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

Understanding risk factors and how to minimize their likelihood is a necessary first step towards making significant impacts in stroke prevention. When blood pressure readings are 140/90 mmHg or higher, and 130/80 mmHg or higher in diabetics, yearly monitoring is recommended. Monitoring can occur every two years if normal levels of 120/80 mmHg exist. Cholesterol levels should be checked every five years using a fasting lipoprotein profile. According to the American Heart Association, women should maintain total cholesterol below 200 mg/dL; HDL above 50 mg/dL; LDL below 100 mg/dL; and triglyceride levels below 150 mg/dL. It is necessary to implement lifestyle changes including a healthy diet, reduction of salt intake, regular exercise, and weight reduction in order to reduce and maintain blood pressure and cholesterol levels. Fortunately, there are preventive treatment measures and lifestyle recommendations emphasizing healthy eating patterns low in saturated fats, and avoiding trans fats, each assisting in cardiovascular benefits. Suggestions for a healthy diet are listed in Table 2.

In addition to following a healthy diet, losing weight and regular exercise, medications, if necessary, have also been used to lower blood pressure, such as:

• Angiotensin-converting enzyme (ACE) inhibitors
• Diuretics
• Angiotensin-receptor blockers
• Beta blockers or alpha blockers

The formation of blood clots can occur from an abnormal heart rhythm, and with clot breakage, ischemic strokes potentially occur. Anticoagulants such as warfarin (Coumadin) or aspirin assist reducing the potential for blood platelets to form clots. Blood clotting medications have shown a 68% reduction of risk for ischemic strokes.

Medications are often recommended if target cholesterol and triglyceride levels have not been achieved after three months of lifestyle changes, LDL cholesterol levels are 190 mg/dL+, and/or personal history identifies one or more risk factors (e.g., heart disease, diabetes, prior stroke, low HDL’s, and high triglycerides). Such options are:

• Statins, Niacin, and Fibrates all used to reduce triglyceride and LDL levels and raise HDL’s.

Statin medications are recommended beyond their cholesterol-lowering effects and are commonly prescribed for ischemic stroke patients upon discharge from the hospital.⁹ Studies have indicated patients discontinuing statins one to two months post-hospitalization increase their risk of dying from a stroke within one year.²¹

A daily low dose aspirin has been shown to reduce risk for a second stroke in women who have suffered either an ischemic stroke or heart attack; however, evidence is mixed regarding a daily low dose aspirin for healthy women.⁹ According to the 2005 Women’s Health Study, healthy women taking a low dose aspirin every other day showed a risk reduction for ischemic strokes by 24%, yet the risk for hemorrhagic strokes rose by 24%. The CVD benefits for women age 65+ taking daily aspirin demonstrated a 34% reduction in heart attacks and fewer ischemic strokes by 30%. The Women’s Health Study further reported that healthy women under age 65 may suffer greater side effects such as gastrointestinal bleeding, bruising, and increased risk for hemorrhagic strokes versus modest benefits from daily aspirin use. Furthermore, healthy women 65+, and younger women with family history of CVD should consult their physician regarding a low dose aspirin therapy (81 mg baby aspirin).⁹

What to do regarding smoking? Avoid smoking and second-hand smoke. Research studies have indicated a three-step approach to quitting along with smoking cessation programs encompassing the following suggestions:

• Chew nicotine gum or wear a nicotine patch.
• Learn techniques to remove thoughts of smoking and activities that trigger such behavior.
• Seek professional counseling and become active in support groups. (Smoking cessation programs are available online and free of charge)

Exercise at least 30 minutes most days and with longer exercising or greater intensity, increased benefits can be achieved. Moderate-intensity exercise such as walking, swimming, and bicycling can assist in recovering from a stroke and reduce the risk for another CVA event. Utilize a physical therapist to design a tailored program if a stroke-related disability has occurred.⁹