A Woman’s Issue Too
There’s a whole highly-paid industry out there that exists solely to get you to fork over your hard-earned cash. Advertising is big business and the people involved in it are on a constant search for exactly the right word that will make your eyes mist over and your pocketbook flip open. A few years ago the magic phrase was “oat bran,” and before that, “fresh” was the adjective applied to everything from laundry soap to toothpaste. For a while, anything labelled “natural” seemed desirable, but today’s savvy shopper is looking out for “low fat” on everything from yogurt to junk food.
Low fat may eventually be succeeded by some other term, but it’s not likely to fade away. North Americans plainly like the taste of fat-laden foods, but they’re beginning to recognize the importance of controlling the intake of dietary fat.
As blood levels of cholesterol rise, so does the risk of developing atherosclerosis, a condition known commonly as “hardening of the arteries” that leads to heart attack and stroke. By 55, women, on average, have higher cholesterol levels than men, with higher concentrations of LDL, the low-density lipoprotein that is believed to retain cholesterol in the bod HDL, high-density lipoprotein, is the “good” cholesterol believed to deliver cholesterol to the liver for elimination. If diet alone can’t lower LDL and raise HDL, medication may be necessary.
Many women, 50 and older, carefully planning low fat meals for their mates may not realize these same meals are important for their own good health. Most of them fear cancer, but it’s heart diseases and stroke that are killing far more women. The latter two figure in 41 per cent of all deaths of Canadian women (37 per cent for men).
In fact, the idea that heart attack and stroke are men’s diseases breaks down dramatically after a woman reaches menopause. By age 75, the mortality rate from stroke for women is 26 per cent higher than that of males the same age.
While it’s believed hormone replacement therapy has some effect reducing the frequency of stroke, recent randomized treatment studies have indicated this may not actually be the case. “Hormonal status obviously has something to do with it,” says Dr. Stephen Phillips, a neurologist and spokesman for the Heart and Stroke Foundation of Canada, “but there may well be other factors that we don’t properly understand.”
For older women living alone, a stroke could mean loss of control over their lives. “One of the things that really makes a difference to recovery is having supportive family and a supportive home situation,” he says. “The gender issue here is that when men have strokes, they can go home and be cared for by their wives. When women have strokes, their men are either dead or gone – as in divorced, separated – or not house-trained… There are a lot of Canadian homes where the woman runs the household, so if a woman is 70 and married to a man who is fairly frail and 75, he may not have the capability to care for her at home when she returns from a stroke.”
Men’s strokes usually occur at an age 10 years younger than those of women’s, so they usually have a wife to return to following hospitalization and rehabilitation. Women often spend more time in hospital (42 days versus 30 for men) as a result of social and medical factors, not neurological status. And they’re more likely to be discharged to nursing homes or long-term care facilities than are men.
The task of caring for a mate disabled by stroke is difficult, stressful and too physically demanding for many older women. And provincial health-care systems can’t always be counted on to provide adequate home care assistance and respite care.
The American Heart Association reports the incidence of stroke doubles every 10 years following the age of 55.
“Unfortunately,” says Phillips, “the older you get, the less good the recovery is. All the biological explanations for that aren’t understood, but we notice in clinical practice how a young person with stroke will tend to make a better functional recovery than an older person with the same kind of stroke.
“Elderly people also tend to have more radical problems. They’ve lived longer and have more things wrong with them,” he says. These other medical conditions have to be considered during their treatment and may limit recovery.
Beyond physical disability, loss of language (aphasia), and the emotional fallout of this life-changing illness – one tragic result of stroke can be dementia. This outcome adds an even greater personal, societal and economic burden.
Stroke has a huge healthcare price tag and ominously, the Heart and Stroke Foundation estimates the number of strokes could rise by 68 per cent in the next 20 years. A 1993 study reported direct costs (for doctors, hospitals and medications) for treating women with stroke amounted to $777 million. Indirect costs, including the loss of future earnings caused by premature death, were estimated at $566 million.
