Women Face Unique Risks for High Blood Pressure and Stroke

Women have a lot on their plates, and sometimes important self-care can take a back seat to work, family and other obligations. In fact, nearly 50% of adult women have high blood pressure, and nearly three-quarters of those with high blood pressure don’t have it under control. Uncontrolled high blood pressure can significantly increase a woman’s risk for a stroke, but a few important steps can help reduce that risk and give women (and their loved ones) one less thing to worry about.

“High blood pressure is a leading cause of stroke and we know that 1 in 5 women will have a stroke and stroke kills more women than breast cancer,” according to Dr. Monik Jiménez, a volunteer with the American Heart Association / American Stroke Association and associate epidemiologist at Brigham and Women’s Hospital and assistant professor of Medicine at Harvard Medical School and Harvard T.H. Chan School of Public Health.

“While high blood pressure isn’t directly linked to gender, different health issues throughout a woman’s life, such as birth control, pregnancy, and menopause, can increase the risk of developing high blood pressure, which can increase the risk of stroke if left uncontrolled,” according to Jiménez.

Doctors and researchers have found a link between birth control pills and an increase in blood pressure among some women. They say that it is more likely to occur in women who are already overweight, have kidney disease or have a family history of high blood pressure. A combination of birth control pills and smoking can be very dangerous to women and is not recommended.

A woman’s health during pregnancy can be a preview of her health in the future. Women who had high blood pressure during pregnancy are at an increased risk for developing high blood pressure and having a stroke later in life.

The physical changes associated with menopause also increase a woman’s risk of developing high blood pressure.

Of note, women of Black and Hispanic ethnicity may develop high blood pressure at a younger age and have a higher average blood pressure than other racial groups, according to the Centers for Disease Control and Prevention.

Fortunately, 80% of strokes may be prevented and lowering high blood pressures reduces stroke risk. Women can measure their blood pressure at home regularly and let their doctors know if it’s normally above 120/80. In addition, lifestyle adjustments such as getting enough exercise, eating healthfully, maintaining a healthy weight, and not smoking can go a long way to reduce women’s disease risk from high blood pressure.

Source: American Heart Association

Device Used for Thousands of Years Eases Major Cause of Female Urinary Problems

Amy Norton wrote . . . . . . . . .

Many women with pelvic organ prolapse may get lasting relief from a treatment that’s been around for a few thousand years, a new study suggests.

With pelvic organ prolapse (POP), weakened muscles and supporting tissue in the pelvis allow one or more organs — including the uterus, bladder or rectum — to protrude into the vagina.

Often, women with the condition do not have symptoms and don’t need treatment, while more severe cases may require surgery to restore support to the pelvic organs. Another option to provide that support is a pessary, a device that’s inserted into the vagina.

Versions of the pessary have been used for centuries, yet there has been little research on the long-term effectiveness.

In the new study, Chinese researchers led by Dr. Lan Zhu, from the department of obstetrics and gynecology at Peking Union Medical College in Beijing, found that three-quarters of women given pessaries to treat POP were still getting symptom relief five years later.

The findings, published recently in the journal Menopause, are based on just 239 patients. But almost all had stage 3 or 4 POP, where the pelvic organs have dropped to or beyond the opening of the vagina.

The symptoms can include not only pressure and pain, but also urinary problems like leakage or difficulty voiding.

Considering that, the outcomes in this study are “pretty convincing,” said Dr. Stephanie Faubion.

Faubion, who was not involved in the study, is medical director of The North American Menopause Society and director of the Mayo Clinic’s Center for Women’s Health.

“I think this is a great conservative option,” she said. “There’s little downside to trying it.”

Kegel exercises, which help strengthen the muscles of the pelvic floor, may also ease symptoms. And Faubion said that even if women are using a pessary, learning Kegels is a good idea.

Pessaries are medical-grade silicon devices that come in various shapes and sizes, explained Cassandra Shaw, a urogynecology nurse practitioner at Duke Health, in Durham, N.C.

The devices do require care, she pointed out. They have to be removed and cleaned, and replaced at intervals. And if women cannot do that on their own — either because of the type of pessary, or difficulty managing it — that would mean more frequent visits to their provider.

