Depressed, middle-aged women twice as likely to have stroke: 9 tips to lower risk

2013-05-18 12:25
Depressed middle-aged women have double the risk of stroke

If you are a middle-aged woman suffering from depression, your risk of having a stroke is more than twice that of your non-depressed counterparts, according to a new study in Stroke: Journal of the American Heart Association.

The 12-year study examined 10,547 Australian females between the ages of 47 and 52 years old and found that those with depression had a 2.4 times higher chance of stroke than those who were not depressed.

Even after the researchers adjusted their findings for factors known to increase stroke risks, the results found that the depressed women were still 1.9 times more likely to experience a stroke.

"When treating women, doctors need to recognize the serious nature of poor mental health and what effects it can have in the long term. Current guidelines for stroke prevention tend to overlook the potential role of depression," said study author Caroline Jackson, Ph.D., an epidemiologist in the School of Population Health at the University of Queensland in Australia.

This is the first large-scale study where researchers observed the link between depression and stroke in younger middle-aged females. In another study from the U.S., the Nurses’ Health Study, researchers found a 30% increased risk of stroke among depressed women, but there was a difference, as the average age of participants in the Nurses’ Health Study was older by 14 years.

In this newest study, researchers gathered and examined data from the nationally representative Australian Longitudinal Study on Women's Health. Then, every three years between 1998 and 2010, the researchers asked women participating in the study certain questions regarding their mental and physical health, including other questions about their personal life.

Next, they evaluated the women’s answers according to a standardized depression scale and took into account their recent use of any anti-depressants. As a result, the researchers found that approximately 24% of the women were depressed.

Based on the women’s answers, as well as death records, the results also showed there were 177 first-time strokes that took place during the investigation

Researchers said they used statistical software and repeated measures at every stage of the study while examining the link between depression and stroke. They also controlled the study for variables that can affect the risk of stroke in order to distinguish the independent characteristics of depression, which included the following:

• age
• socioeconomic status
• smoking
• alcohol
• physical activity
• high blood pressure
• heart disease
• being overweight
• having diabetes

Although the elevated risk of stroke linked to depression was large in the research, the absolute risk of having a stroke remained relatively low for women in the study’s age group.

In the U.S., about 2.1% of women in their 40s and 50s suffer a stroke. In this report, however, only about 1.5% of all women suffered a stroke, which increased to just above 2.0% among the women who suffered from depression.

According to Dr. Jackson, comparable findings could be anticipated in a study of American and European women.

"We may need more targeted approaches to prevent and treat depression among younger women, because it could have a much stronger impact on stroke for them now rather than later in life," she said.

The reason depression is strongly associated with stroke in this age group remains unknown, although Jackson indicates it’s possible that the body's inflammatory and immunological processes, along with their impact on blood vessels, may play a part.

So what can a woman can do prevention-wise?

In a study also published last March in Stroke: Journal of the American Heart Association, researchers showed that green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet.

In this study, researchers asked 83,269 Japanese adults about their green tea and coffee drinking habits, and then followed them for 13 years on average. As a result, they found that the more green tea or coffee people drink, the lower their stroke risks.

“This is the first large-scale study to examine the combined effects of both green tea and coffee on stroke risks,” said lead author of the study, Yoshihiro Kokubo, M.D., Ph.D. “You may make a small but positive lifestyle change to help lower the risk of stroke by adding daily green tea to your diet.”

The study specifically found that:

• People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.

• People who drank two to three cups of green tea daily had a 14 percent lower risk of stroke and those who had at least four cups had a 20 percent lower risk, compared to those who rarely drank it.

• People who drank at least one cup of coffee or two cups of green tea daily had a 32 percent lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. (Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13 percent of strokes are hemorrhagic.)

The following Stroke Prevention Guidelines from the National Stroke Association can also help lower your risk for stroke:

1. Know blood pressure (hypertension): High blood pressure is a major stroke risk factor if left untreated. Have blood pressure checked yearly by a doctor or at health fairs, a local pharmacy or supermarket or with an automatic blood pressure machine.

2. Identify atrial fibrillation (Afib): Afib is an abnormal heartbeat that can increase stroke risk by 500%. Afib can cause blood to pool in the heart and may form a clot and cause a stroke. A doctor must diagnose and treat Afib.

3. Stop smoking: Smoking doubles the risk of stroke. It damages blood vessel walls, speeds up artery clogging, raises blood pressure and makes the heart work harder.

4. Control alcohol use: Alcohol use has been linked to stroke in many studies. Most doctors recommend not drinking or drinking only in moderation - no more than two drinks each day.

5. Know cholesterol levels: Cholesterol is a fatty substance in blood that is made by the body. It also comes in food. High cholesterol levels can clog arteries and cause a stroke. See a doctor if your total cholesterol level is more than 200.

6. Control diabetes: Many people with diabetes have health problems that are also stroke risk factors. A doctor and dietician can help manage diabetes.

7. Manage exercise/diet: Excess weight strains the circulatory system. Exercise five times a week. Maintain a diet low in calories, salt, saturated and trans fats and cholesterol. Eat five servings of fruits and vegetables daily.

8. Treat circulation problems: Fatty deposits can block arteries carrying blood to the brain and lead to a stroke. Other problems such as sickle cell disease or severe anemia should be treated

9. Transient Ischemic Attack (TIA): A TIA is a temporary episode of stroke-like symptoms that can last a few minutes to 24 hours but usually causes no permanent damage or disability. TIA and stroke symptoms are the same. Recognizing and treating a TIA can reduce stroke risk. Up to 40 percent of people who experience a TIA may have a stroke.

Although stroke can happen to anyone, certain risk factors can increase chances of a stroke. However, studies show that up to 80 percent of strokes can be prevented by working with a healthcare professional to reduce personal risk.

SOURCE: Stroke: Journal of the American Heart Association, Depression and Risk of Stroke in Middle-Aged Women, May 16, 2013; doi: 10.1161/STROKEAHA.113.001147. National Stroke Association, Stroke Prevention Guidelines, updated from 1999 issue of Journal of the American Medical Association (JAMA)