the result of broken blood vessels and uncontrolled bleeding—a hemorrhagic stroke.
“As estrogen levels drop at menopause, women lose their protection against stroke,” warns cardiologist C. Noel Bairey Merz, MD, medical director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles. “It’s important to pay attention to your risks because you really can lower your odds for a stroke significantly.”
Your first step: Watch for these five warning signs of female stroke risk.
Your Blood Pressure’s Inching Up
If your blood pressure is higher than 120/80, your risk of ischemic and hemorrhagic strokes rises dramatically. Hypertension can cause your arteries to become thicker and narrower; in the brain, they may even squeeze shut. You’re also more likely to have clogged arteries, and the pounding pressure can make small arteries rupture, causing hemorrhagic strokes.
The fix: Getting your pressure down to an ideal 120/80 or lower cuts your stroke risk in half. A low-sodium diet packed with fruits, veggies, whole grains, and two or three servings of low-fat dairy products a day; regular exercise; weight loss; and regular blood pressure screenings to catch problems can help. If needed, your doctor may prescribe blood pressure-lowering drugs, too.
Your Cholesterol and Triglyceride Levels Aren’t As Good As They Used To Be
Half of all women have total cholesterol levels over 200 mg/dL, one-third have high levels of “bad” LDL cholesterol (over 130), and about one in 10 has dangerously low levels of “good” HDL cholesterol (under 50); many have triglyceride levels above 150, too. High cholesterol and triglycerides are warning signals that you’re more likely to have a dangerous buildup of plaque in artery walls—and the plaque can rupture, forming blood clots.
The fix: Follow the same healthy diet recommended for controlling high blood pressure. To bolster your “good” HDL, get at least a half hour of exercise most days of the week; if you smoke, quit; and snack on a small handful of walnuts often. If lifestyle changes aren’t enough, ask about cholesterol-lowering drugs, such as statins.
Your Heart “Flutters”
Atrial fibrillation (AF)—when the upper chambers of the heart quiver instead of beating steadily—causes twice as many strokes in women as in men, say University of California, San Francisco, researchers who checked the health records of 13,559 people with AF. In AF, blood can pool in the heart and form clots; a strong heartbeat can send a clot to the brain. About 1.1 million women have AF; odds of developing it go up with age.
The fix: Electrical stimulus to regulate your heartbeat or a blood thinner, such as warfarin (Coumadin). Women in the study who took warfarin lowered their stroke risk significantly, but you may have to ask for it; some studies suggest doctors prescribe it less often to women.
Your Mom Had a Stroke
When British researchers checked on close relatives of 806 women and men who’d had strokes, they found that a mother’s stroke meant her daughter’s risk increased by 80 percent. A sister’s tripled the odds. (Surprisingly, strokes in male family members made no difference, and a man’s family history didn’t alter his risk by nearly as much.) Women whose mothers had strokes at an early age were more likely to have strokes around the same age.
The fix: You can’t change your genes, but you can do a great deal to keep your blood pressure, cholesterol, and weight healthy.
You’ve Had Pregnancy Complications
If you ever had preeclampsia or gestational diabetes during a pregnancy, your risk for a stroke later in life is higher, say Duke University Medical Center researchers who tracked the health records of 475 women. The connection: These problems could be early warning signs of cardiovascular problems that lead to stroke.
The fix: “Women who have had pregnancy complications should pay special attention to things like weight loss and exercise—all the things we generally recommend to prevent heart disease and stroke,” says lead researcher Cheryl D. Bushnell, MHS, MD, assistant professor of medicine in the division of neurology at Duke. Keep tabs on your blood pressure, blood sugar, and cholesterol levels, too.
Ask About Aspirin
Ask your doctor about taking a daily low-dose aspirin—the 81-milligram kind once known as baby aspirin. While it doesn’t protect women against midlife heart attacks, it could lower the odds of having a stroke by 17 percent or more.
Sarí Harrar is a regular contributor to Better Health & Living.
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