Long Work Hours Associated with Increased Risk of Stroke

People who worked long hours had a higher risk of stroke, especially if they worked those hours for 10 years or more, according to new research in the American Heart Association’s journal Stroke.

Researchers reviewed data from CONSTANCES, a French population-based study group started in 2012, for information on age (18-69), sex, smoking and work hours derived from questionnaires from 143,592 participants. Cardiovascular risk factors and previous stroke occurrences were noted from separate medical interviews.

Researchers found:

  • overall 1,224 of the participants, suffered strokes;
  • 29% or 42,542, reported working long hours;
  • 10% or 14,481, reported working long hours for 10 years or more; and
  • participants working long hours had a 29% greater risk of stroke, and those working long hours for 10 years or more had a 45% greater risk of stroke.

Long work hours were defined as working more than 10 hours for at least 50 days per year. Part-time workers and those who suffered strokes before working long hours were excluded from the study.

“The association between 10 years of long work hours and stroke seemed stronger for people under the age of 50,” said study author Alexis Descatha, M.D., Ph.D., a researcher at Paris Hospital, Versailles and Angers University and at the French National Institute of Health and Medical Research (Inserm). “This was unexpected. Further research is needed to explore this finding.

“I would also emphasize that many healthcare providers work much more than the definition of long working hours and may also be at higher risk of stroke,” Descatha said. “As a clinician, I will advise my patients to work more efficiently and plan to follow my own advice.”

Previous studies noted a smaller effect of long work hours among business owners, CEOs, farmers, professionals and managers. Researchers noted that it might be because those groups generally have greater decision latitude than other workers. In addition, other studies have suggested that irregular shifts, night work and job strain may be responsible for unhealthy work conditions.

Source: American Heart Association

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Is It Fatigue — Or a Stroke? Women Shouldn’t Ignore These Warning Signs

Stroke is a leading cause of death and disability in the U.S., and women make up nearly 60% of all stroke deaths.

Why?

In part, experts say, women may have symptoms subtle enough to be missed or brushed off in the daily juggle of work-life balance. That can lead to delays in getting time-sensitive, lifesaving treatments.

Men and women who have strokes often experience a similar set of symptoms that can be remembered using the mnemonic F.A.S.T.: face drooping, arm weakness, speech difficulty, time to call 911. Other signs include problems seeing out of one or both eyes and balance or coordination problems.

But some women experience other, more understated symptoms they may hesitate to bring to a doctor’s attention — or to a 911 operator.

“Women more frequently have atypical, vague symptoms. They might start with fatigue, confusion or maybe general weakness, as opposed to weakness on one side of the body,” said Dr. Pooja Khatri, a neurology professor at the University of Cincinnati.

Khatri advised taking note of any sudden change or unusual body function.

She said many women may disregard something like a sudden, unusually bad headache if they’re generally used to getting headaches. Or, they may dismiss difficulty walking, exhaustion, brain fog or an overall malaise and instead blame it on stress or being overworked. Nausea or vomiting often gets explained away to viral illnesses.

It’s critical to zero in on “any sudden symptom or loss in function that you can’t explain. The key is that it’s sudden,” said Khatri, director of the University of Cincinnati Stroke Team.

Studies suggest women are just as knowledgeable as men, if not more, about recognizing the more typical stroke symptoms. Yet because women are more likely than men to minimize their symptoms, they’re also more likely to reach out to their primary doctor or drive themselves to the hospital instead of calling 911, said Dr. Amytis Towfighi, director of neurological services for Los Angeles County Department of Health Services.

“The key to getting the treatments we have available is having the ambulances alert the hospitals that they’re coming with a stroke patient, so that the whole team is activated and ready to give the medication,” said Towfighi, an associate professor of neurology and preventive medicine at the University of Southern California’s Keck School of Medicine.

“Whereas if you just walk into the ER, you might be stuck in triage waiting to be seen. And since women in particular may have nontraditional symptoms, the staff may not figure out right away that they’re having a stroke, and there could be delays in getting seen and getting treatment.”

Minutes matter during a stroke, which happens when the brain is deprived of oxygen after blood flow is cut off by a clot or a ruptured vessel. Treatment is extremely time-sensitive, and delays can increase the risk of death or permanent brain damage.

When deciding whether to seek help, Khatri said women — and men — should be comfortable with the idea of a potential false alarm.

“It’s not worth the risk of it being a true stroke that you failed to get treated for quickly,” she said.

