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WOMEN AT RISK RECOGNIZE STROKE'S SYMPTOMS, KNOW HOW TO PROTECT YOURSELF.

Byline: Mariko Thompson Staff Writer

For Wendy Anderson, the first warning came at work, when her left arm and fingers went numb. By lunchtime, she had trouble walking. That night, the 43-year-old collapsed in the bathroom of her Canoga Park home and couldn't get up.

Her mother, Arlene Barnes, thought Anderson had a pinched nerve. But at the hospital, Anderson learned she'd suffered a stroke in the right side of her brain. She was stunned. Sure, women in their 40s worried about breast cancer. But stroke?

``It came out of the blue,'' Anderson says. ``It just happened one day. It's scary.''

Anderson had been taking medication to lower her blood pressure. She didn't know at the time that she also had high cholesterol. Elevated blood pressure and cholesterol levels are both risk factors for stroke. Though stroke is the third-leading cause of death in the U.S. and the leading cause of disability among adults, many Americans associate stroke only with old age. That's a perception that medical experts want to change.

``There's absolutely a greater risk of stroke as we grow older,'' says Dr. Gene Sung, director of the USC Stroke Center. ``It doubles every decade of life after (the age of) 40.''

Just recently, a new study using data from the Framingham Heart Study assessed the lifetime risk by age and gender. The study, presented earlier this month at the American Stroke Association conference, found that women over the age of 55 have a 1-in-5 risk of stroke, while men the same age have a 1-in-6 chance. But researchers also found both sexes could reduce their lifetime risk by controlling their blood pressure - those with high blood pressure had more than twice the stroke risk than people with normal blood pressure.

Stroke occurs when a blood vessel in the brain either becomes clogged or bursts. About 85 percent of strokes are ischemic, where a clot forms in the vessel. The rest are hemorrhagic, where a weakened blood vessel bursts.

High blood pressure raises the risk of stroke by causing the blood vessels to narrow. Two numbers are used to assess blood pressure, which is the force of blood against the artery walls. The top number, called systolic pressure, measures the force against the artery wall when the heart contracts. The bottom number, called diastolic pressure, measures the force against the artery wall between beats when the heart relaxes.

Normal blood pressure should be below 120 over 80. Blood pressure that's 140 over 90 or beyond is considered high. About one in four adults in the U.S. has high blood pressure, though experts estimate up to 65 percent go undiagnosed or untreated.

``Decreasing your blood pressure by just a few points can reduce your risk of stroke,'' says Temperance Evans, a neuropsychologist at Valley Presbyterian Hospital in Van Nuys.

Last year, the National Heart, Lung and Blood Institute released new guidelines that created a pre-hypertension range, meaning anyone with a blood pressure reading of 120-139 over 80-89 would be at risk of developing high blood pressure. For people who fall in the pre-hypertension range, the guidelines recommend changing lifestyle habits rather than taking medication. Regular exercise, a healthy diet and quitting smoking all help to lower blood pressure.

Stroke often strikes without warning. But some people suffer from mini- strokes first. Called transient ischemic attacks, the symptoms - which include slurred speech and difficulty walking - can last a few minutes over a 24-hour period. A narrowing of the carotid arteries in the neck also can lead to an ischemic stroke. Doctors can diagnose the narrowing if they hear an abnormal sound through the stethoscope. An ultrasound screening also can detect it.

``If there is a blockage of the carotid artery, then the risk of stroke is especially high,'' Sung says. ``We need to do something more aggressive.''

The standard surgical procedure to correct the problem is called an endarterectomy. Surgeons make an incision in the neck and scoop out the fatty deposits from the carotid artery. In recent years, a newer stenting procedure has been developed. A USC team is participating in a national trial that compare the outcomes of endarterectomy to the stenting procedure. The Carotid Revascularization Endarterectomy-Stenting Trial (CREST) is funded by the National Institute of Neurological Disorders and Stroke (NINDS) and will run for five years.

In the newer, less invasive procedure, surgeons insert a catheter in the groin and snake a mesh tube called a stent to the carotid artery. A filter catches debris while the stent keeps the vessel open. Researchers want to compare complications and long-term outcomes from both procedures, says Dr. George Teitelbaum, professor of neurological surgery at the USC Keck School of Medicine.

``It would be premature to say (stenting) will replace endarterectomy,'' Teitelbaum says. ``The trial needs to run its course.''

According to the NINDS, about 700,000 Americans suffer a stroke each year. About two-thirds survive. While the rehabilitation process can't reverse the brain damage, it can help people relearn skills from walking to bathing to communicating. Stroke can impact motor control, sensation, language, thinking and memory, and cause emotional disturbances that include depression. Rehabilitation can include physical therapy, occupational therapy and speech therapy.

One month has passed since Anderson suffered her stroke, and the arduous road of rehabilitation continues. The day after the stroke, she couldn't sit up without falling over. Two weeks later, she could walk.

``It's amazing what you take for granted,'' she says. ``I'm learning how to get dressed all over again. Just taking a shower makes me so tired I have to lie down.''

Anderson says she's lucky. Her mother and her two children, 13-year-old Ryan and 9-year-old Haylie, are there to support her. The kids inspire her to do all the things that can help recovery - sticking to a low-sodium diet, taking medication every day, doing physical therapy and walking.

``I work hard because I don't want to be lying around for the rest of my life,'' Anderson says. ``It's not just my life that has changed, but my family's life.''

Mariko Thompson, (818) 713-3620

mariko.thompson(at)dailynews.com

Are you at risk?

Some stroke factors can't be changed. Stroke risk increases with age. African-Americans, who have a greater incidence of hypertension, also have a higher risk of stroke. So do diabetics or who have a family history of stroke. But some factors can be treated or changed:

High blood pressure: Experts say this is the most important risk factor. Elevated blood pressure can cause the blood vessels to narrow.

Heart disease: High cholesterol, physical inactivity and obesity not only contribute to heart disease, but also to stroke.

Cigarette smoking: Nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system and raise the risk of stroke.

Transient ischemic attack: Also called a mini-stroke, these are strong predictors of stroke. The attacks usually last less than 5 minutes.

Warning signs of a stroke include:

--Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

--Sudden confusion, trouble speaking or understanding.

--Sudden trouble seeing in one or both eyes.

--Sudden trouble walking, dizziness, loss of balance or coordination.

--Sudden, severe headache with no known cause.

Source: American Heart Association and American Stroke Association

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) Women and stroke

With a 1-in-5 risk, know the signs and how you can beat the odds

(2) Physical therapists Becca Stark, left, and Tina Stere, right, at Valley Presbyterian Hospital in Van Nuys help Wendy Anderson, 43, relearn how to walk after her stroke.

(3) Anderson, whose stroke impaired movement on the left side of her body, gets some help with her arm from Stark. It took two weeks after the stroke before Anderson, 43, could walk.

John McCoy/Staff Photographer

Box:

Are you at risk? (see text)
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Publication:Daily News (Los Angeles, CA)
Date:Feb 23, 2004
Words:1305
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