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Women & Stroke: A Deadly Combination

Stroke is often thought of as an old man's disease. But more women than men die from it, and many factors (birth control pills, hormone therapy and pregnancy) put us at risk. Learn the key facts to protect yourself.

By Norine Dworkin-McDaniel

Women & Stroke

It was 7:30 on a November evening four years ago, and Kimberly Dunne had just finished her 12-hour shift as an emergency room nurse at St. Mary's Medical Center in Langhorne, Pennsylvania. It had been a grueling day in the ER, and she just wanted to get home to her husband, Jerry, and their daughters, Kiera, now 8, and Erin, 6.

As she started the seven-minute drive home, she shifted uncomfortably in her seat. Her left leg had fallen asleep. She shook it and stomped her foot, but the tingling persisted. Then she reached for the left turn signal. She couldn't seem to put her hand on it. Kim started to panic. Her experience told her this was a stroke symptom. I'm too young! I'm only 31. I can't be having a stroke!

She grabbed her phone with her right hand and hit speed-dial.

"Jerry! I'm having a problem," she whimpered. Except that it came out all garbled.

"Kim?" Jerry asked. "Honey? Have you been drinking?"

She cried harder. She knew exactly where she was, but she was unable to tell him. By the time she miraculously pulled into her driveway, her left side was completely paralyzed. Jerry opened the car door, moved her to the passenger seat, bundled the girls into the car, and raced back to St. Mary's.

Not Just a Man's Disease

Stroke is like a heart attack that strikes the brain. But with stroke, an artery in or leading to the head, rather than the chest, bursts or gets blocked. This deprives the brain of blood and oxygen, and cells begin to die. Body functions controlled by the part of the brain that's dying, like vision, coordination, and speech, are disrupted.

With both heart disease and stroke, fatty deposits and high blood pressure are the culprits that harm the arteries, explains Louise McCullough, M.D., Ph.D., associate professor of stroke research and education at the University of Connecticut Health Center in Farmington. Not surprisingly, stroke's biggest risk factors are the very things that can also lead to heart attacks, like obesity, smoking, and excessive use of alcohol. About 700,000 Americans experience strokes each year, making stroke the number one cause of disability and the number three killer after heart disease and all cancers combined. Stroke risk doubles every decade after 55, and two-thirds of strokes occur in people over 65.

It's wrong to think of stroke as something that happens only to old men. Women are more likely than men to experience strokes, to have more complications from them, and to die after suffering one. And it's not just older women. "Women in their 30s and 40s are frequently too young to have strokes as a result of what we think of as 'traditional risk factors,'" explains Emil Matarese, M.D., spokesperson for the American Stroke Association's Power to End Stroke program and director of the St. Mary's Stroke Center, where Kim Dunne was treated. "Instead, otherwise healthy young women have strokes because of less commonly known problems that go undetected until they have their first brain attack." Here, a closer look at these obscured, but ever-present, risk factors.

Risk One: Migraines

About 18 million American women get migraines. But it's the 20% of migraines that come with aura—the visual disturbances that warn of impending headaches—that seem to be associated with an increased stroke risk. One recent study found that among women who get migraines with aura, those who smoke and take oral contraceptives have seven times the risk for stroke. That lethal combination is what's thought to have contributed to Kim's stroke. She's since given up cigarettes and gone off the pill—smart moves for any woman who gets migraines, even those without aura (since one French study found that suffering from migraines without aura can still triple stroke risk).

Risk Two: Blood Clotting Disorder

If a person's blood is in a "hypercoagulable state," which basically means that it clots more than it should, she is at risk of having a stroke. "This type of blood can result in either blockages in brain arteries or clots that form in the heart but then flick off and lodge in the brain," explains Dr. Matarese.

You may be prone to this disorder if you've had more than one miscarriage, you or a close relative has had a blood clot in a leg or the lungs, or you regularly suffer from migraines with aura. A simple blood test that looks for specific antibodies that cause abnormal clotting can confirm this condition, which can be managed with blood-thinning medications.

