The first-ever guidelines for preventing stroke in women don’t fool around. They offer ways to prevent this disabling and potentially deadly event from adolescence to old age. More than half of the 800,000 Americans who have strokes each year are women. Nearly 4 million American women are living with the aftermath of a stroke. And because women live longer than men, their lifetime risk of having a stroke is higher. Those numbers are why stroke prevention is especially important for women. The guidelines cover the use of oral contraceptives, high blood pressure during pregnancy, the use of hormones after menopause, and migraine with aura. They also cover the fundamentals of stroke prevention, like controlling blood pressure, exercising more, eating a healthy diet, and not smoking.
Howard LeWine, M.D.
Posts by Howard LeWine, M.D.
For some people, like those with an addiction, any amount of alcohol is too much. For others, drinking alcohol is something of a balancing act — a little may be healthful, while more than a little may be harmful. A new report in the journal Neurology highlights the dual effects of alcohol in men. As part of the Whitehall II study in Britain, researchers assessed the drinking habits of middle-aged men and women three times over a 10-year period. The study participants also took a mental skills test three times over the next 10 years. Compared with men who didn’t drink or who drank moderately, mental decline began to appear one to six years earlier in men who averaged more than 2.5 drinks a day. (There weren’t enough heavy drinkers among women to show any clear differences.) How does a person know if he or she is drinking too much? The CAGE and AUDIT tests can help.
A recent article in Parade magazine caught my eye because it has lessons for us all. The article was about Olga Kotelko, a 94-year-old woman, who is a competitive runner and track star. Her age alone is impressive. The fact that she didn’t enter her first Master’s competition until she was 77—an age when many people are hanging up their sneakers—is amazing. The article offers six lessons that anyone can learn from Ms. Kotelko’s daily life. She can be an inspiration for anyone, at any age, who wants to start exercising or to exercise more. You are never too old or too frail to start exercising. Start out with a safe, easy program. Gradually add more and harder exercise. Who knows where you might end—possibly in an event challenging the likes of Olga Kotelko.
When it comes to your “health numbers,” your two blood pressure values are important to know—and keep under control. New guidelines for managing high blood pressure in adults, released this morning in a report in JAMA, aim to help doctors know when to start treating high blood pressure and how best to do it. The new guidelines recommend different treatment targets for individuals age 60 and older and those under age 60. They also offer doctors advice on the best medications to start with to control high blood pressure. Although the new guidelines address an area of controversy—how low should blood pressure go—they don’t change the basics: Know your blood pressure. Consider high blood pressure to be a reading of 140/90 or greater. Lifestyle changes are important. And tailor treatment to your needs.
A longer lifespan can be a double-edged sword. You live for more years, but the later years may not necessarily be what you had in mind. We’ve known for some time that about 25% of older Americans can’t perform some activities of daily living without help. But we don’t know much about the other 75%. A new study suggests that two-thirds of Americans over age 65 need help doing everyday activities such as eating, bathing, and getting in and out of bed or a chair. Things you can do to help ward off becoming frail or disabled include staying active, managing weight and eating a healthy diet, preventing falls, making connections with others, and seeing your doctor(s) regularly.
In many ways, women are different from men. One way in which they are alike is how they “feel” a heart attack: with similar kinds of chest pain. Other heart attack symptoms may differ, but chest pain is pretty standard, according to European study of nearly 2,500 men and women. Few differences in chest pain were seen between the sexes. What’s more, the kind or duration of chest pain didn’t help tell a heart attack from some other problem. The conclusion? A careful medical history, an electrocardiogram, and blood tests are the best way to diagnose a heart attack in men and women. During a heart attack, more than three-quarters of men and women experience chest pain or discomfort. In the run-up to a heart attack, chest pain with exertion is a more common warning sign in men, while women often have other types of symptoms, such as fatigue and disturbed sleep.
It’s been a topsy-turvy few days in the world of heart health and disease. Last week, the American Heart Association and American College of Cardiology released new guidelines that upended previous recommendations for who should take a cholesterol-lowering statin. A few days later, two Harvard physicians challenged the accuracy of the calculator included in the guidelines, saying it would cause many people to unnecessarily take a statin. The story made headlines in The New York Times and prompted a closed-door review by the guidelines committee. The controversy over the calculator should serve to improve this tool. Adoption of the guidelines should help prevent more heart attacks, strokes, and premature deaths. It’s important to keep in mind that guidelines are just that—information to guide a decision, not to mandate it. The best approach is to talk about what’s best for you with a trusted physician.
Most people take balance for granted. They navigate without thinking, effort, or fear. For millions of others, though, poor balance is a problem. Some struggle with long-term dizziness or imbalance. Others suffer balance-related falls and injuries. A new study concludes that exercise can reduce not only the odds of falling but the odds of sustaining fall-related injuries. In many urban areas, there’s no shortage of classes aimed at improving balance. You can find them at senior centers, Y’s and Jewish Community Centers, health clubs, and the like. There’s also a lot you can do at home. The American College of Sports Medicine Standing recommends standing with one foot in front of another, lifting a foot off the floor, and shifting weight in various directions as three examples of home exercises.
Today is World Stroke Day. It offers a good reminder of the profound impact that stroke has on individuals and communities. Nearly 800,000 Americans have strokes each year. Worldwide, one in six adults will have a stroke during their lifetime. Although most survive, stroke is a leading cause of disability in the United States and many other countries. A report published last week in The Lancet documents a troubling trend: more and more young people are experiencing strokes. Between 1990 and 2010, the number of strokes among people aged 20 to 64 years increased 25%. This age group now accounts for one-third of strokes worldwide. Some stroke survivors recover fully and regain their previous levels of function. Others don’t. Keys to full recovery include rapid identification of stroke symptoms, immediate evaluation and treatment, early rehabilitation, and support
There’s no question that tests to detect cancer before it causes any problems can save lives. But such tests can also cause harm through overdiagnosis and overtreatment. A study published yesterday in JAMA Internal Medicine indicates that the majority of people aren’t informed by their doctors that early warning cancer tests may detect slow-growing, or no-growing, cancers that will never cause symptoms or affect health. Undergoing surgery, chemotherapy, or radiation for such cancers provides no benefits and definite harms. The researchers found that only 9.5% of people were informed by their doctors of the risk of overdiagnosis and possible overtreatment. Compare that to 80% who said they wanted to be informed of the possible harms of screening before having a screening test. Informing patients about the risks of screening isn’t easy to do in a brief office visit. It’s complicated information. And the researchers suggest that many doctors don’t have a good grip on relative benefits and harms of screening.