BY BARBARA FABER, APNP
Ascension Medical Group

Stroke is the fourth-leading cause of death in the United States, behind heart disease, cancer and breathing-related problems, but for women, stroke ranks number three.

In middle age, women and men face roughly the same stroke risk, but after menopause, a woman’s stroke risk doubles. The disparity means that women suffer 55,000 more strokes per year than men. Women are more likely to die (60 percent of stroke deaths occur in women), and they are also more likely to suffer severe health and lifestyle consequences.

Because many older women live alone as the result of being widowed or divorced, a disabling stroke may result in the need to move to a nursing home or assisted living.

A stroke occurs when the blood supply that carries oxygen and nutrients to the brain is interrupted, either by a blood clot that forms in an artery (causing an ischemic stroke), or because of bleeding in the brain from burst blood vessels (a hemorrhagic stroke). Ischemic strokes from a blood clot are the most common, accounting for 87 percent of strokes.

Some of the risks of stroke are common to both men and women, including high blood pressure, smoking, being overweight, diabetes and high cholesterol. If the list sounds familiar it’s because they’re the same risks for heart disease.

Like a heart attack, stroke can kill suddenly. More often, however, patients survive. But because stroke is a brain attack and the brain is the control center of the body, the aftermath can be more debilitating.

Depending on the severity, stroke can leave people with the loss of use of an arm or leg, sometimes both. Some patients suffer memory loss and even the ability to speak.

High blood pressure is profoundly linked to stroke risk, and it can be controlled–with lifestyle measures such as weight loss and exercise, using less salt and, if these measures are not successful, medication.

Being overweight or obese increases stroke risk. In Nurses’ Health Study 116, 759 women aged 30 to 55 who were followed for 16 years, found that women with a BMI over 27 (in the overweight category) had a significantly increased risk of stroke. That risk continued to rise as the BMI reached the cutoff for obesity, a BMI of 30 or above.

Smoking increases the risk of stroke as well as a host of other health problems. If you smoke, make an appointment with your doctor to find out how you can get help quitting.

Factors affecting women

There are a number of risks for stroke that apply specifically to women.
• Pregnancy. Women in the childbearing years have a risk of 11 per 100,000, but pregnancy is known to increase that risk to as high as 34 per 100,000, according to one study.

Women with high blood pressure before pregnancy are advised to work with their doctor to lower blood pressure and to monitor it throughout the pregnancy. Preeclampsia, a complication of pregnancy associated with high blood pressure, increases a pregnant woman’s risk of stroke both during pregnancy and during the postpartum period, when it is highest. A history of preeclampsia during pregnancy also increases a woman’s risk of stroke later in life.

• Hormone replacement therapy, once commonly used by postmenopausal women, was thought to lower stroke risk. It’s now known that it raises the risk of stroke, and women are cautioned against HRT.

• One in five women will suffer a stroke at some time in life, but the highest risk occurs in older women.

• Atrial fibrillation, a heart rhythm disorder, quadruples the risk of stroke and is seen more often in women than men after age 75. Stroke guidelines for women recommend that women over age 75 be screened for atrial fibrillation.

When diagnosed, atrial fibrillation can be treated with warfarin, an anti-clotting agent, or other medications, to lower the risk of blood clots and ischemic stroke.
Surveys show overwhelmingly that living independently in one’s own home is a key marker of quality of life as women age. Being aware of stroke risks and following healthy lifestyle habits that guard against stroke can help ensure health and independence.

Barbara Faber, APNP is a Nurse Practitioner with Ascension Medical Group. For more information, please visit ascension.org/Wisconsin