Stroke

Stroke

It's Not Too Early
for Prevention

Of all the thieves of youth, stroke is the swiftest and most tragic. In an instant, a vital, vibrant woman can lose her ability to speak, to move freely--even to think as clearly as she did just seconds before.

And despite its reputation as an older person's problem--an older man's problem at that--stroke doesn't discriminate. More than 8,000 American women between the ages of 30 and 44 suffer strokes each year. Nearly one in every three strokes is fatal. And the aging effects on those who survive can be brutal. Survivors could suffer brain damage affecting speech, memory, thought patterns and behavior. Sometimes there is temporary--or permanent--paralysis.

The good news is that you can significantly cut your risk of stroke. "We're beginning to realize that stroke is not an inevitable process," says Michael Walker, M.D., director for the Division of Stroke and Trauma at the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland. "It's preventable, and it is treatable."

It may mean eating more fruits and vegetables, exercising a few times a week and staying vigilant about your blood pressure. But when you weigh the options, it's not a bad trade-off.

The Risk for Women

Stroke is a sudden severe illness that attacks the brain. There are two basic types. Ischemic strokes, which account for about 80 percent of all strokes, happen when blood flow to a part of the brain is cut off, causing brain cells to die from lack of oxygen. This frequently occurs due to hardening and clogging in your carotid arteries, which feed blood from your neck to your head. Ischemic strokes can also be caused by atrial fibrillation, an irregular heartbeat that leads to clots that may travel through your body and lodge in the brain's arteries.

Hemorrhagic strokes account for the remaining 20 percent. These strokes are caused by bleeding from ruptures in either a blood vessel on the surface of your brain or an artery in the brain itself. These strokes can be even more deadly than ischemic strokes, with a mortality rate of close to 50 percent.

Women ages 30 to 44 are about half as likely to have strokes as men in the same age group, according to figures from the American Heart Association. Black women are at greater risk than white women of dying from stroke. Family history of stroke can play a role, too, though just how much remains unclear. And the risk of stroke goes up as a woman ages. American Heart Association statistics show that the incidence of stroke more than doubles each decade for a woman after she reaches age 55.

Younger women have some protection against stroke because their bodies produce large amounts of estrogen. That helps keep cholesterol levels lower and checks the onset of atherosclerosis, or hardening of the arteries. After menopause, though, the rate of stroke rises quickly. By age 65, women and men have about the same incidence of stroke.

Pregnancy can cause a slight increase in stroke risk, though the odds are still quite low. There are a few reasons for this increased risk, says Harold Adams, Jr., M.D., professor of neurology at the University of Iowa Hospital and Clinic in Iowa City. A woman's blood clots differently during pregnancy. And her blood pressure also tends to be a bit higher. Studies also show that certain forms of birth control pills may slightly increase stroke risk, too--especially for smokers older than 35 or for women with high blood pressure.

Of course, you have no say over age or gender. But Dr. Adams says there are many risks you can definitely control.

High blood pressure, for example. Also known as hypertension, it's the single most important risk factor for stroke. "About half of all strokes are caused by high blood pressure," says Edward S. Cooper, M.D., past president of the American Heart Association.

High blood pressure causes stroke by speeding up atherosclerosis and damaging smaller blood vessels. And in Dr. Cooper's words, it can cause tiny blood vessels in your brain to "blow out like an overinflated tire."

Smoking also puts you at increased risk for stroke by accelerating clogging of the carotid arteries, says Jack P. Whisnant, M.D., chief investigator for a study of carotid artery disease at the Mayo Clinic in Rochester, Minnesota. Women who smoke are over 2.5 times more likely to suffer strokes than nonsmokers, according to a Harvard Nurses' Health Study that tracked 117,000 female registered nurses between the ages of 30 and 55 at entry to the study. The more women in the study smoked, the greater their risk. Compared with nonsmokers, women who smoked 1 to 14 cigarettes per day had twice the risk of stroke, while women who smoked 35 to 44 cigarettes per day--about two packs--had a fourfold increase in risk. Those who smoked more than 45 cigarettes per day were 5.4 times more likely to suffer strokes.

Women with diabetes are also at increased risk for stroke. And obese women and those with high blood cholesterol levels may be at higher risk of developing atherosclerosis and thus having strokes.

An Intervention Strategy

Strokes are still shrouded in mystery. They seem to strike without warning. Sometimes it's hard to tell when you're even in danger.

But early prevention can be the key to improving your chances of avoiding stroke. "The process leading to a stroke begins in your forties, even earlier, so now is the time to intervene," says David G. Sherman, M.D., head of neurology at the University of Texas Health Science Center at San Antonio.

To help lower your risk, try these tips.

Ease the pressure. Many people don't even know they have high blood pressure, because it has few outward signs. That's why the American Heart Association recommends having your blood pressure checked by a doctor or another health care professional at least once a year if your blood pressure is 130/85 or higher. If your blood pressure is lower, get it checked every two years. Many cases of high blood pressure begin developing between ages 35 and 45.

Research shows that controlling high blood pressure can cut your risk of stroke by as much as 40 percent. Any reading above 140/90 is considered high.

Your doctor will be able to prescribe treatments for high blood pressure, from dietary changes to getting more exercise to drug therapy. Follow the advice like your life depends on it. It might.

"Controlling hypertension is absolutely vital in stroke prevention," Dr. Adams says.

