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Are You At Risk For A Stroke?

You’re eating oatmeal regularly to lower cholesterol. You’re also keeping an eye on your blood pressure, and maybe even taking a statin drug. You’re sure you’re doing everything you can to prevent cardiovascular disease and a stroke.

But if you’re female, middle-aged and overweight, your expanding waistline represents a danger you’ve probably never considered.

Research presented at the International Stroke Conference in February 2008 revealed a significant increase in strokes among middle-aged women. Comparing two federal health surveys – one conducted from 1988 to 1994 and another from 1999 to 2004 – the later survey showed a threefold increase in strokes among women ages 35 to 54.

Surprisingly, the typical variables – high blood pressure, blood cholesterol, smoking and diabetes – didn’t change much between the two study periods.

What did change?

Women in the later study were heavier, with an average body mass index (BMI) of about 28.7, up from about 27.1. For a woman who is 5 feet 4 inches tall, that represents a change from 158 pounds (BMI of 27.1) to 167 pounds (BMI of 28.7). The women’s average waist size went up too – about 1.6 inches.

A spare tire also endangers men. Research published in the Archives of Internal Medicine in 2002 showed that men with a BMI of 30 (considered obese) or higher had twice the stroke risk of men with a BMI of less than 23.

This article will outline ways to shed the fat, enhance your fitness and minimize your risk of a stroke.

Understanding Strokes
Strokes occur when a blood vessel that carries blood to the brain is blocked by a clot or when a blood vessel breaks and blood leaks into the brain.

Each year about 780,000 U.S. adults have a stroke. About 150,000 people die from a stroke annually, and those who survive often experience long-term disability.

The odds of having a stroke double each decade after age 55. And although men are more likely to have a stroke, more women die from one. African-Americans are at much higher risk, in part because of greater rates of high blood pressure, diabetes and obesit

Key risk factors for a stroke include:

• Prior heart attack, stroke or transient ischemic attack (a “warning stroke” that does not cause lasting damage)
• Family history of stroke
• High blood pressure
• Smoking
• Diabetes
• Artery disease
• Atrial fibrillation, a disorder in the heart’s rhythm
• Heart disease
• Sickle-cell disease
• High total blood cholesterol and low HDL (good) cholesterol
• Obesity
• Sedentary lifestyle
• Abuse of alcohol, cocaine, amphetamines or heroin

Taking oral contraceptives also increases the chances of a stroke. Women over 35 who take birth-control pills and smoke are especially endangered. Pregnant women experience a temporarily greater risk as well.

Successful treatment of a stroke depends on an immediate response – within three hours of the onset. The American Stroke Association uses the phrase “Give Me 5” to teach the warning signs of stroke:

1. Walk – is the person’s balance off?
2. Talk – is speech slurred or face droopy?
3. Reach – is one side weak or numb?
4. See – is vision all or partly lost?
5. Feel – does the person have a severe headache?

Call 911 immediately if you or someone else experiences any of these signs.

Eat Better To Avoid A Stroke
A healthy food plan includes plenty of vegetables and fruits and is low in fat and refined carbohydrates. It turns out that such a diet is also ideal for losing fat, decreasing blood pressure and reducing the risk of a stroke.

There’s no need to go out and buy the latest diet book. The DASH eating plan – Dietary Approaches to Stop Hypertension – developed by the National Heart, Lung and Blood Institute (NHLBI) is available online at no charge. To download “Your Guide to Lowering Your Blood Pressure With DASH,” which includes recipes, or a condensed version, visit www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm.

DASH limits dietary sodium – which is correlated to high blood pressure – as well as saturated fats, trans fats and cholesterol. At the same time, it encourages higher intakes of:

• Vegetables and fruits
• Whole grains rather than refined carbs
• Lean meat, poultry and fish
• Fat-free or low-fat dairy
• Beans, seeds and nuts

“NHLBI studies have shown that the DASH eating plan can significantly lower high blood pressure, even within the first few weeks,” said NHLBI director Elizabeth G. Nabel, M.D., when the updated plan was released in 2006. And lowering your blood pressure can help you decrease your risk of having a stroke.

