Archive for stroke


More About Your Heart

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Last week I gave you all some links sent to me by the NIH to help women come to terms with the possibility of heart disease. What is it you need to know about to determine if you need to be worried?

Here are some of the basics.

1. What is your blood pressure, glucose, and cholesterol? These 3 things are the early warning signs of potential harm to your heart and blood vessels.

An elevated blood pressure occurs for a variety of reasons but basically the blood vessels are too narrow and the heart has to work harder as a pump to get the blood to flow through and make it to the organs. The heart over time can enlarge, and not work as effectively.

An elevated glucose causes problems with the walls of the blood vessels, making them less healthy, inflamed and eventually not effective as conduits for the blood flowing through.

Elevated bad forms of cholesterol can infiltrate into the lining of the blood vessels, causing blockages. These can eventually rupture, causing a complete blockage. When this happens in the brain, it is a stroke; in the coronary blood vessels it is a heart attack.

2. What are your genetics for heart disease? In other words, have many family members had early heart attacks and strokes?

Having a strong family history of heart disease indicates there is a tendency to inflammation in your blood vessels that contributes to poor health of arteries. This genetic predisposition may include diabetes, high cholesterol, high blood pressure.

Having a family history does not mean you are fated to have an MI or stroke, but it does mean you need to be very careful what you do in terms of lifestyle and habits. You can avoid the fate of your genes with careful living.

3. What are your health habits? Yes, yes; this is what we medical people preach about day in and day out!

It is the one most important modifiable action you can take however, which is why we stress healthy habits so much. You have the power to change the fate of your genes!

Exercise helps the heart get a good work out, it exercises the muscle and gets the blood flowing all over your body. It uses up the excess calories you may have eaten. It lowers cortisol levels that are elevated in most of us due to the stress of our lives. This lower cortisol following exercise causes the muscle layer around the outside of the blood vessel to relax a little, making the tube a little wider and easing the heart from having to pump so hard. The idea is for your heart to work hard during exercise, and not all the time. Additionally, exercise helps your liver make more of the good cholesterol which then helps the body get rid of the bad cholesterol.

A healthy diet low in animal fats, trans fats, and saturated fats that come from fried foods, packaged and processed baked foods; helps to keep cholesterol lower and inflammation in the blood vessels lower. Then the cholesterol flowing through your blood stream doesn’t have as much inflammation to latch onto, creating a plaque or potential blockage.

Lowering sugar in the diet also helps reduce inflammation, avoid diabetes with its’ destructive actions; and helps with weight.

Sodium is a major contributor to high blood vessel for many people through retention of fluid and tightening to the blood vessel walls, making them more narrow.

Maintaining a health weight reduces the amount of blood vessels your heart has to pump blood too, as fat needs blood vessels also. There is less mileage that the heart has to pump blood through. The actions that it takes to maintain a healthy weight also helps the heart, and is described above.

Do you smoke cigarettes or use nicotine products? Nicotine contributes to heart disease mostly through the inflammation and disease to blood vessel walls. Nicotine also contributes to tightening of the blood vessels, making them more narrow. The inflammation and narrowing then helps cholesterol do its’ bad thing with blockages.

Do you get enough good quality sleep? Hey, everything has to rest! Sleep helps aid in repair of the body, lowering of inflammation, mobilizing excess fluid.

OK, quick tips:

  • Instead of frying foods, saute in a little olive oil or other healthy oil
  • Add very little salt to food, use other seasons like pepper and herbs, spices
  • Get out and move every day, figure out a way this will work for you
  • Get a good nights sleep, work on sleep habits to aid this occuring
  • ditch the sodium, nicotine products, fast foods, fried foods, fatty meats. Make them a rare occurrence
  • decrease sugar, white starches like bread, pasta, potatoes, rice; as they basically act like a big dose of sugar in the body
  • limit alcohol and caffeine products to a healthy consumption
  • have your glucose, cholesterol and blood pressure monitored regularly and talk to your provider about what to do to reduce them if they are elevated.

Think about it, the only rest your heart gets is between each beat. Not to scare you, but that muscle keeps going, all the time. Why would you not be kind to it, protect it, pay attention to it?

