Menopause Before 40 Tied to Higher Stroke Risk

Thor Christensen wrote . . . . . . . . .

Early menopause could mean an increased risk of stroke caused by blocked blood vessels, according to a new study. Yet for each year of menopause delay, stroke risk fell by 2%.

Stroke is the second-leading cause of death worldwide, and women have a 4% higher lifetime stroke risk than men. Some studies show women who experience menopause at an earlier age have a higher risk of heart disease in general. But research has produced mixed results on the relationship between stroke and the age menopause started.

The study, published Thursday in the American Heart Association journal Stroke, looked at data from 16,244 postmenopausal women, ages 26-70, in the Netherlands.

After following the women for about 15 years and adjusting for various factors, researchers found women whose menopause occurred before age 40 had 1.5 times higher risk of ischemic stroke than women who experienced it between ages 50-54. Researchers also discovered a 2% lower stroke risk for each year menopause was delayed.

The risk between earlier menopause and stroke was limited to ischemic stroke, which is caused by a vessel blockage, and not hemorrhagic stroke, which occurs when a weakened vessel ruptures. The study also found the link between age at menopause and stroke was stronger for women who experienced natural menopause than for those who experienced menopause after surgery to remove the ovaries.

“It is of utmost important for all women to try and achieve optimal cardiovascular health before and after menopause, but it is even more important for women with early menopause,” said Dr. Yvonne van der Schouw, the study’s co-author and a professor of chronic disease epidemiology at Utrecht University in the Netherlands.

The results point to the need for new research into the link between early menopause and stroke risk, van der Schouw said, adding that further studies “may eventually lead to new, still unknown pathways and new clues for preventive measures.”

Scientists already have been studying how hormone replacement therapies in early menopause might improve cardiovascular health. According to an AHA scientific statement published last year in its journal Circulation, certain hormone replacement therapies have cardiovascular benefits, decrease the risk of Type 2 diabetes and protect against bone loss.

A growing body of research also is looking at how estrogen impacts a woman’s brain health.

A 2019 study in the journal Menopause found giving women estrogen early – within the first five years of menopause – might protect against cognitive decline. It also showed women exposed longer to natural estrogen because of longer reproductive periods had better cognitive function later in life.

Dr. Samar El Khoudary, who was not involved in the new research, said the study was limited by the use of data that relied on participant questionnaires to report details on menopause.

Still, she said, “this study as well as other similar studies help make us better aware of the risks related to menopause when it comes to cardiovascular health.”

She called for more studies to examine how hormone replacement therapy impacts age at menopause and stroke. “It’s the big elephant in the room (since) midlife women use hormone therapy to treat menopause-related symptoms,” said El Khoudary, an associate professor of epidemiology at the University of Pittsburgh’s Clinical and Translational Science Institute.

But whether or not they use hormone replacement therapy, women experiencing menopause need to educate themselves about the risk of stroke and what they can do to prevent it, El Khoudary said.

“During midlife when women transition through menopause, women need to maintain physical activity, have a healthy diet and a healthy weight, stop smoking, and get enough sleep,” she said. “At this stage, reducing their risk becomes very important.”

Source: American Heart Association

Obsessive Compulsive Disorder Linked to Increased Ischemic Stroke Risk Later in Life

Adults who have obsessive-compulsive disorder (OCD) were more than three times as likely to have an ischemic stroke later in life compared to adults who do not have OCD, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

“The results of our study should encourage people with OCD to maintain a healthy lifestyle, such as quitting or not smoking, getting regular physical activity and managing a healthy weight to avoid stroke-related risk factors,” said study senior author Ya-Mei Bai, M.D., Ph.D., a professor in the department of psychiatry at Taipei Veterans General Hospital and National Yang Ming Chiao Tung University College of Medicine, both in Taiwan.

Worldwide, stroke is the second-leading cause of death after heart disease. Stroke is a medical emergency that occurs when blood and oxygen flow to the brain are interrupted, usually by a blood clot (ischemic stroke). Less common is stroke from a burst blood vessel that causes bleeding in the brain (hemorrhagic stroke). In both types of stroke, immediate treatment is critical to prevent brain damage, disability or death. The abbreviation F.A.S.T. can help people remember the warning signs and what to do: F-face drooping, A-arm weakness, S-speech difficulty, T-time to call 9-1-1.