And that could dim their satisfaction with the option, Shaw noted.

On the other hand, pessaries are a generally safe option; Shaw said complications are “rare.”

When they do happen, they include ulcerations of the vaginal tissue and bleeding. The odds of those problems can be minimized, Shaw said, if women use vaginal moisturizers or estrogen creams to protect thinning tissue from becoming irritated.

In this study, she noted, women were prescribed estrogen creams, unless there was a medical reason to avoid them.

The study included 265 women who were 69, on average, and had a “successful” pessary fitting to manage POP. (In another 47 women, the fitting failed, usually because patients found it uncomfortable or the device failed to stay in place.)

The findings show that pessaries are an “effective and safe long-term management option,” Shaw said.

Certain factors did lower the likelihood of long-term success: Women whose urinary symptoms were not improved after three months were less likely to stick with the devices.

“There are pessaries specifically for stress urinary incontinence that can support the urethra and provide relief,” Shaw pointed out.

But, she added, those devices may or may not do the trick, depending on the degree of prolapse.

For some women, Shaw noted, the pessary can actually “unmask” previously unrecognized urinary incontinence: Sometimes the prolapsed tissue obstructs the urethra, the duct through which urine moves out of the bladder. So once those prolapsed tissues are supported by the pessary, the incontinence becomes apparent.

All in all, though, both experts said the conservative route is worth trying.

“Surgery is not fool-proof, either,” Faubion pointed out. It carries potential long-term risks, including incontinence and pain during sex.

Source: HealthDay

How Science Evolved Its Views on Women’s Health

Michael Merschel wrote . . . . . . . . .

Men and women are different.

This might sound like the opening to a comedy routine, but scientific understanding of the significance of those differences – and how to study them – evolved slowly in recent decades.

Researchers who have been part of historic investigations say science had to overcome its own blind spots.

The awareness has been gradual, said professor Linda Van Horn, chief of the nutrition division in the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

“It wasn’t a moment in time. It was growing recognition, as most things in medicine are,” she said.

Eventually, researchers accepted that figuring out how men and women are different biologically was worthy of exploration. “It now seems kind of laughable, if you think about it,” Van Horn said.

The contrasts can be critical. Considering heart health alone, women now are known to suffer more from the effects of smoking and can exhibit different heart attack symptoms.

The barriers to understanding such differences were not always simple sexism, said Dr. Frank Speizer, the Edward H. Kass Distinguished Professor of Medicine at Harvard Medical School in Boston.

“I think everybody knew women got the same diseases” as men, said Speizer, who also is a professor of environmental health at the Harvard T.H. Chan School of Public Health. But when it came to heart disease, accepted wisdom declared women were protected until menopause. Research would disprove that. “But people thought that at the time. And therefore, to make a career, you had to study where the disease was,” he said. “And the disease was in men.”

Speizer was the founding principal investigator of the Nurses’ Health Study, one of the most significant studies of women’s health ever undertaken.

It aimed to look at the health effects of oral contraceptives. Speizer and his colleagues modeled their work after a famous English survey of doctors that linked smoking and cancer. Based on the groundbreaking science that study accomplished, Speizer planned to survey doctors’ wives.

“That just seemed like the logical way to go,” he said. And a test run succeeded in England in 1971.

But a follow-up test didn’t go so well. Reflecting how society was changing, test questionnaires were addressed to “Mrs.,” “Ms.” or “Doctor, give this to your wife” to see which would generate the most responses. The “Ms.” group fared worst, and in the “Mrs.” group, researchers learned that many women had never seen the survey; their husbands had filled out the form for them.

Realizing “it was an impossible situation,” Speizer shifted to surveying nurses. The rest became health history, as the study, which launched with 121,700 married nurses in 1976, and its spinoffs continue to generate valuable science. The nurses, he said, became “extraordinarily collaborative, trusted colleagues in providing their health information.”

Over the years, the Nurses’ Health Study researchers diversified both the participants (the original group, reflecting the profession at the time, was 97% white) and research areas, leading to findings about diet and exercise that shaped federal guidelines.