“Time is brain, and the longer you take to get definitive treatment, the more brain (tissue) that’s going to die, and the less well you’re going to be in the long run. In fact, fast treatment can even completely reverse the stroke. It’s worth taking that risk of being wrong. You want to err towards being seen.”

Source: HealthDay


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Study: Dietary Cholesterol or Egg Consumption Do Not Increase the Risk of Stroke

A new study from the University of Eastern Finland shows that a moderately high intake of dietary cholesterol or consumption of up to one egg per day is not associated with an elevated risk of stroke. Furthermore, no association was found in carriers of the APOE4 phenotype, which affects cholesterol metabolism and is remarkably common among the Finnish population. The findings were published in the American Journal of Clinical Nutrition.

Findings from earlier studies addressing the association of dietary cholesterol or egg intake with the risk of stroke have been contradictory. Some studies have found an association between high dietary cholesterol intake and an increased risk of stroke, while others have associated the consumption of eggs, which are high in cholesterol, with a reduced risk of stroke. For most people, dietary cholesterol plays a very small role in affecting their serum cholesterol levels. However, in carriers of the apolipoprotein E phenotype 4 – which significantly impacts cholesterol metabolism – the effect of dietary cholesterol on serum cholesterol levels is greater. In Finland, the prevalence of APOE4, which is a hereditary variant, is exceptionally high, with approximately one third of the population presenting as carriers. Yet, research data on the association between a high intake of dietary cholesterol and the risk of stroke in this population group has not been available until now.

The dietary habits of 1,950 men aged between 42 and 60 years with no baseline diagnosis of a cardiovascular disease were assessed at the onset the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984–1989 at the University of Eastern Finland. APOE phenotype data were available for 1,015 of the men participating in the study. Of those, 32% were known carriers of APOE4.

During a follow-up of 21 years, 217 men were diagnosed with stroke. The study found that neither dietary cholesterol nor egg consumption was associated with the risk of stroke – not even in carriers of APOE4.

The findings suggest that moderate cholesterol intake or daily egg consumption are not associated with the risk of stroke, even in persons who are genetically predisposed to a greater effect of dietary cholesterol on serum cholesterol levels. In the highest control group, the study participants had an average daily dietary cholesterol intake of 520 mg and they consumed an average of one egg per day, which means that the findings cannot be generalised beyond these levels. One egg contains approximately 200 mg of cholesterol. In this study, about a fourth of the total dietary cholesterol consumed came from eggs. Furthermore, the generalisability of this study is also weakened by the fact that the study population did not have a pre-existing cardiovascular disease at baseline and the size of the study population was relatively small. Therefore, the findings of the study should be verified in a larger cohort as well as in people with a pre-existing cardiovascular disease, who are currently advised to limit their intake of cholesterol and eggs.

Source: University of Eastern Finland

Acetaminophen Safe For Most Older Adults—But May Increase Stroke Risk For Those With Diabetes

Acetaminophen (otherwise known by brand names such as Tylenol) is one of the most widely used pain relievers. Almost 60 years of widespread use have made acetaminophen a household product. It’s distributed over the counter (OTC) in most countries and judged safe by the scientific community. However, acetaminophen is also one of the most common medications involved in overdoses (the medical term for taking more of a medicine than you should) and is the most common cause of drug-induced liver failure.

Surprisingly, we are only now coming to understand how acetaminophen works—and recent research shows that we may need to develop a better understanding of the need for caution when using acetaminophen, especially when it comes to avoiding some of the risks associated with its use. Past research suggests these can range from increased asthma to interactions with other medications or the risk for developing other health concerns (such as kidney toxicity, bone fractures, or blood cancers).

Another important reason to look more carefully at all medications is that our bodies may react to these treatments differently as we age. Older adults experience physical changes as they age including, for example, reduced muscle mass, more fat tissue, changes in body composition, and less fluid in the body systems. Older people may also have multiple chronic conditions and take several different medications. These issues affect many different body functions, and that can raise your risk of having an unwanted reaction to a medication.

For all these reasons, a team of researchers decided to study the safety of acetaminophen in a nursing home setting. Their study was published in the Journal of the American Geriatrics Society.

The researchers’ aim was to explore any connection between acetaminophen use, death, and major heart events such as strokes and heart attacks in a large group of older adults living in nursing homes in southwestern France.

The researchers used information from the IQUARE study, which relied on two different questionnaires completed online by nursing home staffers. The researchers looked at deaths, heart attacks, and strokes that took place during the 18 months of the study period.

