Journalist Neena Kathuria, 48, was working on her laptop when she felt a sudden numbness overpowering her body. She started perspiring profusely, her vision became blurred and her left side felt paralyzed. She collapsed in a heap on her chair and had to be rushed to hospital. Neena's condition was later diagnosed as an ischemic stroke or brain stroke triggered by a blood clot that had blocked a blood vessel in her brain.

According to medical experts, about 1,200,000 Indians - up from 900,000 five years ago - are hapless victims of the life-threatening brain stroke every year.

Instances of stroke amongst women in the 45-54 year age group have surged dramatically, which neurologists say is a matter of grave concern. Further, women are also twice as likely as men in the same age group to suffer a brain stroke.

Research published last month in the online edition of Neurology, the medical journal of the American Academy of Neurology (AAN) revealed that more women than men have been falling prey to mid-life strokes. Heart disease, an increased waist size (abdominal obesity) and stress, among other factors, are the major contributors to this trend. For the study, AAN analysed data from 17,000 people aged over 18 years who participated in a National Health and Nutrition Examination Survey.

"While our analysis shows that an increased waist size and coronary artery disease are predictors of stroke among women aged between 45 and 54 years, it is not immediately clear why there is a sex disparity in stroke rates among this age group," noted the study's author Amytis Towfighi, MD, Stroke Center and Department of Neurology, University of California.

"While further probe is needed, this mid-life stroke spiral among women merits close attention so that more care can be given to the cardiovascular health of women in their mid-30s to mid-50s with a goal of mitigating this burden."

But what exactly is a stroke? How does it impact our health? According to Dr Girish Vaishnav, Head, Internal Medicine, Fortis Hospital, NOIDA, a stroke occurs when blood flow to the brain ceases causing brain cells to begin dying within seconds. He elaborates, "There are two types of stroke - ischemic, which is triggered by a blood clot that blocks a blood vessel in the brain; and haemorrhagic, that occurs when a blood vessel breaks and bleeds into the brain." Both, says the doctor, are life-threatening.

Risk factors for a stroke include high blood pressure, smoking, diabetes, heart or artery disease, high blood cholesterol, a sedentary lifestyle and obesity. Another reason for the upward spiral of mid-life stroke, especially amongst Indian women, is the increased consumption of oral contraceptives, a phenomenon that has become common even amongst teenage girls due to fear of unwanted pregnancies.

Explains Dr Aruna Chopra, a gynaecologist and obstetrician at Max Medicare, New Delhi, "Oral contraceptives lead to a spike in atherogenesis - the formation of atheromas or plaques in the inner lining of the arteries - which can trigger off a stroke. Often young girls who come to us for consultation are so desperate to ward off unwanted pregnancies that they really don't think twice before opting for a birth-control measure."

Another common condition that makes most women vulnerable is obesity, particularly abdominal obesity. A perceptible rise in the number of women smokers in India over the last decade, too, has contributed quite a bit. According to Dr Chopra, smoking exacerbates the risk of ischemic stroke, as elevated nicotine levels increase the body's bad cholesterol or LDL (low-density lipoprotein) which augments the blood's stickiness and hardens the arteries. "This development enhances the blood's chances to clot more readily. Sticky blood flowing through hardened arteries can lead to the formation of a clot and block an artery. And the result can be catastrophic," she warns.

But the good news is that the moment a person kicks the habit, the excess risk of coronary heart disease comes down greatly. In fact, the risk is substantially reduced within a year of cessation of smoking. And it takes about 10 to 15 years for it to reach the level of a woman who has never smoked.

According to AAN, though women become vulnerable to a stroke after the age of 65, the youth and the middle-aged remain at risk. Ultimately, it is the lifestyle choices that determine the magnitude of one's risk from a stroke. And, only a disciplined lifestyle can be a preventive measure.

For this, smoking and alcohol need to be shunned.

Doctors advise a healthy diet, rich in fruits, veggies, cereals and whole grains; and regular exercise - cardiovascular exercise for a minimum of 180 minutes per week is imperative. Also it is a good idea to maintain a close watch on one's blood pressure, cardiac condition and sugar levels. "Nobody is advocating that one turn into a saint. But if people factor in all these healthy habits into their lifestyle, stroke can be prevented to a great degree," concludes Dr Vaishnav.  

August 19, 2007

By arrangement with WFS 

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