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Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part II)

Course Number: 330

Risk Factors in Women

While men and women share similar risk factors for stroke as with other chronic conditions, stroke is often caused from a combination of factors and sex/gender-specific risk factors do exist. Oral contraceptive use combined with smoking has demonstrated higher stroke and heart attack risks than in non-smokers using birth control protection.32 In 2002, the Women’s Health Initiative trial of hormone replacement therapy (estrogen-plus-progestin) was discontinued due to CVD incidences and increased risk for strokes among women participating. The current recommendation for hormone therapy is at the lowest effective dose and for short-term relief. If consideration for its use is necessary, the benefits and risks should be discussed with a physician.18

Stroke risk increases after age 55, and a woman’s risk more than doubles each decade following.33 Ethnicity represents a risk factor. African-American women exhibit an increased risk for stroke and heart attack more than white Caucasian women, and compared to white Caucasian, African-American women and men are more likely to die from stroke.33 Risk factors increase if a family history of stroke exists, especially with a first-degree relative, a personal history, heart attack or heart related conditions. Having experienced a transient ischemic attack (TIA), known as a mini-stroke, increases the risk ten-fold regardless of sex/gender and age.33 High blood pressure is considered one of the major risk factors for heart attacks and the most critical factor leading to strokes. People who have high blood pressure have one and a half times the risk of having a stroke compared to those who consistently have optimal blood pressure of 120/80.34 Obesity/overweight are primary risk factors for stroke for men and women of all races. An excess of fatty tissue has been shown to have a significant association with risk of stroke/transient ischemic attack (TIA), independent of other vascular risk factors. Waist circumference and related ratios can better predict stroke than BMI. Overweight individuals present with additional risk factors, such as sleep apnea, left ventricular hypertrophy, Syndrome X, and diabetes.35 Strokes occur twice as often in diabetics with hypertension than those with hypertension alone.36 Adults with diabetes have two to four times greater death rates than adults without. Diabetics often exhibit elevated blood pressure levels, cholesterol, and obesity and overweight concerns posing them at greater risks for CVD conditions18 and six times greater risk for stroke than those without diabetes.37 Controlling and maintaining blood pressure levels can reduce risks of strokes by 30-40%.18

Reported data from the Women’s Health Study indicated abnormal cholesterol levels doubled risk factors for ischemic strokes in healthy women. The results were from one of the first studies to confirm a link between stroke risks in women with no prior CVD conditions. Additionally, the study provided supporting data from clinical trials demonstrating statin medications reducing stroke risk.38 Studies have indicated women’s cholesterol levels tend to be higher than men’s from age 55+. Research has indicated low levels of HDL cholesterol (the good cholesterol), and higher triglyceride levels in women appear as stronger risk factors for stroke and heart disease than observed in men. Smoking remains one of the major causes of CVD among women.13 Smoking can double the chances of ischemic strokes and hemorrhagic stroke risk quadruple from tobacco use.37 Tobacco usage can elevate blood pressure, damage the lining in blood vessels, increase risk for blood clots, and lower beneficial HDL cholesterol – all serious risk factors for potential strokes. Data from The Nurses’ Health Study indicated women who quit smoking lowered their stroke risk by 25% within a one to two-year period, and after five+ years, the risk was equivalent to someone who never smoked.18

According to the American Heart Association, a woman with more risk factors increases her chance of experiencing a stroke or heart attack. Many of the identifiable risk factors (Table 1) cannot be modified such as: family health history, race, increasing age and sex/gender. Yet, many of the modifiable factors: high cholesterol, high blood pressure, diabetes, obesity, (Figure 5), lack of exercise and smoking can be treated or controlled by medication along with making positive changes in lifestyle habits.13

Table 1. Risk Factors for Stroke in Women.

Non-Modifiable Risk FactorsModifiable Risk Factors
  • Advancing Age
  • Sex/Gender
  • Family History of stroke
  • Personal history of stroke
  • Ethnicity/Race
  • Hypertension
  • Heart Disease
  • Smoking, especially when combined with oral contraceptives
  • Diabetes
  • Unhealthy diet
  • Physical Inactivity
  • Obesity and Overweight
  • Excessive alcohol intake
  • High total cholesterol levels
  • High triglyceride levels

Figure 5. Obesity and Stroke in Women.

  • According to the Women’s Health Study, obese women (those indicating a BMI score of 30+) were 50% more likely to suffer a stroke in comparison to healthy BMI scores under 25.18
  • In fact, the Nurses’ Health Study reported being overweight was not a single concern; however, gaining weight and especially in the waist area posed for serious consequences. Adult women gaining 22 to 24 pounds were 70% more likely to suffer ischemic strokes compared to women who maintained their weight.18
  • Older women are heavier now than a decade ago, and according to the WHO, the number of people considered overweight will increase to 1.5 billion by 2015.35
  • The American Stroke Association recommends to stay away from diets high in trans fats, saturated fats, and reduce salt intake in order to further reduce risk of stroke.35

After suffering from a stroke, odds can be reduced in having another by necessary medications, altering diets, and implementing healthy habits. Reducing the risk of ever having a stroke starts with healthy lifestyles, regular medical examinations detecting at-risk conditions, and positive steps towards controlling any one of the risk factors.

According to the Women’s Health Study, monitoring 38,000 participants for 10 years proved that risk factors really matter. The study indicated women with the greater number of healthy habits, BMI scores less than 22, who never smoked, ate a diet high in fiber, omega-3 fatty acids, folic acid, low in trans fat, saturated fat and refined carbohydrates, had four to 10 alcoholic beverages weekly, and exercised four or more times weekly were 71% less likely to suffer from an ischemic stroke.18