Of the 5,429 participants in the study, 3,190 were not taking acetaminophen and 2,239 were taking acetaminophen. Participants were around 86 years old and 74 percent were women.

The researchers reported that acetaminophen did not affect the number of heart attacks the participants experienced. There also was no increase in overall deaths.

The researchers found that the number of strokes was about the same in both groups—about 5 percent of the people who took acetaminophen had strokes, while about 4 percent of those who did not take acetaminophen had strokes. However, in participants who had diabetes, there was a slightly higher risk for stroke among people who took acetaminophen.

The researchers concluded that acetaminophen is a safe first choice in pain management for most older adults but should be considered with a bit more caution for older adults with diabetes.

As the population gets older and frailer, studies need to focus on the safety of the drugs these frail older adults commonly use to better our practice, said the researchers.

“My personal message to the people in my everyday practice is that any drug they take may have some form of harmful side effect unknown to them, even those they can buy over the counter. It is always best to check with your health care provider before you take any new medication, and make sure you’re taking the dose that’s right for you,” said study author Philippe Gerard, MD.

Source: Health In Aging


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The Often-Overlooked Connection Between Sleep Apnea and Stroke

Getting a good night’s sleep can be difficult for many, but restful slumber can be especially hard for stroke survivors. And although various studies have examined the association, doctors continue to overlook the interplay between sleep disorders and stroke, finds a new report on the issue.

More than 50 percent of stroke survivors are estimated to have some type of sleep problem, yet few get formally tested, in part because of “the lack of awareness” among stroke providers, according to the review published Thursday in the American Heart Association journal Stroke.

In addition to increasing stroke risk, sleep disturbances may worsen after a stroke, the report said. So, remedies to reduce sleep impairments could help prevent a first or subsequent stroke.

Sleep apnea is a condition in which breathing is repeatedly stopped and restarted because of changes in airflow. The report said more than 70% of stroke survivors have a specific condition known as obstructive sleep apnea, in which the tongue or other obstruction blocks airway in the throat.

This can cause a person to snore or to stop breathing entirely for several seconds before gasping for air, disrupting sleep in the process. One study cited in the new report found people with obstructive sleep apnea had a nearly twofold increase in stroke or death.

People with severe cases of obstructive sleep apnea may find their sleep interrupted more than 30 times per hour, said Dr. Sandeep Khot, the report’s senior author and an associate professor of neurology at the University of Washington School of Medicine in Seattle.

“You end up with what we call fragmented sleep. Your sleep is fitful because you never really get into slow-wave sleep or REM sleep, the deeper types of sleep that are associated with feeling refreshed the next day. This may affect your recovery from stroke, along with the physiologic changes that happen with your body, especially blood pressure changes,” Khot said.

It can particularly lead to high blood pressure, or hypertension. That may be a reason why some doctors miss the connection between sleep disorders and stroke, said epidemiologist Donna Arnett, dean of the University of Kentucky College of Public Health.

High blood pressure is the strongest risk factor for stroke, but another big contributor is obesity, and both are strongly associated with sleep apnea, she said.

“Most clinicians caring for stroke patients have probably thought that it’s the hypertension and the obesity that are the causal factors for stroke and they may have missed the association with sleep apnea,” said Arnett, who was not involved in the review.

Continuous positive airway pressure, or CPAP, has been deemed “the gold standard of treatment” for obstructive sleep apnea. But many people consider CPAP treatment, which involves wearing a mask during sleep, challenging and don’t always use it.

While there are other treatments available for sleep apnea, Khot said CPAP is the primary one for stroke survivors. “We really have to have an open mind on who may and may not tolerate the treatment.”

Khot said a large study, called Sleep SMART, is currently recruiting patients and will examine the impact of CPAP treatment for people who have either had a stroke or a high-risk TIA, a transient ischemic attack often called a mini-stroke. The study will look at the treatment’s ability to prevent a second stroke, as well as recovery from the first one.

For now, he’d like to see more health care providers who work with stroke survivors start incorporating questions about sleep patterns into visits.

“We think of the traditional risk factors for having another stroke or vascular event — hypertension, diabetes, cholesterol, smoking. But most of us don’t ask about sleep apnea,” Khot said. “Just simple questions about sleep. And if you have someone who has had a stroke, consider a low threshold for sending them to a sleep center for testing.”

Source: HealthDay


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