Sharp Drop in Strokes a Reason to Celebrate? Yes and NoAug 28, 2014
Dr. Jones: Stroke; it's up there with cancer as the medical problem we don't ever want to have. But is it a woman's issue? Yes, yes, yes. Women are not protected from stroke, because they are women. And they are the major caretakers of others with stroke. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University Health Care, and today some good news about stroke in the U.S. and what women should do on The Scope.
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Dr. Jones: Stroke is dead brain tissue; scary isn't it? It's usually from a problem with blood flow to the brain. It affects about 800,000 Americans each year, and remains the fourth leading cause of death. Worse than death for some of us is disability; and stroke is the main cause of adult disability in the U.S.
Women are at increased risk of stroke in their childbearing years, because of blood clots to the brain associated with pregnancy and high blood pressure in pregnancy. And rarely, or less than one in a hundred thousand women, related to hormones in birth control pills.
The risk factors for strokes later in life are from smoking, high blood pressure, diabetes, and coronary artery disease. Now the rate of coronary artery disease in men has decreased by 50% over the past 50 years. That is huge. The risk of coronary artery disease in women hasn't decreased quite so much, but until a study published this July, this week in fact, we didn't think that stroke was decreasing so much. But the good news is that the rate of strokes in men and women over 65 has decreased by 50% in the last 20 years. And the rate of deaths from stroke has decreased by 40% in the same time.
Now this is huge. When there's a big decrease in a rare event, that's what's often in the newspaper. That's good, but it only means small numbers. But when there's a big decrease in a disease that's really common, it's really big.
So what are we doing right, and what does this mean for women? First the science. A study following 14,000 people in four communities who were 45 to 65 in 1987 were followed for 20 years. None of them had strokes before the study started. They were followed carefully each year and their medical records carefully reviewed. The rate of stroke and deaths from stroke was measured each year and that's how the decrease was noted.
Why did this happen? Why the decrease? Well this isn't a prospect of randomized study in genetically identical mice where you can change one thing in a mouse's life and see what happens. Humans are complicated and they don't all do the same stuff. But here are some ideas.
Better control of blood pressure. About 30% of the people in the study were using blood pressure medicine at the beginning, and 45% were using blood pressure meds at the end of the study.
Second there was a decrease in smoking over the time period, and this is really important, because smoking is a major risk factor.
Thirdly there was better control of cholesterol. Cholesterol can increase the risk of coronary artery disease and that is a factor that can be involved with stroke as well. Coronary artery disease is caused by plaque or abnormalities in the lining of the coronary artery, and people who have that often have it in their carotid arteries, or the arteries that feed the brain. So control over cholesterol makes a big difference. Lastly there were better treatments for stroke when people get to the hospital right away.
So what does this mean for women in their own health? Women need to get their blood pressure checked, and cholesterol checked, and high blood pressure and high cholesterol need to be treated. Women need to get their checkups, and they need to take their medicine. Women aren't always so great about doing what they're told about medicine.
Now stroke is more common in poor people, and better access to primary health care is good news for all of us with the Affordable Care Act. Although this decrease in stroke was seen in women over 65 who have Medicare, getting health care before you get to 65 can decrease the risks.
Now what does this mean for women as caretakers and nudger? Time out here.
What is a nudger, or nudger? I think both pronunciations are okay. Two definitions apply here. One, first; one who pushes gently. And second; someone who is annoyingly persistent. The first might be the self definition by the nudger. And the second might be the definition from the nudgee; the person getting nudged. But if someone who makes someone else do what they don't want to do. So women need to get their family members in for basic health care, checkups, and nudge them to take their medicine and stop smoking.
Lastly, we know heart attacks are a medical emergency, and early hospital care has better outcomes. The same is true for stroke, which would be called a brain attack.
So what are the signs of stroke? One; sudden numbness or weakness of your face, arm, and leg, especially on one side of the body. Two; sudden confusion, trouble speaking, or understanding for no good reason; not from too many margaritas in the summertime. Three, sudden trouble seeing in one or both eyes that persists longer than a few minutes. Four, sudden trouble walking, dizziness, loss of balance or coordination; and the same is true about the margaritas here, too. And lastly, sudden onset of the worst headache of your life.
To increase the chance that medical care can decrease the effect of stroke call 911 and go to a hospital that is a stroke center, if you have one in your area. That's either you, if you have any symptoms, or as the primary nudger, getting your family member, if you notice these things.
So yea for us in the U.S.; a 50% decrease in the incidence of stroke over the past 20 years is a really big deal. But the obesity and diabetes epidemic in young people will be possibly sabotaging this great news in years to come.
So ladies, get your blood pressure checked; get your cholesterol checked, keep moving, and be nudgey about getting your family in for primary care checkups. And thanks for checking up with us on The Scope.
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