The Crystal Ball of Stroke Prevention May Be Changing For Postmenopausal Women

by Alysia Drummond on February 7, 2012

It seems everywhere I go women around me are discussing “the change,” when the days of cramps and tampons give way to hot flashes and night sweats.  Along with menopause comes an increased risk for stroke and heart disease.  Physicians monitor these changes and their effects on women’s health via blood work and lifestyle factors.  In the case of stroke prevention, much of the focus is currently on cholesterol.  While cholesterol levels may be an accurate predictor of stroke risk among some populations, a new study claims post-menopausal women aren’t one of them.  Instead, triglyceride levels may be a more accurate predictor in these women.

Photo Credit: Construction Deal

This prospective case-control study looked at 1,548 post-menopausal women (774 stroke patients and their controls), and was the first to evaluate triglycerides as a stand-alone method for determining the risk of ischemic (meaning caused by a blood clot as opposed to a brain bleed) stroke.  Results of the study indicated that the odds of women whose triglycerides were in the highest group (>192 mg/dL) experiencing a stroke were 56% greater than women whose triglycerides were in the lowest group (<104 mg/dL).  Total cholesterol, HDL (good) cholesterol, and LDL (bad) cholesterol are often used as indicators of ischemic stroke risk, but were not found to be predictive of stroke in these women.

The reasoning behind these findings is not well understood.  It may be that thicker artery walls develop with high triglyceride levels.  Or that high triglycerides trigger blood-clotting abnormalities.  The researchers of this study state there are probably multiple changes happening in the presence of high triglycerides and that it’s a combination of these changes that lead to ischemic stroke.

More research is needed to replicate this finding before changes are seen in clinical settings.  In the mean time, we’re left with the cholesterol, an imperfect measure.  So what does all of this mean?  Although the pharmaceutical aspect of stroke prevention may change, the lifestyle factors remain the same.  A healthy diet filled with fruits, vegetables, and whole grains paired with an active lifestyle is still the key to ward off stroke.

Resource:

Berger, J.S., McGinn, A.P., Howard, B.V., Kuller, L., Manson, J.E., Otvos, J., Curb, D., Eaton, C.B., Kaplan, R.C., Lynch, J.K., Rosenbaum, D.M., Wassertheil-Smoller, S. (2012). Lipid and lipoprotein biomarkers and the risk of ischemic stroke in postmenopausal women. Stroke, 43.  DOI: 10.1161/​STROKEAHA.111.641324

Jorge February 8, 2012 at 6:50 pm

This is a very interesting article on a topic that is not well understood (yet feared) by many -including me.

I think this post would be an easier read if some of the details were explained in simpler terms. For example, what is a triglyceride? Can we do anything about it? How can researchers isolate one specific cause of stroke?

Overall, very well done.

I’ll share this post with my mom’s doctor.

Alysia Drummond February 9, 2012 at 11:51 pm

Thanks for your suggestions, Jorge.

Patricia February 8, 2012 at 11:48 pm

Very interesting topic you found, and a lot of uncertainities around. But I feel something is laking, like it is a school homework instead of a blog post. Maybe trying a sound introduction or comparing other studies can help, but “feeling” is missing, unlike your previous posts.

Alysia Drummond February 9, 2012 at 11:53 pm

Thanks for the insight, Patricia.

MB Lewis February 9, 2012 at 9:28 pm

Alysia: Conversational intros like this have many advantages for pulling readers in, but do you perhaps make too quick a jump from anecdotal talk of those currently experiencing the change to health of POST-menopausal women? Aren’t these really 2 different populations? (possibly separated by a decade, or more). Despite such niggling, I am glad to see your coverage of a critical issue for older women, because I think they haven’t always been the “sexiest” of research subjects…
One more question: Was the reasonable return to the issue of lifestyle factors at the end your own thinking, or part of the study conclusion? I kinda wondered… I’m guessing your own conclusion?
Best, MB

Drew Heyding February 10, 2012 at 10:03 am

I agree with Mary Beth that focusing on a study of women’s cardiovascular health is always welcome. For too long, studies in this area were conducted on white, middle-aged men. It’s also well timed, coming only a few days after Go Red for Women’s Heart (cardiovascular) Health Day.

Since the authors did bring their study conclusions back around to lifestyle modifications, it was reasonable for you to do the same. As the authors point out, the neck step to follow-up on a study like this would be design something prospective (ideally experimental) that can link reductions in triglyceride level (whether by diet/lifestyle change or pharmaceutical intervention) to stroke outcomes.

Alysia Drummond February 11, 2012 at 1:43 pm

Yes, women’s cardio health is definitely an area that needs more research. Thanks for your tie in to Go Red and for your comment regarding the study conclusion. Much appreciated!

Alysia Drummond February 11, 2012 at 1:40 pm

Thanks for you comments. Regarding your question of menopausal and post-menopausal women, the differences depend on the subject area. Healthy blood work (this study focused on triglycerides) is important for both menopausal and post-menopausal women, as well as men and children. The increased health risks post-menopausal women experience don’t happen over night. It’s a progression that occurs over many years throughout menopause into post-menopausal life. Like you mentioned, much research regarding heart disease and stroke is focused on men. Because of this, we don’t have a detailed understanding of which health indicators are most predictive among women, especially at different stages of life. With that said, triglycerides and cholesterol are both measured in routine blood work. Regardless of sex, age, or lifestyle, high triglycerides are not a good thing.

Anna February 10, 2012 at 12:25 pm

It’s always encouraging to learn better predictors! I wish your blog was a little longer, perhaps with some of Jorge’s suggestions, but I certainly understand that it’s not the only thing you have going on right now!

Alysia Drummond February 11, 2012 at 1:44 pm

Thanks for your suggestion, Anna.

Angela February 10, 2012 at 9:00 pm

Thank you for the post. A bit difficult to read, but made me very curious about the current status of research on the menopause – and on how hormones/hormonal changes affect bodies in general. There seems to be a tightly entangled mixture of myth and research around, so it’s great to have insights into one of the different research angles.

Alysia Drummond February 11, 2012 at 1:53 pm

Thanks for commenting, Angela. Yes, as Drew and Mary Beth pointed out, issues specific to women (i.e. hormones and menopause) are often overlooked in research. It is definitely an area to keep an eye on as we learn more. Thanks for reading!

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