January 27, 2020

Don’t Forget Women’s Stroke Risk

Cardiovascular disease still remains the number one cause of death in women.  Heart attacks account for 24% and strokes 7% of all deaths.  Among minority women, these numbers are even higher.  The challenge remains that doctors traditionally have not identified women at high risk of stroke.  Internists and cardiologists do not routinely think of stroke prevention in women, and neurologists have been busy treating stroke victims and have had no time for prevention.  Women need to stay in charge of their own health!

There are risk factors that are specific to women, which have been ignored:
1. Pregnancy complications, such as preeclampsia (high blood pressure during pregnancy),
2. Hormonal contraception,
3. Hormonal therapy for menopause.

Ask your doctor about your risk of heart disease and stroke.  Then, ask what you can do to prevent a heart attack and stroke.

Treatment of pregnant women with systolic blood pressure in the 150-160 mm Hg should be considered.

Hypertensive disorders during pregnancy should be considered and documented as major risk factors for cardiovascular disease in women.  There is a fourfold risk for developing hypertension and twofold risk of stroke later in life when diagnosed with hypertension during pregnancy.  Follow up is vital to these women.

Reducing blood pressure is the single most important modifiable factor for stroke prevention in both men and women.  As blood pressure tends to rise with age, women develop further increased risk after menopause.

What patients do for themselves is by far more important than what doctors can do when it comes to prevention.  Here are simple yet effective habits to follow:
1. Stop smoking!  Get help.
2. Regular exercise (moderate paced 30 minutes of walking four times per week).
3. Limit alcohol consumption to no more than 8 ounce of red wine per week.
4. Eat a diet rich in fruits, vegetables, nuts and olive oil, and minimize processed food.
5. Limit salt intake to less than 2000 mg of sodium per day.
6. Maintain yourself close to your ideal body weight. 
7. Avoid obesity which can lead to hyperlipedimia, metabolic syndrome, insulin resistance and diabetes.

For healthy women aged 65 or older, a baby aspirin of 81 mg has been shown to reduce cardiovascular risk.

Those with diabetes should be under the care of an aggressive preventive cardiologist who can manage and balance all necessary medications to keep LDL Cholesterol < 70, Systolic BP <120 mm Hg, and avoid drug-drug interactions, common in diabetic patients.  A diabetic patient should be thought as someone who has already had a heart attack or a stroke in order to prevent a bad outcome.

Women with atrial fibrillation history must be anti-coagulated as their male counterparts.

For those of you who love the women in your life, make sure you share this information with them so that they can take charge of their own health and prevent a heart attack or stroke.


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