Vandita Samavedi, MD

May is National Stroke Month: Are Young Women at Risk?

 

Although most strokes occur in people older than 50, about one in 5,000 women ages 15 to 49 suffers a stroke each year, according to the National Institute of Neurological Disorders and Stroke (NINDS). 

A stroke occurs when brain cells die because the brain is deprived of oxygen. The most common cause of stroke is a blockage in an artery, a blood vessel that brings oxygen-rich blood to the brain. This type of stroke is called an ischemic stroke. The blockage is nearly always because of a blood clot that has formed in the artery and becomes so big that it stops or greatly decreases the amount of blood that can flow past it. The blockage can also be caused by a dislodged fragment of a clot from elsewhere in the body that has become wedged in an artery too narrow for it pass through.

Another type of stroke occurs when a tear in the wall of an artery in the brain allows blood to flow out of the artery. The blood leakage deprives the brain of oxygen. This type of stroke is called a hemorrhagic stroke.

How a stroke affects a person depends on where in the brain it has occurred and how many brain cells have died.

Risks for stroke
In younger women, the risk factors for stroke are obesity, high blood pressure (hypertension), type 2 diabetes, and cardiovascular disease. Some research has shown that women who are obese or who have gained more than 44 pounds since they were 18 years old are about 2-1/2 times more likely to have an ischemic stroke than lean women who have not gained a lot of weight.

Smoking or using oral contraceptives also increases the risk for stroke. The stroke risk is increased even for women who use low-estrogen contraceptives. Women who smoke, are older than 35, and use oral contraceptives are at higher risk.

Healthy women ages 45 to 64 can cut their risk for ischemic stroke by exercising regularly, eating a healthy diet, drinking only moderate amounts of alcohol, not smoking, and controlling high blood pressure.

Other risk factors
In general, African American women are up to three times more likely that have a stroke than white women. For both African American and white women ages 15 to 49, however, having a particular gene boosts the risk for ischemic stroke. The gene, phosphodiesterase 4D, encourages both the buildup of plaque in arteries and the formation of blood clots. It also raises the risk for hemorrhagic stroke. If you smoke and have a certain variation of this gene, you are at especially high risk for stroke, the NINDS says.

Pregnancy can slightly increase the risk for ischemic stroke. It is more of a risk for women with high blood pressure linked to pregnancy, a condition called preeclampsia, and for women undergoing cesarean delivery. A woman with preeclampsia during pregnancy is also at risk in the days just after delivery.

Sickle-cell anemia

Younger women who use cocaine or methamphetamine are at greater risk for stroke.

Act F.A.S.T. if you see these signs of stroke:

 

Posted in High Blood Pressure, Obesity, Pregnancy, Preventive Health, Stroke, Women, Women's Health & Wellness | Tagged , , , , , , , , , , , , | Leave a comment
Grace Kalish, MD

Don’t Wait Until You Have a Fracture to Learn About Osteoporosis

 

Osteoporosis is a condition in which our bones become weakened, increasing the risk of fracture, typically in the hip or spine.  Our bones reach a maximum density when we are about 30 years old, and from that point, the density begins to decline.  Fractures can result in loss of quality of life from the pain and decreased activity. Some individuals also suffer from depression as a result. 

Roughly 10 million Americans have osteoporosis and about 34 million are at risk. It is especially prevalent in people over age 50. It is a silent condition–there are no symptoms that alert us to our bones losing density, until we have a fracture. 

Osteoporosis not only increases the risk of large hip, spine or wrist fractures, even with a minor trauma such as bumping into furniture or slipping off the couch, but it may also cause shortened height due to repetitive small vertebral fractures. 

How can you know if you’re at risk? Your healthcare provider can assess your risk by asking you questions about your health and lifestyle. Your gender and age significantly impact your risk, as does your history of smoking and alcohol use.  Both smoking and alcohol use are linked to lower bone density. Your medication history, level of physical activity and your family history of fractures is also important information.  And lastly, if you are a woman your menopausal status and overall reproductive history are also factors to consider.

Your healthcare provider may also recommend a bone density scan. Sometimes called a DXA examination (dual x-ray absorptiometry), this low-dose x-ray measures the bone density in your spine and left hip, and sometimes in your left wrist.

A FRAX (Fracture Risk Assessment Tool) score is calculated in individuals who 1) have low bone density (osteopenia), 2) are post-menopausal or over the age of 50, and 3) have never taken an osteoporosis medication.  The FRAX tool was developed by the World Health Organization (WHO) to estimate how likely you are to suffer from hip and other fractures over the next 10 years.

What can you do to prevent osteoporosis? Maximizing your intake of calcium and vitamin D, as well as exercising go a long way towards prevention. Women over age 50 and men over age 70 should take at least 1200mg of calcium daily, either through diet alone or through over-the-counter supplements. Additionally, 800-1,000 IU of vitamin D should be taken daily by men and women over age 50. 

What forms of exercise are best for lowering your risk? Weight bearing movements and muscle strengthening exercises are best. Weight bearing exercises include dancing, hiking, jogging, and stair climbing. Muscle strengthening can be achieved by lifting weights, or through no-impact balance and posture exercises (usually taught by a physical therapist).

Minimizing the amount of alcohol you drink and quitting smoking are also important in reducing your risk of osteoporosis. 

If tests show your bone density is severely low, or if you have already suffered a fracture, your healthcare provider may recommend prescription medications including bisphosphonates (Fosamax, Boniva, Actonel, etc.), Selective Estrogen Receptor Modulators (SERMs), (Raloxifene), estrogen, or calcitonin. 

If you are over the age of 50 and have not yet had an osteoporosis risk assessment, talk to your healthcare provider.

The Breast Center at Valley Medical Center conducts bone density scans. For more information call 425-656-5588 or visit valleymed.org/breastcenter.

Posted in Bone Density and Osteoporosis, Calcium & Vitamin D, Diet, Fitness, Injury, Nutrition, Preventive Health, Women, Women's Health & Wellness | Tagged , , , , , , , | Leave a comment