Women's Heart Advisor April 2015 Issue

Lower Your Risk of Stroke by Taking Control of Two Risk Factors

Women suffer more strokes than men each year, and often have a more difficult recovery. But you can take steps to help prevent a “brain attack.”

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Strokes affect women more often than men. But if you take precautions now, such as managing your blood pressure and cholesterol, you can cut your stroke odds significantly.

If you are at risk for heart attack, you are also at increased risk for stroke, or “brain attack.” That’s because the same process that causes fatty plaques to build up in the arteries of your heart can affect the carotid arteries in your neck. If a carotid plaque ruptures or grows large enough to hinder blood flow to your brain, you’ll have a stroke.

“Stroke is not just a man’s problem. It hugely impacts women,” says Cleveland Clinic neurologist Irene Katzan, MD.

Stroke is the fifth-leading cause of death in this country and the most common cause of permanent disability. Stroke often leaves its victims unable to live independently at home, requiring them to move to assisted living or a nursing home.

Ten factors play a role in 80 to 90 percent of strokes. Two risk factors—high blood pressure (hypertension) and high blood cholesterol (hyperlipidemia) levels—are very common. Therefore, a good way to prevent stroke is to make sure your blood pressure and cholesterol remain at normal levels.

Why you should care

Women have a higher lifetime risk of stroke than men, primarily because they live longer. About 55,000 more women than men suffer a stroke every year. Of all adults who die from stroke, 65 percent are women.

Because stroke risk in women accelerates after age 85, many women who suffer a stroke are already widowed and living alone. Older age and lack of support can be devastating.

“Stroke hugely impacts women. Many have cared for a spouse who had a stroke, yet when they have a stroke, there is no one left to care for them. Lack of a loving caregiver may be one reason women tend to do worse than men after a stroke,” says Dr. Katzan.

Lower your blood pressure!

Normal blood pressure is 120/80 mmHg or lower. According to the latest American Heart Association statistics, 77 percent of people have a blood pressure reading of 140/90 mmHg or higher when they have their first stroke. For each 10 mmHg rise in systolic blood pressure (the first, or higher, figure), the risk of stroke increases by 36 percent. Experts estimate that 290,000 of the 795,000 strokes occurring each year could be prevented by controlling blood pressure.

In women, blood pressure tends to rise around the time of menopause and continues to climb with age. Because higher blood pressure may not cause symptoms, many people are unaware of this danger until it’s discovered during a regular physical exam—or until a stroke occurs.

Control your cholesterol, too

More women than men tend to have high total cholesterol levels, greater than 200 mg/dL. In one study, the risk of stroke increased 12 percent for each 18 mg/dL increase in total cholesterol. Experts estimate that approximately 168,000 strokes a year could be prevented if people maintained normal cholesterol levels.

Medications to prevent stroke

If your doctor diagnoses you with high blood pressure, you will be started on one or more medications. It may take several different medications and dosage adjustments before the right combination that brings down your blood pressure is found. Don’t give up! An analysis of blood pressure trials involving more than 26,000 women found that the risk of stroke dropped 38 percent once high blood pressure was brought down with medication.

As far as cholesterol is concerned, different types of cholesterol-lowering medications are available. Because statins are the most effective, they are usually the first choice. Statin therapy is particularly important in preventing a second (recurrent) stroke. In one study, the maximum dose of atorvastatin (Lipitor 80 mg) reduced the number of recurrent strokes by 16 percent over placebo.

Use as prescribed

Medications prescribed for high blood pressure and high cholesterol can help only if you take them. Unfortunately, many women don’t. In one study, two-thirds of women never filled their prescriptions or stopped taking the medications. The reasons varied, but forgetting was the most common. However, more women than men said they stopped taking an important medication after experiencing an adverse reaction.

If you have a bad reaction to a medication, call your doctor immediately. If you are unsure how to take the medication, ask your doctor. A reminder system or refillable pillboxes might make it easier for you to comply.

Treat or prevent?

If your doctor is concerned that you might be at increased risk for stroke, an ultrasound of your carotid arteries may be ordered. If a blockage of 60-70 percent is found, and you are having symptoms of stroke, you may need an endarterectomy to clean the fatty deposits from your arteries, or a stent to improve blood flow to your brain.

“In general, however, reducing the risk of stroke with blood pressure- and cholesterol-lowering medications is more effective than trying to recover from a stroke, after it happens,” says Dr. Katzan.

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