Kick the habit. The Nurses' Health Study showed that women who stopped smoking cut their stroke risk substantially. In fact, the risk of stroke dropped to normal levels for women two to four years after they quit.

"Don't just cut back on cigarettes," Dr. Adams says. "There's no such thing as moderate smoking. You have to stop altogether, all the way, right now."

Go low with the Pill. For years, doctors warned women about birth control pills and increased stroke risk. But with the low-dose estrogen pills now in use, Dr. Adams says the risk of stroke is lower.

"We're seeing more and more evidence that low-dose estrogen oral contraceptives are safer," he says. "Low-dose estrogen is probably safe."

There are two caveats, however. Smoking and the Pill are a dangerous mix--especially for women over age 35. And high blood pressure, combined with the Pill, can also increase stroke risk. "If you have those risk factors, birth control pills are not advisable," Dr. Adams says.

Check your neck. Ask your doctor to listen for a bruit, a whooshing sound in the carotid arteries in your neck. This is caused by partial blockage and turbulence in the crucial blood vessels that feed oxygen to the brain.

"This is especially important if you have atherosclerosis causing blocked blood vessels elsewhere in your body," says Patricia Grady, Ph.D., acting director of the National Institute of Neurological Disorders and Stroke.

Also, make sure the doctor checks your heart. Treating atrial fibrillation can reduce stroke risk by up to 80 percent.

Get some exercise. Physical inactivity may be a risk factor for stroke, but a total exercise time of at least 20 minutes a day, three times a week, could reduce your risk for stroke. Walking, tennis, bicycling, stair climbing, aerobics and even gardening and Ping-Pong can be potential stroke busters.

A British study showed that the sooner you start exercising, the better. Women who started exercising between ages 15 and 25 had a 63 percent reduction in their risk for stroke. Even if you're a little late getting started, you can still benefit from exercise: The study showed that people who began exercising between ages 25 and 40 reduced their risk by 57 percent and that people who started exercising between ages 40 and 55 cut their risk by 37 percent.

"Exercise has so many benefits," Dr. Adams says. "If you're not exercising, you could be robbing yourself of years later on."

Crunch some carrots. The same Nurses' Health Study that looked at smoking also discovered a link between the nutrient beta-carotene and stroke.

"We found a 22 percent reduction in the risk of heart attack and a 40 percent reduction in stroke for those women with high intakes of fruits and vegetables rich in beta-carotene compared with those with low intakes," says JoAnn E. Manson, M.D., co-principal investigator of the cardiovascular component of the Nurses' Health Study who is co-director of women's health at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, both in Boston.

Just one large carrot, which has 15 milligrams of beta-carotene, provides the amount of the nutrient that was associated with the lowest risk in the study. Other foods that worked were sweet potatoes, mangoes, apricots and spinach. Beta-carotene can be found in most dark green and orange fruits and vegetables.

Pass the potassium. Researchers at the University of California, San Diego, have found that adding a single daily serving of potassium-rich food to your diet could cut your risk of fatal stroke by as much as 40 percent. The reason for the benefit isn't completely clear. Although potassium is known to help lower blood pressure, the amount of potassium the test subjects ate had little direct effect on their blood pressure readings. Studies at the University of Mississippi Medical Center in Jackson showed that potassium may help prevent the formation of blood clots, one of the primary factors in heart attack and stroke.

If you're looking for a high-powered potassium boost, eat a baked potato every day. Potatoes are one of the richest sources of potassium. Other foods rich in potassium include dried apricots, lima beans, Swiss chard, bananas, skim milk, roasted chestnuts, okra and oranges.

Know about aspirin. Aspirin might help ward off ischemic stroke by thinning potential blood clots, Dr. Adams says. But unless you already have a risk factor, such as atherosclerosis or a prior stroke, it may not do you much good. In fact, research shows that aspirin might be linked to a slightly higher incidence of hemorrhagic stroke.

Just how much aspirin you should take also remains debatable. Some studies have found benefits with an 81-milligram daily dose (a children's aspirin). Others tout a 325-milligram daily dose (a regular-strength adult aspirin). And now some researchers say that as many as three regular aspirin tablets daily may be necessary. The bottom line: See your doctor before you start an aspirin regimen for stroke prevention.

Keep it in balance. What's good for your heart is good for your brain. Keeping your cholesterol in check can slow atherosclerosis and ward off ischemic stroke. So eat a low-fat diet. The current recommendation from most doctors and researchers is to limit fat to no more than 25 percent of your total calories.

"Along with exercise and quitting smoking, what you eat is key to preventing stroke," Dr. Adams says. "What we're talking about is a good diet that will help lessen the risk of hardening of the arteries." This diet doesn't need to be extreme, he says. It does need to be well balanced and low in fat.

Toast your health--in moderation. Excess drinking means increased stroke risk. Numerous studies show that having more than four drinks a day greatly increases your chances of having a hemorrhagic stroke.

But some studies show a link between moderate alcohol intake and a slightly reduced risk of ischemic stroke, at least among whites.

"There may be something about alcohol that helps in small levels. It may prevent both heart attack and stroke. I'm not telling my patients to drink for their health," Dr. Adams says. "If you're not drinking now, I don't recommend starting. If you do have more than a couple of drinks a day, the potential complications of alcohol are probably going to hurt you in the long run. The key to alcohol use is moderation."