OCD is a common, sometimes debilitating, mental health condition characterized by intrusive, unwanted thoughts, ideas or sensations (obsessions) that make a person feel driven to do something repetitively (compulsions). The repetitive behaviors characteristic of OCD, such as hand washing, checking on things or continuously cleaning, can significantly interfere with a person’s daily activities and social interactions. Previous research found that OCD often occurs after stroke or other brain injury. What remained unclear was whether the reverse is true: can OCD increase stroke risk?

To find out, researchers examined health records from 2001-2010 from the Taiwan National Health Insurance Research Database to compare stroke risk between 28,064 adults with OCD and 28,064 adults who did not have OCD. The average age at diagnosis with OCD was 37 years, and women and men were nearly equally represented in the data. Researchers compared stroke risk between the two groups for up to 11 years.

The analysis found:

  • Adults with OCD were more than three times as likely to have a stroke from a blood clot compared to adults who did not have OCD; the greatest risk was among adults ages 60 and older.
  • OCD was an independent risk factor for ischemic stroke even after controlling for other factors known to increase stroke risk, including obesity, heart disease, smoking, high blood pressure, high cholesterol and Type 2 diabetes.
  • No difference in risk was found for a hemorrhagic stroke (burst blood vessel).
  • Similarly, medications to treat OCD were not associated with an increased risk of stroke.

“For decades, studies have found a relationship between stroke first and OCD later,” Bai said. “Our findings remind clinicians to closely monitor blood pressure and lipid profiles, which are known to be related to stroke in patients with OCD.”

Limitations of the study were that only stroke among patients who sought health care were included, so some cases may have been missed; and information on disease severity was not included along with family medical history or environmental influences. The study also was observational, so it could only show an association between OCD and later stroke; it does not prove cause and effect.

“More research is needed to understand how the mental processes connected to OCD may increase the risk of ischemic stroke,” Bai said.

Source: American Heart Association

Simple Surgery Prevents Strokes in Heart Patients

A simple surgery saves patients with heart arrhythmia from often-lethal strokes, says a large international study led by McMaster University.

Researchers found that removing the left atrial appendage— an unused, finger-like tissue that can trap blood in the heart chamber and increase the risk of clots— cuts the risk of strokes by more than one-third in patients with atrial fibrillation.

Even better, the reduced clotting risk comes on top of any other benefits conferred by blood-thinner medications patients with this condition are usually prescribed.

“If you have atrial fibrillation and are undergoing heart surgery, the surgeon should be removing your left atrial appendage, because it is a set-up for forming clots. Our trial has shown this to be both safe and effective for stroke prevention,” said Richard Whitlock, first author of the study.

“This is going to have a positive impact on tens of thousands of patients globally.”

Whitlock is a scientist at the Population Health Research Institute (PHRI), a joint institute of McMaster University and Hamilton Health Sciences (HHS); a professor of surgery at McMaster, the Canada Research Chair in cardiovascular surgical trials, a cardiac surgeon for HHS, and is supported by a Heart and Stroke Foundation career award.

The co-principal investigator of the study is Stuart Connolly who has also advanced this field by establishing the efficacy and safety of newer blood thinners. He is a professor emeritus of medicine at McMaster, a PHRI senior scientist and a HHS cardiologist.

“The results of this study will change practice right away because this procedure is simple, quick and safe for the 15 per cent of heart surgery patients who have atrial fibrillation. This will prevent a great burden of suffering due to stroke,” Connolly said.

The study results were fast tracked into publication by The New England Journal of Medicine and presented at the American College of Cardiology conference today.

The study tracked 4,811 people in 27 countries who are living with atrial fibrillation and taking blood thinners. Consenting patients undertaking cardiopulmonary bypass surgery were randomly selected for the additional left atrial appendage occlusion surgery; their outcomes compared with those who only took medicine. They were all followed for a median of four years.

Whitlock said it was suspected since the 1940s that blood clots can form in the left atrial appendage in patients with atrial fibrillation, and it made sense to cut this useless structure off if the heart was exposed for other surgery. This is now proven to be true.

