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Obesity and Diabetes Triples Stroke Risk

Posted: Wednesday, March 11, 2009

The record number of midlife strokes among women in the United States is a reflection of the epidemic of obesity and insulin-resistant diabetes, which also bring an increase in cardiac-disease risk, according to a new study.

Historically, women have suffered fewer strokes than men, but there has been a tripling of strokes in the United States in women aged 35 to 54 in the last few decades, while stroke numbers have remained stable among men in the same age category.

"It used to be that fewer women suffered strokes than men, and [their] strokes did not occur until menopause -- but stroke has now tripled in the last 20 years in younger women," stated Amytis Towfighi, MD, University of Southern California, Los Angeles, California and Rancho Los Amigos National Rehabilitation Hospital, Downey, California..

The increase in midlife stroke was hypothesized to go hand in hand with increases in the 10-year risk of coronary heart disease, as predicted by the Framingham Coronary Risk Score (FCRS).

Dr. Towfighi and colleagues utilized data from the National Health and Nutrition Examination Surveys (NHANES), a nationally representative study of male and female US adults. The researchers examined data specifically from individuals aged 35 to 54 participating in NHANES III (1988 to 1994) and NHANES IV (1999 to 2004) to determine temporal trends in gender-specific heart attack prevalence among midlife individuals.

The study specifically assessed vascular risk factors among individuals without known coronary heart disease to determine the gender-specific 10-year risk of future cardiovascular events among midlife individuals without a history of heart attack. FCRS and the individual components of the FCRS (total cholesterol, high-density lipoprotein [HDL] cholesterol, systolic blood pressure, history of smoking, and history of diabetes) were compared between the men and women in the study.

Results demonstrated that in both NHANES III and NHANES IV, the 10-year risk of heart disease was higher in men than in women in the midlife years.

Men aged 35 to 54 who participated in the NHANES IV, however, had a lower 10-year risk of heart disease than similarly aged men who participated in the NHANES III, while women aged 35 to 54 who participated in NHANES IV had a higher 10-year risk of heart disease than similarly aged women in NHANES III.

Diabetes prevalence was the only component of the FCRS that worsened in women from the time of NHANES III to NHANES IV (total cholesterol, systolic blood pressure, and history of smoking remained stable, while HDL cholesterol levels actually improved). Systolic blood pressure improved among men between NHANES III and NHANES IV (124.2 mm Hg vs 121.8 mm Hg, respectively) and incidence of smoking history decreased (68.5% vs 56.5%, respectively).

"Even though there was a decrease in blood pressure and a decrease in cholesterol [in women], there was an increase in diabetes prevalence," noted Dr. Towfighi. "In women, the numbers are getting worse, and in men they're getting better."

Source: Diabetes In Control: [Presentation title: Midlife Stroke Surge Accompanied by Rise in Coronary Heart Disease Risk Among Women in the United States. Abstract P172] International Stroke Conference (ISC) 2009.

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