These figures will surely rise as Canada’s female population ages. At the present time, approximately 58 per cent of Canadians over 65 are women. By 2016, almost one fifth of the country’s women will be 65-plus.
To encourage better outcomes for patients and control costs, the Canadian Stroke Society, Heart and Stroke Foundation of Canada and Canadian Association of Emergency Physicians are taking action to help hospitals across the country treat stroke as a brain attack – a medical emergency. They’ve developed STEP: the Stroke Treatment Educational Program, an organized stroke care plan to rapidly assess and treat people who arrive in emergency rooms with acute stroke.
Although they can’t stop the march of time, women can take steps to hold its ravages at bay. (Aging, of course, is a risk factor for stroke that can’t be changed but there are several that can be modified.) A yearly medical check-up helps determine the “invisible” risk factors. Good medical care, and compliance with doctor’s orders is particularly important in preventing a stroke once one has already had a stroke or heart attack.
“All the general lifestyle things that apply for preventing heart attack also apply for stroke,” notes Dr. Phillips, adding that the number one risk to check is hypertension. “People can have high blood pressure without knowing it. It’s only the complications of high blood pressure that cause symptoms, and the most serious complication of high blood pressure is having a stroke.”
Significantly, after age 55, women are more likely than men to have high blood pressure. Untreated high blood pressure brings with it a 40 per cent chance of stroke within 10 years. The Heart and Stroke Foundation notes 66 per cent of the strokes women suffer can be blamed on hypertension. Almost five million adult Canadians have high blood pressure, but only 16 per cent are treated and controlled. Another 23 per cent have been treated, but don’t follow their doctor’s orders and take their medication properly.
“Probably at the top of the list for lifestyle things is not smoking,” comments Phillips. A less common, but still important – and treatable – risk factor is atrial fibrillation, where the muscle fibres in the upper chambers (atria) of the heart beat out of rhythm. This ineffective beating predisposes to stroke, “on average by a factor of five,” Philips notes. The risk increases dramatically with age – from 1.5 per cent for women in their 50s to almost 24 per cent for women in their 80s. You may not notice this irregularity, so an annual checkup is important. “The good news is that medication (the anticoagulant warfarin) can substantially reduce the risk by about two-thirds. Those who can’t take warfarin, who take Aspirin, reduce the risk by about a fifth.”
Women with diabetes are particularly at risk for cardiovascular disease, including stroke, so careful monitoring of blood glucose is vital. And just as weight control is a factor in controlling diabetes, it’s a significant element in reducing hypertension and in preventing stroke. Two thirds of older women are overweight, according to a 1999 Report Card on Canadian Health for the Heart and Stroke Foundation.
Almost as many admit to a lack of physical activity. It appears they don’t recognize the beneficial effect exercise has on hypertension, diabetes, weight control and reducing the risk of cardiovascular disease.
He’s also concerned busy women, whose attention may be focused on other family members, may ignore significant warning signals like transient ischemic attacks (TIAs), known commonly as mini-strokes.
“These are stroke symptoms that come and go, usually within 10 or 15 minutes TIAs are important because they’re a warning of a stroke coming, and of increased risk of heart attack. “It’s important they get medical attention, to investigate why it occurred and what treatment is needed to minimize the risk of a stroke or heart attack.”
Waiting to see if the symptoms will disappear is dangerous, because current treatment for stroke requires the patient be assessed and treated within three hours of the onset of symptoms. “We like to see people quickly because it gives us the most scope to intervene,” he says. There’s some evidence race plays a role in the incidence of strokes. Afro- and Asian-Canadians appear to have a greater risk of stroke, while Canadian native women are twice as likely to have a stroke as are non-native women. It’s difficult to do studies in this area, however, as race is not usually included in potentially useful data such as hospital admissions.
Symptoms of stroke may be similar for both men and women, but more research is needed into areas of stroke prevention and therapy for women. Some of the issues: Can more be done to help women recover and reintegrate into society following a stroke? Are drug dosages based on research gleaned from men appropriate for women? And what role do hormones play in stroke prevention?