Van Horn is on the steering committee for a different massive research project called the Women’s Health Initiative. That study, launched in 1992, recruited more than 161,000 women. Initially, it was to examine the effects of hormone therapy, diet, and calcium and vitamin D supplementation in postmenopausal women. Breast cancer was the primary focus, but the study collected data on broad areas of women’s health.

Today, Van Horn said, the initiative continues to offer data-driven results on outcomes that are based on lifestyles led for more than two decades.

It took “some pretty strong champions of women’s health” to build support for such research, said Van Horn. She and Speizer both noted the efforts of Bernadine Healy, who, in 1991, became the first woman to run the National Institutes of Health.

In 1993, Congress rewrote laws to require the inclusion of women in medical studies. But some changes have come slowly. Many early drug studies to determine appropriate dosages were done using only male lab animals, Van Horn noted.

This was rationalized on the grounds that hormones and menstrual cycles can complicate research data. “Surprise!” she said. “They complicate life for women.”

It was only in 2014 that the NIH started requiring both male and female lab animals to be used in studies. Van Horn recalled how this prompted comedian Stephen Colbert to devote an entire monologue to the topic, cracking, “Any scientist knows it’s crucial to eliminate extraneous variables – like half the global population.”

Work remains. One study of clinical trials about cardiovascular health between 2000 and 2017 showed only 38% of the participants were women.

But future research will be able to build on efforts that began decades ago. For example, in the 1980s, Nurses’ Health Study researchers began to gather blood, tissue and toenail samples. “Those are just going to pay off in the next probably 10 years,” Speizer said, as scientists learn more about genetics and how behaviors and environment affect how genes work.

In looking to what’s next beyond these two landmark studies, Van Horn is excited about the prospects for using precision nutrition to help prevent disease. It’s clear that fruits, vegetables, whole grains and the like are good for people. “What we still don’t know – and what I’m finding more and more fascinating is – what are the male-female differences?”

Source: American Heart Association

Most Women Receive Inappropriate Treatment for Urinary Tract Infections

Nearly half of women with uncomplicated urinary tract infections received the wrong antibiotics and almost three-quarters received prescriptions for longer than necessary, with inappropriately long treatment durations more common in rural areas, according to a study of private insurance claims data published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

“Inappropriate antibiotic prescriptions for uncomplicated urinary tract infections are prevalent and come with serious patient- and society-level consequences,” said Anne Mobley Butler, PhD, lead author of the study and assistant professor of medicine and surgery at Washington University School of Medicine, St. Louis. “Our study findings underscore the need for antimicrobial stewardship interventions to improve outpatient antibiotic prescribing, particularly in rural settings.”

Researchers studied insurance claims data for 670,400 women ages 18 to 44 who received an outpatient diagnosis of uncomplicated urinary tract infection between April 2011 and June 2015. They identified filled antibiotic prescriptions, assessed adherence to clinical guidelines, and compared rural and urban antibiotic usage patterns.

Rural patients were more likely to receive a prescription for an inappropriately long duration of therapy than urban patients, according to an analysis of geographic data from the claims database. While use of both inappropriate antibiotic choice and inappropriate duration of prescriptions declined slightly over the study period, inappropriate prescriptions continued to be common with 47% of prescriptions written for antibiotics outside guideline recommendations and 76% for an inappropriate duration, nearly all of which were longer than recommended.

“Accumulating evidence suggests that patients have better outcomes when we change prescribing from broad-acting to narrow-spectrum antibiotics and from longer to shorter durations,” Butler said. “Promoting optimal antimicrobial use benefits the patient and society by preventing avoidable adverse events, microbiome disruption, and antibiotic-resistant infections.”

Clinicians should periodically review clinical practice guidelines, even for common conditions, to determine the ideal antibiotic and treatment duration, Butler said. Auditing outpatient antibiotic prescribing patterns and periodic feedback to healthcare provider helps remind clinicians of the best practices and improves antibiotic prescribing. However, additional research should be performed to understand and ultimately improve rural outpatient antibiotic prescribing practices for urinary tract infections and other common conditions.