Depending on your size and whether you need to maintain or lose weight, DASH indicates precisely how many servings from each major food group you need every day.

Lose Fat To Reduce The Risk Of A Stroke
A safe, healthy rate of fat loss is one to two pounds a week. That might seem like a snail’s pace, but studies prove that those who reduce weight slowly are more likely to keep it off. And people who keep the weight off reduce their risk of a stroke.

Most people can achieve a one- to two-pound weekly loss by adding 30 minutes of exercise, such as walking, five or six days a week and by cutting daily calories by 300 to 500.

If you drink sugary sodas and consume junk food on a daily basis, eliminating those and eating a balanced diet may be enough to start the fat loss.

If you’re eating right and exercising but reach a plateau, make sure you’re not consuming too many calories. Measure or weigh your food and count calories for a week or two to make sure you’re not eating more than you think – a common phenomenon for dieters.

Ever-larger meals at restaurants have left most people with portion distortion and no idea of reasonable serving sizes. Dieticians train clients to reduce overeating by visually comparing portions to everyday objects.

A three-ounce serving of meat, poultry or fish, for example, is about the size of a deck of cards. A half-cup serving of potatoes, rice or pasta is about half the size of a baseball.

Finally, you’ll experience a major improvement in health and a reduction in disease risk by losing even 5 percent to 10 percent of your current weight, according to the National Heart, Lung and Blood Institute.

Get Active To Prevent Strokes
U.S. scientific organizations agree that to stave off disease, maintain weight and stay healthy into old age, adults should get at least 30 minutes of moderately intense physical activity on most days of the week.

A 2008 study presented to the International Stroke Conference concluded that both men and women with higher levels of cardiovascular fitness enjoyed about a 40 percent lower stroke risk than those who were least fit.

Start by setting goals that are specific, attainable and forgiving, advises the National Heart, Lung and Blood Institute. A good example is deciding to walk 30 minutes, five days a week.

If it’s too hard to take 30 minutes at a time, break up the activity into two 15-minute or three 10-minute bouts. The health benefits are just as significant.

More ways to increase your activity, courtesy of the American Heart Association:

• Do your own housework
• Rake leaves, dig in the garden or mow the grass with a walk-behind mower
• When possible, walk or bike to run errands
• Stand or pace while talking on the phone
• Park at the far end of parking lots
• Schedule walking meetings with employees or clients
• Take stairs, not elevators
• Plan active vacations that include hiking, swimming or rowing

See Your Doctor For Stroke Risk Factors
As you work to improve your nutrition and exercise habits, stay in touch with your doctor so she can monitor other risk factors that can lead to a stroke.

Have your blood pressure (BP) checked every year or two if it’s normal. Have it checked more frequently if you have a family history of high blood pressure or if your BP is greater than 120/80. A BP of 140/90 or more is considered high risk.

Know your blood cholesterol numbers. Total blood cholesterol should be 200 mg/dL or lower; 240 or higher is high risk.

For good cholesterol, or HDL, a higher number is better. A level of 60 or above is ideal; high risk is less than 40 for men, less than 50 for women.

LDL, or bad cholesterol, should ideally be less than 100; 160 or more is high, and 190 or greater is very high.

In addition, taking low-dose aspirin may reduce the risk of stroke, although it can increase the chances of developing an ulcer. Ask your doctor whether aspirin therapy is right for you.

For More Information
For more information on increasing fitness, losing weight and reducing your risk of a stroke, visit these Web sites:

Choose to Move is an initiative for women from the American Heart Association
www.choosetomove.org/

My Start Online from the American Heart Association includes information on workplace fitness
www.mystartonline.org/

Obesity Education Initiative from the National Heart, Lung and Blood Institute offers a menu planner, a BMI calculator and tips on portion control
www.nhlbi.nih.gov/NASE/oei/index.htm