Wednesday, April 23, 2014
The recent release of the first-ever evidence-based guidelines for prevention of stroke in women has raised awareness about a health threat that’s gone under the radar for too long. Nationally, strokes are the third leading cause of death in women and the fifth leading cause of death in men, and women face risk factors that men don’t, such as pregnancy complications and hormone use.
New guidelines recognize that hypertension tends to increase women’s risk of stroke more than it does for men and urge measures like blood pressure checks to diagnose high blood pressure. Expanding MaineCare eligibility criteria would allow more women to access such preventive care.
The stepped-up prevention effort should be particularly welcome in Maine, where at least one woman dies of a stroke every day. Indeed, the stroke death rate in Maine (for both women and men) is the highest in New England. Low-income people are much more likely than others to have strokes, and the cost of preventive care in a state with a high poverty rate has made it harder for many women to take steps to reduce stroke risk.
Access to health insurance is important to everyone, but it’s particularly pertinent to women, who generally make less than men, pay more in out-of-pocket health care expenses and are more likely than men to be dealing with multiple chronic illnesses – driving up their care costs.
That’s why it’s critical for legislators to accept funds to expand Medicaid, halting the progress of a debilitating and too-often deadly disease and ensuring that thousands more Maine women can access the care they need to lead healthier lives.
RISK FACTORS AND RECOMMENDATIONS
Also known as a “brain attack,” a stroke occurs when the blood supply to the brain is stopped because of a blood clot or the narrowing of an artery, causing nerve cells to die because they aren’t getting enough oxygen. Consequences can include paralysis, memory loss and impaired speech.
Women share many of the same stroke risk factors as men: obesity, smoking, diabetes, high blood pressure (also known as hypertension) and high cholesterol. They also have unique risk factors. Taking oral contraceptives can raise stroke risk in women with hypertension. And during pregnancy, women can develop dangerously high blood pressure, which can cause a seizure and double the risk of stroke later in life.
The American Medical Association calls for women to be screened for high blood pressure before starting on the pill. It also recommends blood pressure medication for pregnant women with very high blood pressure and suggests considering it for pregnant women with moderate hypertension.
Women no longer in their childbearing years need screening for hypertension, diabetes, certain kinds of migraine headaches and irregular heartbeat, all of which tend to boost women’s risk of stroke more than they do for men, according to the AMA.
THE HEALTH CARE GAP
Of course, offering recommendations for reducing stroke risk presumes that a woman has a family doctor and access to regular care. Uninsured women – who account for 53,000 Maine women, or 12 percent of all women in the state ages 18 to 64 – are less likely to have either than are insured women, according to an analysis of a survey of women with family incomes of $35,000 a year or less.
Researchers also have found that uninsured women are more likely to forgo preventive and other medical services because of cost; to get lower-quality services when they are in the health care system; and to be in poor health.
These findings make for a bleak prognosis regarding stroke prevention. The forecast doesn’t get any brighter, given that uninsured women don’t make a lot of money (41 percent live below the poverty line).
Poorer people are more likely than their higher-income peers to smoke and less likely to exercise and eat a healthy diet, all of which contribute to the hypertension that is the leading cause of stroke.
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