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We here a lot about what we should be doing every day in terms of supplements and vitamins. A question I often get in the clinic is whether a daily aspirin should be taken and if so, how much. As with almost everything in life, it depends!

Aspirin has been around for a long time and is a marvelous pain reliever. One of its other major actions is that of a blood thinner. This can benefit you in preventing clots such as those that accumulate in the arteries that supply blood to the heart muscle. People with cholesterol blockages in those arteries are at greater risk for clot formation occurring on and within these cholesterol blockages. These are the types of clots and blockages that can rupture and cause a heart attack.

So it would stand to reason that we should all take a daily aspirin to prevent heart attacks. Not so fast! Aspirin can have serious side effects and not everyone needs that much protection from a heart attack.

It is currently recommended to take a daily aspirin if you have had a heart attack or stroke,  if you have had a stent placed in an artery, if you have angina or if you have had coronary bypass surgery. You could also benefit from aspirin therapy if you are at high risk for a heart attack. It is also recommended in men over 50 and women over 60 with diabetes.

It is NOT recommended for you to take aspirin if you have a clotting disorder that causes you to bleed easily, if you have an allergy to aspirin and/or get asthma symptoms when you take aspirin, and if you have stomach ulcers. It is also important not to take aspirin if you are already on a blood thinner, as this would increase your risk of bleeding.

The dose of aspirin is as confusing as whether or not to take aspirin. Because of the increased risk of bleeding, especially from stomach ulcers; a low dose aspirin is often the first recommendation. A baby aspirin, or 81 mg, is low enough to usually not cause stomach problems but high enough to help with anti-coagulation (blood thinning). By the way, I don’t think babies are given aspirin any more. Full dose aspirin is 325 mg, and is usually recommended in the high risk groups.

The next question usually revolves around whether enteric coated aspirin is better than regular. Enteric coating prevents breakdown and absorption in stomach, theoretically preventing ulcers. This does not always work and there is some question as to how available and effective enteric coated aspirin is for protection. The aspirin given at the time of chest pain and potential heart attack is always #4  81 mg aspirins chewed. This has been shown to help survival and limit damage to heart muscle when taken early in a heart attack. Taking an aspirin when you think you may be having a stroke is generally not recommended as you may worsen a hemorrhagic stroke.

There has been some recent research suggesting aspirin reduces cancer. This is still debatable and studies have been inconclusive and contradictory; as has the reporting of these study results.

It does seem that high dose aspirin (too high for you to do without recommendation by your provider) may prevent or reduce colon cancer risk in high risk individuals with a specific gene mutation. There have been some early reports of reduction of breast cancer in women taking aspirin therapy, but the data is still inconclusive and no specific doses or length of therapy has been determined.

So the question remains, should you take a daily aspirin? I recommend discussing this with your medical provider at the next visit, as it is not my role to give medical advise through this blog. If however, you are not at high risk for heart attack or disease, do not have a bleeding disorder or stomach problems; a low dose 81 mg every other day will most likely not harm you and may give you some benefit for prevention of cancer and cardiovascular events. Ask your provider at your next visit what is right for you. He or she will know best how to answer this question knowing your personal and family history, your health habits and risk factors.


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Did you ever think you are at risk for a stroke? There are some surprising risk factors you may not have considered , even events from younger years!

Every year 425,000 women suffer from a stroke. That is 55,000 more strokes than men. As with heart attacks, strokes in women are increasing and also present differently from men. In addition to this, women are more likely to delay going the the hospital or seeking medical help at the onset of their symptoms.

This delay can be very detrimental as many successful therapies require quick and early action.

There are 2 types of strokes. One type is caused by bleeding, called a hemorrhagic stroke. This type accounts for 15-20% of strokes. The far more common stroke is caused by a blood clot, called embolic stroke. Embolic strokes account for 80-84%, and are also called ischemic strokes.

The symptoms of a stroke occur when the blood supply to a portion of the brain is interrupted. Symptoms are usually related to what part of the brain has been affected. Hemorrhagic strokes occur due to bleeding, either from a ruptured aneurism or trauma which ruptures a blood vessel. Embolic or thrombotic strokes occur when a clot travels and blocks a blood vessel, causing damage to that part of the brain.

