Incidence of Strokes in Women On the Rise

It looks like the statisticians have finally caught up with another damaging effect of obesity and the Standard American Diet. Anybody who has an ounce of horse sense about wellness could have predicted this, but a report was just released indicating that the number of strokes in women, especially those younger than their mid-fifties, is significantly on the rise. Always a killer, strokes were once found mainly in men, and almost always in the elderly of both genders. However, it appears that even though the number of smokers, male and female, has dropped sharply, other factors such as a poor diet and a lack of regular physical exercise are taking up the slack and causing the incidence of strokes and other forms of cardiovascular disease to increase.

It is clear that the answer to restoring the health of Americans cannot be found in a pill bottle. Billions of dollars are spent on statin drugs to lower cholesterol, but it is only making people sicker. The marketing gurus in the drug companies would have us believe that we can eat anything we want, as long as we take our medicine faithfully. The truth that is being whitewashed is that our diets of fatty, artificial foods is creating an environment for disease in our bodies rather than making us well, as natural, organic foods are designed to do. The real cause behind the epidemic of national sickness is the increased inflammation in our bodies caused by eating junk that has minimal nutritional value, and actually does more harm than good. Brings to mind the old saying that does quite a good job at summing up SAD: Americans are digging their own graves with a knife and fork.


A Surge in Strokes
Rates among younger women have nearly tripled over the last decade.
Here's how to reduce your risk.

Pat Wingert and Barbara Kantrowitz
Newsweek Web Exclusive
Updated: 5:05 PM ET Mar 10, 2008

Her workday at a local school had just ended when 54-year-old Joanne Puopolo developed a headache so severe she had to pull her car off the road. The Duxbury, Mass., teacher's aide had been feeling sick all day and figured she'd caught "a bug" from one of her students. But soon after walking into her house, her left arm went stiff, and then her left hand suddenly flew up in the air. Her husband called 911, and by the time the ambulance arrived, Puopolo's entire left side was paralyzed. "I knew something was really wrong, but I wasn't thinking it could be a stroke," Puopolo says. After all, strokes only happen to elderly people, don't they? And men are much more vulnerable than women, right?

While the risk of stroke is still comparatively small before age 65, new trend data suggest that age and gender rates are starting to tip in the wrong direction for women. Not only are older women now as likely as older men to suffer a stroke, but recent health surveys indicate that the proportion of women between the ages of 35 and 54 having strokes has nearly tripled in the last decade, while the rate for men the same age has remained flat. While it's always possible that the number of strokes could have risen because of more accurate diagnoses, the fact that the same self-reporting survey was used repeatedly in a relatively brief period, gives Towfighi confidence that the rise is real.

The new incidence rates are still small - only 1.8 percent of women between the ages of 35 and 54 report having had a stroke. (About 80 percent of "brain attacks" are ischemic, caused by a blood clot or plaque that cuts off blood flow to the brain. The remainder are hemorrhagic and occur when a blood vessel in the brain leaks or ruptures.) But stroke researcher Amytis Towfighi, an assistant professor of neurology at the University of Southern California, was worried by the new numbers, a big increase from the .63 percent of women reporting strokes in this age group a decade ago. Towfighi also knew that researchers had actually expected incidence rates to fall, as the number of people taking medication to control their blood pressure and cholesterol levels rose.

This puzzling turn of events warranted more study, Towfighi decided. "I wanted to understand if this was a new phenomenon, and if so, why it was happening," she says. "Most [stroke] studies focus on individuals who are over 60. But there are now more than 1 million stroke survivors aged 25 to 59 in the United States."

After scrutinizing data from the National Health and Nutrition Surveys conducted between 1988 and 1994 and again between 1999 and 2004, Towfighi and her former colleagues at the UCLA Stroke Center were able to publish a series of studies. They confirmed that the spike in strokes among middle-aged women is new and real, and they were also able to hypothesize about the cause of the increase: the expanding waistlines and rising body mass index (or BMI, a measure of body fat based on weight and height) of midlife women.