Possible explanations for study findings, which are consistent with other research reflecting rural disparities, may be that rural providers may not be as aware of current antibiotic treatment guidelines. In addition, urban providers who treat rural patients may prescribe longer antibiotic durations because of distance-to-care barriers in case symptoms persist. Further research is needed to identify reasons for higher inappropriate prescribing in rural settings.

Source: The Society for Healthcare Epidemiology of America

Feeling Stressed about Your Role in Life? For Women, that Could be a Health Risk

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

How a woman feels about her roles at home and at work during midlife can affect several factors that influence her heart health, new research shows.

The study, published Friday in the Journal of the American Heart Association, found women who felt more stressed at their jobs or in their roles as caregivers, mothers and spouses had greater odds of having high blood pressure, being overweight and not eating a healthy diet.

Conversely, those who felt their roles were more rewarding were substantially more likely to be physically active and to not smoke. And that can potentially help their heart health, said lead author Andrea Leigh Stewart. The research was part of her doctoral dissertation at the University of Pittsburgh Graduate School of Public Health.

The study analyzed whether the stress and reward of social roles for women between the ages of 42 and 61 would impact their ability to maintain good heart health, as measured by seven risk factors: body mass index, blood pressure, blood sugar, cholesterol levels, physical activity, diet and smoking. The measures are part of what the American Heart Association calls Life’s Simple 7.

The study found women who felt their roles were rewarding had 58% greater odds of engaging in at least two hours of moderate to vigorous physical activity per week and 30% higher odds of not smoking. Federal guidelines recommend adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity – or a combination of both.

The study also found that for every point higher a woman scored on her average stress rating, she had 13% lower odds of maintaining an ideal blood pressure, 10% lower odds of maintaining a BMI under 30, which is the clinical definition of obesity, and 18% lower odds of eating a healthy diet.

But whether the stress and rewards influenced a woman’s heart-healthy behaviors or if those behaviors affected her feelings about her roles remains unclear.

“Since this was an observational study, we can’t tell which direction this relationship is going,” Stewart said. Even for women with healthy habits, researchers don’t know if less stress and higher satisfaction played a role. “Do women with more rewarding social roles feel more motivated to participate in regular physical activity? Or are the social roles themselves more physically active?”

Many women in midlife would benefit from greater social support and resources to cope with stress, she said. “Women shouldn’t have to take on so much of a burden that their physical health is put at risk.”

Midlife can be a critical time for health, especially in women.

“In addition to physical and mental changes, women may be taking care of both children and aging parents, and their relationships with their spouses and jobs may also be changing,” Stewart said. “What happens to a person during these years has direct consequences for their health and well-being as they progress into old age, when they become more likely to experience physical illness or disability.”

Managing the risk factors represented by those seven health metrics helps maintain more than good heart health – it also may improve brain health and potentially prevent or delay the onset of dementia, according to an AHA advisory in 2017.

“Research over the past several years has shown that what is healthy for the heart is healthy for the brain,” said Hannah Gardener, an epidemiologist and associate scientist in the department of neurology at the University of Miami. Gardener, who was not involved in the new study, has led prior research showing those who scored higher on the heart-healthy behaviors in Life’s Simple 7 exhibited better cognitive performance than those with fewer heart-healthy behaviors.

“This study provides some indication that the high-reward roles in our lives can buffer some of the negative health effects of stress,” Gardener said. “Rewarding roles are a really important avenue to think about because this is something that’s modifiable. For example, we can seek out more rewarding work opportunities that can counterbalance our stress.”

Doing so is more important now than ever, Gardener said. Changes to women’s roles and responsibilities brought on by quarantines and work-at-home arrangements during the COVID-19 pandemic can exacerbate stress, reduce social supports and limit opportunities for physical activity.

“For the first time, there’s a prevalent confluence or overlap of roles,” she said. “Women are balancing working at home while simultaneously taking care of young children, overseeing remote schooling, and caring for older family members as well. For a lot of us, the stresses addressed in this paper are heightened during the pandemic.”

Source: American Heart Association