Atrial fibrillation is common in elderly people and is responsible for about 25 per cent of ischemic strokes which are caused when blood clots block arteries supplying parts of the brain. The average age of patients in the study was 71.

“In the past all we had was medicine. Now we can treat atrial fibrillation with both medicines and surgery to ensure a much better outcome,” said Whitlock.

He said that the current study tested the procedure during cardiac surgery being undertaken for other reasons, but the procedure can also be done through less invasive methods for patients not having heart surgery. He added that future studies to examine that approach will be important.

Whitlock said the left atrial appendage is a leftover from how a person’s heart forms as an embryo and it has little function later in life.

“This is an inexpensive procedure that is safe, without any long-term adverse effects, and the impact is long-term.”

Source: McMaster University

Obesity in Teens, Higher Risk of Stroke Before 50

Denise Mann wrote . . . . . . . . .

Strokes are on the rise among people younger than 50, and new research suggests that packing on the pounds during the teen years is a big reason why.

The more overweight you were from ages 16 to 20, the greater your risk of having a stroke before age 50, the new study shows.

“Given ongoing trends of adolescents who are overweight and obese in the U.S., Israel and other Western countries, the future burden of stroke among young adults is expected to rise further,” said study author Dr. Gilad Twig. He is an associate professor in the medical corps of the Israel Defense Forces and the Department of Military Medicine at Hebrew University in Jerusalem.

The researchers looked at teen body mass index (BMI) and first stroke before age 50 among 1.9 million Israeli males and females. Two nationwide databases were used: the Israel Defense Forces and the Israeli National Stroke Registry. All study participants had a complete physical between 1985 and 2013 when they were 16 to 20 years old. They were ranked from underweight to obese, according to their BMI. (BMI is a measure of body fat based on height and weight.)

Follow-up between 2014 and 2018 showed there were 1,088 strokes, at an average age of 41. Some occurred before age 30.

Overweight teens had twice the risk of having a stroke before turning 50. With obesity, they had a 3.4-times higher risk for stroke, when compared to folks in the low-normal BMI group.

Even those with BMIs in the high-normal range were more likely to have a stroke before 50 than those with lower BMIs, the study showed.

The new findings were seen in men and women and held even after researchers controlled for type 2 diabetes, which is known to increase stroke risk.

Exactly how teenage obesity affects stroke risk is not fully understood yet. The study can’t say for sure that losing weight in your 20s, 30s or 40s will reduce your risk of having a stroke before age 50, as researchers didn’t look at weight loss or gain during these decades.

But “our findings underscore the importance of effective treatment and prevention of high normal and excessively high BMI during adolescence,” Twig said.

Strokes are on the rise among young people, said Dr. Deepak Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center in Boston. “The causes are multifactorial and include increasing rates of obesity, diabetes and, in some cases, illicit drug use,” he said.

Weight loss can reduce your risk of stroke, as well as the risks of heart attack, heart failure and diabetes, among other health problems, added Bhatt, who was not involved in the new study.

“The researchers have identified what appears to be a modifiable risk factor for ischemic stroke in the young — being overweight or obese in adolescence,” Bhatt said. “These data provide yet another compelling reason to encourage adolescents to be physically active and eat a healthy diet.”

You’ve been warned, said Daniel Lackland. He is a professor of epidemiology at the Medical University of South Carolina and an expert volunteer at the American Heart Association and the American Stroke Association.

The new findings don’t mean you are powerless if you were overweight or obese as a teen, said Lackland, who was not part of the study. “Quit smoking if you smoke, and if you lose weight, you lose your risk for diabetes and high blood pressure, which is at the top of the barrel for stroke risk factors,” he said.

The bottom line? “If you lose the weight,” Lackland added, “you might not eliminate your risk for stroke, but you will certainly reduce your risk of having a stroke at an early age.”

The study appears in the journal Stroke.

Source: HealthDay

5 Critical Steps to Help Prevent a Stroke

Laura Williamson wrote . . . . . . . . .

If there’s one good thing that can be said of strokes, it’s this: The vast majority of them don’t need to happen.

Up to 80% of strokes can be prevented through healthy lifestyle changes and working with health care practitioners to control stroke risk factors. Researchers have identified numerous steps people can take to lower stroke risk, but health experts agree, trying to do them all at once can feel overwhelming.