Risk Three: Pregnancy History

Although women's stroke rate is highest during the six weeks around the delivery of a baby, personal pregnancy experience can impact stroke risk long after the baby is born. Research conducted by Cheryl Bushnell, M.D., associate professor of neurology at Wake Forest University Health Sciences in Winston-Salem, North Carolina, has revealed that women who developed pre-eclampsia (a form of high blood pressure) or gestational diabetes during their pregnancies are twice as likely to have a stroke by age 40 as women whose pregnancies were uncomplicated. This may be because of damage done to the blood vessels during pregnancy.

Risk Four: Hormone Therapy

Women dealing with menopause symptoms often rely on hormone replacement therapy (HRT) to relieve hot flashes, vaginal dryness, mood swings, insomnia, and vanishing libido. But one reason the hormone trials of the Women's Health Initiative (WHI)—which studied HRT's effect on cardiovascular disease, osteoporosis, and breast and colorectal cancers—were halted early was the higher incidence of stroke among women undergoing HRT. Among those taking estrogen and progestin, there was a 41% increase in strokes; and for women taking only estrogen, strokes increased 39%. However, because the average age of the women in WHI was 63, there's some thought that starting HRT earlier in menopause may be less risky, says JoAnn Manson, M.D., a professor of medicine at Harvard Medical School and a WHI principal investigator. If you're beginning to deal with signs of menopause, the current thinking is that you can use hormone therapy just to control symptoms and then get off it, says Dr. McCullough. "But if you have an increased risk for stroke because of other risk factors, be cautious." And for symptoms that persist past menopause, like vaginal dryness, topical estrogen creams are considered safe because they contain less estrogen than hormone pills.

Time Lost Is Brain Lost

Six years ago, when Venita (an events manager in Atlanta who goes by her first name only) boarded a plane for a visit with her daughter, her vision was blurred and her right side was so weak and tingly she needed help with her suitcase. She chalked it up to fatigue and stress.

The next morning she woke up with a colossal headache. She took some aspirin and went back to bed. When she woke up again her right side was paralyzed.

Although African-American women have nearly twice the stroke risk as white women, it never occurred to Venita, then 46, that she was having one. Rather than call 911, she waited for her daughter to come home from work to take her to the hospital.

"Stroke is the quintessential medical emergency. The earlier I see people, the better chance I have to help them," says Lewis Morgenstern, M.D., director of the stroke program at the University of Michigan Health System in Ann Arbor. A UCLA study found that for every 12 minutes treatment is delayed, a pea-size part of the brain dies. With untreated strokes, the dead area can be as large as one and a half Ping-Pong balls.

It was a few months before Venita could walk again, two years before she was able to fully return to work, and she still has problems with tunnel vision and her short-term memory.

Reduce Your Risk

To lower your odds of having a stroke, you need to do the same things that safeguard your heart: lower your cholesterol, quit smoking, exercise daily, and eat sensibly so you maintain a healthy weight. In addition, keep an eye on your blood pressure. For every 10-point increase in your top number, you nearly double your stroke risk, says Dr. McCullough. Heart disease and stroke are closely linked. Work to reduce your risk of one, and you automatically lower your chances of suffering from the other.

You May Be Having a Stroke If You Have...

What Kind of Stroke Is It?

Ischemic stroke. More than 80% of strokes are ischemic, which means they are caused by a blockage in an artery that is in or leading to the brain. They are often treated with clot-busting drugs like tPA.

Hemorrhagic stroke. These occur when a blood vessel leaks or bursts, causing bleeding in or around the brain. Surgery is often done to repair the damage.

Silent stroke. These strokes have no symptoms. You may not know you've had one. Their damage shows up on CT scans or MRIs.

Transient ischemic attack. Known as a TIA or "mini stroke," one occurs when blood flow to the brain is reduced, though not fully blocked, causing mild stroke-like symptoms that often pass within a few minutes. TIAs can impair brain function and signal a bigger stroke to come: After one or more TIAs, stroke risk is almost 10 times higher.

Artery dissection. Roughly 20% of strokes in people under 45 result from artery dissection, in which the lining of an artery in the neck tears and closes off the blood vessel. Many things cause dissection, including trauma from an accident, weakness in blood vessels, even mild injury such as twisting or overextending your neck.



Copyright © 2008. Used with permission from the February 2008 issue of Family Circle magazine.

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