"There was really no significant difference in women's risk factors like smoking, high blood pressure, cholesterol levels and diabetes," Towfighi says. "But when we looked at biomarkers we found that these women's BMIs and waist circumferences had increased significantly." Men had also gained weight and inches, but not as much as women. (Overall, 50 percent more women had moved into the worrisome zone with waist circumferences over 35 inches, while only one-third more men had passed 40 inches, the outer limit of normal for males.) This was a disturbing trend, Towfighi said, because abdominal fat increases the risk of stroke more than fat deposits in other places because it's "visceral" fat, meaning it wraps itself around vital internal organs.

But even women whose weight is within the normal range, like Puopolo, can be at increased risk. In the last few years Puopolo, a former smoker, had developed high blood pressure and started taking medication to control it. But side effects prompted her to stop, and she let months go by without making an appointment to get a different medicine. "I wasn't really aware how dangerous high blood pressure was," says Puopolo.

Towfighi says recent data seem to indicate that women's blood pressure is increasing at a faster rate - 8 to 10 points a decade, starting at age 35 - than men's, which is increasing by 4 or 5 points per decade. Taking medication helps reduce the risk, but it doesn't eliminate it. "Before most people started on their medication, damage was done to their blood vessels, and that increases their risk of stroke," says Towfighi.

High cholesterol, another risk factor, is also becoming a bigger problem for women. Studies indicate that before age 44 men's cholesterol tends to be higher than women's. But after age 44 women's total cholesterol begins to rise faster than men's, and by the time women are between 55 and 64 they typically have higher cholesterol levels than men.

Not surprisingly, having multiple risk factors (including smoking and using birth control pills or hormone therapy) increases the chance of stroke. So does having the constellation of conditions known as metabolic syndrome, which not only exponentially increases the overall risk of stroke but increases the risk of stroke more for women than for men, says Towfighi. Those with metabolic syndrome suffer from high blood pressure, insulin resistance, increased fat around the waist and abnormal cholesterol levels (specifically, elevated levels of triglycerides and reduced levels of high-density lipoprotein, known as HDL, or the good fats).

The lesson to be learned from this latest round of stroke research, says Towfighi, is that women should really make a point of eating a healthy diet. That means avoiding saturated fat and foods high in cholesterol, eating five servings a day of fruits and vegetables, and exercising at least a half an hour a day. Women should also know what their blood pressure is, and what normal is. The same is true of cholesterol. "We need to start curbing our risk factors early on," says Towfighi.

It's also crucial that women learn the warning signs of a stroke and know what to do if one occurs. The American Stroke Association says that if someone has any of these "five suddens" she should be rushed to the hospital to determine if she has had some type of stroke:

1) Sudden numbness or weakness, typically on one side of the body
2) Sudden difficulty speaking
3) Sudden headache
4) Sudden blurry vision
5) Sudden dizziness, or difficulty with balance or coordination

Other signs of a possible stroke include an inability to form a smile or raise both arms above the head.

These symptoms should be taken seriously, even if they last only a short time and the person resumes full function within a few minutes. Many people don't realize that a transitory stroke often comes before a full-blown stroke by hours, days or months. (Studies indicate that 10 percent of people who have a transitory stroke will have a major stroke within a week, and 20 percent will have one within three months.) Quick diagnosis and treatment can save lives, prevent disability and, in the case of transitory stroke, lower the chance that a more severe stroke will soon follow.

It's also important to realize that the warning signs of stroke in women tend to be "more nonspecific, like feeling weak all over or having a headache," Towfighi says. As a result, some women hesitate to call an ambulance or even their doctor. That may help explain why a woman is more likely to die after having a stroke than a man.

"People need to take all strokes seriously," says Towfighi, who suggests that you call 911 immediately, because time is of the essence. "If you call your doctor or try to drive yourself to the hospital, it may take too long," she says. "You want to get treatment initiated within three hours."


Strokes kill about 200,000 Americans a year and are the third leading cause of death, after heart disease and cancer, and the leading cause of adult disability. Puopolo, the mother of two sons, was one of the lucky ones. She was flown via helicopter to Massachusetts General Hospital for emergency surgery. Once discharged, she spent weeks in a rehabilitation center. Three months later, she's now home, but she continues with occupational and physical therapy. She still doesn't have full use of her left hand. She can't drive, and a lot of everyday tasks remain difficult. "When this first happened, and people heard that I'd had a stroke, they would say, 'She's too young to have had a stroke'," says Puopolo. But as she found out, you're never too young to take steps to reduce the risk that it could happen to you.

URL: http://www.newsweek.com/id/120369