“The biggest mistake people make is they are overly ambitious, and then they fail and give up,” said Dr. Vladimir Hachinski, a Canadian neurologist and global expert in the field of stroke. “You have to start small.”

The rewards are enormous, said Dr. Cheryl Bushnell, a neurologist and director of the Comprehensive Stroke Center at Wake Forest Baptist Health in Winston-Salem, North Carolina. It’s “not just for preventing stroke, but for preventing dementia as well. You can do the same things to prevent both. You are killing two birds with one stone.”

Here are five ways to get started on the road to prevention.

If you smoke, quit

Studies show that for every five cigarettes a person smokes each day, the risk of having a stroke goes up by 12%. For Black adults, smoking cigarettes more than doubles the risk of stroke compared to never smoking, a 2020 study found.

“People understand that smoking causes lung cancer, but they don’t understand it also damages the brain and blood vessels,” Bushnell said. “In terms of stroke prevention, quitting smoking is the lowest hanging fruit.”

Move more

More active men and women have a 25%-30% lower risk of stroke than those who are least active. Physical activity has been shown to lower cholesterol, help maintain a healthy weight and lower blood pressure – all factors that can reduce stroke risk.

“The evidence for physical activity is undeniable,” said Bushnell, who co-authored a 2014 statement from the American Heart Association and American Stroke Association on stroke prevention. “Even just moving around for 10 minutes every hour is better than sitting for an extended period of time. You don’t have to run a 5K.”

Hachinski placed exercise among the top three things a person could do to lower stroke risk – and agrees it needn’t be overly ambitious. “The worst thing that can happen is to sit all day. Walking is the best exercise there is. Get up and walk around.”

Keep blood pressure under control

High blood pressure, also called hypertension, is the leading cause of strokes. Half of all men – 52% – and 43% of women in the U.S. have blood pressure that is too high, according to AHA statistics. While it can be controlled through lifestyle changes or by taking medication, only about 1 in 5 adults keep it properly managed. Smoking, diabetes, obesity, high cholesterol and eating an unhealthy diet can push blood pressure out of the healthy range.

At-home monitoring and regular communication with doctors to make sure medications are working are important to keep high blood pressure in check, Bushnell said.

“People have to keep track of their own blood pressure,” she said. “They have to know what their numbers are, know their medications and how to take them.”

Eat a healthy diet

“One of the most subtle things that happens to people as they get older is they put on weight,” Hachinski said.

Being careful to choose healthy foods can minimize weight gain, he said. But there’s value to making healthier food choices regardless of weight.

“Nutrition is more important than weight loss,” agreed Bushnell. “There are multiple diets shown to decrease the risk of stroke,” such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean diets. Both emphasize eating a lot of fruits, vegetables and low-fat dairy, whole grains, fish and nuts, while cutting back on foods high in saturated fats, cholesterol and trans fats.

Start early

Strokes happen to young people, too. About 10%-15% of all strokes occur in adults age 50 or under. Recent research shows Black young adults have up to four times the risk as their white peers.

And recent research shows the same factors that cause strokes in older adults – such as high blood pressure, high cholesterol, obesity and diabetes – are causing strokes in younger adults.

“You don’t think about disease when you are young,” Hachinski said. But that’s when good habits should start.

Hachinski recommends people start monitoring their blood pressure, cholesterol, lipids and blood sugar levels as soon as they transition from a pediatrician to a primary care physician as a young adult. “If you’re going off to college or leaving home, your habits will change at this time. You begin eating on your own. This is a good time to think about how to prevent disease.”

Other life transitions – such as moving in with a partner – should also be triggers for checking health metrics, he said. “It’s a good time to take inventory, because it’s when habits will change.”

It doesn’t have to be a massive undertaking, Hachinski said. Focus on just one thing to get started. “Identify the most important thing you are lacking,” he said. “Is it exercise? Are you snacking too much?”

Set a specific and measurable goal, he said, and then break it into parts and stick to it until you reach it. Having a partner can help maintain motivation, as long as that person has healthy habits. “If you can get someone to do it with you, you double your chances for success.”

Source: American Heart Association