There are risk factors for stroke that are common to both men and women; as well as risk factors specific to women.

Common risk factors to both men and women include:

  • hypertension
  • atrial fibrillation
  • depression and stress

Risk factors specific to women include:

  • use of oral contraceptives
  • use of post menopausal hormone replacement
  • history of pre-eclampsia during pregnancy
  • history of gestational diabetes
  • history of migraine with aura

The symptoms of stroke commonly experienced by both men and women include:

  • numbness or weakness of face or an extremity
  • difficulty speaking, seeing, or understanding
  • difficulty walking, balance, and coordination
  • severe headache with no known cause, often nicknamed “thunderclap” headache

Stroke symptoms that tend to be more common in women include:

  • nausea, or hiccups
  • sudden pain in face or limb
  • general weakness
  • sudden chest pain, cardiac palpitations, or trouble breathing

It is still unclear why women tend to experience stroke differently then men. The subtlety of symptoms may be related to the location of circulation that is interrupted, but more research is needed to tease this out. It is clear however, that the more subtle symptoms can easily be overlooked or attributed to a more benign process.

It becomes important for you to familiarize yourself with the symptoms of stroke for both men and women, as we all live in communities and groups where we can help identify a family member or friend who may be experiencing a stroke.

Early intervention with getting to a hospital for treatment within hours of the onset of symptoms can prevent permanent  damage.


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I have not found a woman yet who welcomes hot flashes!  But…

A recent study performed by researchers at Northwestern Memorial Hospital in Chicago in conjunction with researchers at Harvard University may cause you to celebrate your hot flashes!

These researchers analyzed data from the Women’s Health Initiative and categorized women participants according to when their hot flashes appears in relation to menopause. The 4 groups consisted of hot flashes at start of menopause and before their enrollment in the study(early), before enrollment but persisting during enrollment (early-persistant), after menopause and after enrollment (late) or no hot flashes at all.

What they found in looking at these groups has challenged the recent notion that the presence of hot flashes at all may signal diminished cardiovascular health. The current theory that hot flashes is a result of instability of the blood vessels in the skin and may also indicate a problem with larger blood vessels supplying the heart and brain, may not be the only story.

Some surprising results were obtained when analyzing this data. When comparing the group who experienced no hot flashes to the group that experienced hot flashes at the beginning of menopause,  it appeared that the latter group of women  experienced less cardiovascular events, like stroke and death!

However, the group of women who experienced a later onset of hot flashes during the menopausal transition where more likely to experience stroke, heart attacks, and other cardiovascular events; when compared to the group with no symptoms of hot flashes.

This new analysis of existing data from the Women’s Health Initiative clearly indicates that there is much we do not know about menopause and what is happening within our bodies. It does however indicate the importance of heart health and cardiovascular fitness as you transition through the menopausal years. February, and heart health month, is now over but that does not mean you should not think about your heart health.

Your heart could be struggling as we speak, to bring blood to the heart muscle, to your brain, to your legs and to your vital organs! What can you do about it?

  • See your provider and get a check up with focus on your heart
  • Discuss your risk factors for heart disease and stroke with your provider and make note of them
  • Decide on a plan on how you will reverse the effects of these risk factors with your provider
  • Pick someone who will help you with this plan i.e. a friend to walk with or your partner to help improve your diet
  • Read our posts again about diet and exercise and pick what may work for you!
  • Mark on you calender a small change you can make every day towards health
  • As the Nike commercial says “Just do it!”
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Heart Disease and other vascular disease in Women part 2

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Anne Vaillancourt

Anne Vaillancourt


Anne and I finish our discussion about women and cardiovascular disease.

By listening to these mp3 files you should be able to answer the following questions:

How prevalent is heart disease in women?

What are “Risk Factors”?

What is Hypertension?

What puts YOU at risk for cardiovascular disease?

What can you control to prevent heart disease?

What is the effect of Tobacco and Nicotine on heart disease?

How do you “get” Diabetes?  What is the heart risk from Diabetes?

What is cholesterol?  What is a cholesterol “particle”?  How does the size of cholesterol particles affect our risk of heart disease?

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