 And joining us now to talk about your health is Dr. Seaman Chaturvedi, Professor of Neurology at the University of Maryland School of Medicine and Director of the University of Maryland Medical Systems Stroke Program. Dr, thank you for joining us. We want to talk about stroke in women in particular. Are any of the risk factors different in women? Yeah, I think it's helpful to divide that up into before age 50 and after age 50. After age 50, the risk factors are pretty similar. And so we frequently talk about the big four being high blood pressure, diabetes, high cholesterol, and then history of smoking. And so the good news is that all four of those are treatable and controllable to some extent. And then you should probably add in as a fifth risk factor, obesity, and potentially sleep apnea, which is a risk factor for both men and women. Before age 50, obviously there are some differences because women can become pregnant. And so pregnancy is a condition where the blood or you have an enhanced tendency for blood clots. And also in the four to eight weeks after pregnancy, there's also an enhanced tendency for blood clots. And so that's an increased risk time for women to have strokes. And then below age 50, we also have the issue of oral contraceptives and birth control pill use because estrogen containing birth control pills, they enhance the tendency for clots to develop in the body. And that can lead to strokes. Luckily, the risk is fairly low, but it's definitely higher in women over age 35 and women who smoke. And each year at our medical center, I would say we probably see about four to six women, four to six women who have a stroke while taking birth control pills. And so although it's relatively rare, it's something that definitely does happen. Is there anything that women in that age group can do to mitigate the risk of oral contraceptives or pregnancy related strokes? For oral contraceptives, definitely don't take them if you're a smoker and especially a smoker over age 35 or 40. And then another group where there's a little bit of concern is women who have migraine with warning symptoms called aura. And there are some concern that if you have a migraine with aura and you take birth control pills, you may have slightly higher risk. And so if you have migraines, it would probably be best to get those under control as well and also discuss the individual risks with your provider. For pregnancy, I think the important thing is to have early access to pregnancy care and make sure that the blood pressure is well controlled, that there's no what we call gestational diabetes, which is diabetes developing during pregnancy. And but really the blood pressure is I think the most important factor. And of course, avoid smoking during pregnancy and avoid any drug use. Now, what about strokes that are connected to a heart rhythm abnormality called AFib, atrial fibrillation? Are women more likely to get AFib or to have that complication of it? Yeah, once again, it's important to look at age because before age 75, men definitely have higher risks of AFib compared to women. But over age 75, AFib is the leading cause of stroke in women. And that's partly because women live longer. And so the percentage of women over age 80 is significantly higher than the number of men. And so because women live longer, there are a lot of women over age 75 who have AFib related strokes. And it's estimated that there are about 50,000 more women disabled from stroke each year in the US compared to men. And also many, some people may not realize that about 60% of the deaths in the US due to stroke occur in women. And that's partly as a result of, as I said, with the fact that women live longer and there's a higher number of women in the over age 80 group. And so interestingly, we're trying to start one program at the University of Maryland Medical Center to screen women for AFib if they're over 70 and if they have risk for AFib such as high blood pressure, diabetes, or a history of heart failure. Now, if you find women in that situation or men in that situation, are anti-clotting medications always prescribed? And maybe talk a little bit about the risks and benefits of those drugs. Yeah, the anti-clotting medications are very effective. They can reduce the risk of stroke by about 60 to 70%. But unfortunately, they're actually underutilized in the United States. And so there are a lot of patients who should be on them who are not. And that occurs for several reasons, including the fact that sometimes clinicians overestimate the risk of bleeding or patients may not be fully aware of the risks of stroke. But the medications are effective in both men and women. And so usually, the doctor will look at the patients age, whether they have heart failure, whether they have vascular disease elsewhere in the body. But in general, the majority of patients over age 65 with atrial fibrillation should be on anti-blood thinning medications or medications that impair the clotting system. And they should have regular follow-up with their physicians to make sure that they're adhering to the medication and taking it as prescribed. Let's focus for a bit on your work as director of the University of Maryland Medical System Stroke Program. That's something that affects all of the institutions in the system? Yes. Yeah, one thing which we did way back in 2019 is we started a stroke clinical network all across the University of Maryland Medical System. And one thing, there are a couple of goals of that is that we want to have the same level of care regardless of which institution you present to. And if you present to the emergency room on the eastern shore or in the greater Baltimore area, we want to make sure that there were consistent protocols in terms of patients who are evaluated for either clot busting medication or a potentially interventional therapy for stroke. An interventional therapy for stroke can be quite remarkable in that the interventional physician can pull out a clot from the brain which is obstructing the blood flow and that can lead to a significant improvement in the patients. And we've seen some who have remarkably improved even within the first 24 hours. And we have a few videos on our website of patients who've benefited tremendously from interventional treatment. So I would encourage viewers who have interest in that to learn more about the interventional treatments for stroke and also to seek urgent medical attention because those procedures are most useful if they can be done within six hours of stroke. They can also be helpful for select patients up to 24 hours of stroke but it's important to seek rapid attention if you're in that circumstance. And to do that, you need to know that you need rapid attention, right? You need to be able to recognize the symptoms of a stroke in yourself or in somebody nearby. Yes, definitely. And the patient actually experiencing the stroke, they may not be able to call 911 or they may not be able to recognize the symptoms in all circumstances. And so if you have atrial fibrillation or a long history of hypertension or diabetes or if you have heart problems, it's important that your family members be aware of the warning signs and you should definitely educate your significant other, your children, or people that you come in frequent contact with to recognize the warning signs of stroke. There's one tool that we use called B-FAST, which stands for balance, eyes, face for facial droop, speech for speech problems, and A for arm weakness, and then T for time. And time is to, that's a reminder to call 911 in case the person has one or more of these symptoms. And for the arm, we ask the patients to like hold up their arms for 10 seconds and if one side drops to the ground or is fading on one side and if there's clearly asymmetric weakness, that could be a potential sign of stroke. And so that's important for the family members to know. How much has stroke care changed since you got into the field of neurology? It's been like a light bulb. Like back when I was doing my residency, I don't want to date myself, but when I was doing my training, there was really no specific treatment for somebody who was having an acute stroke. And then in the mid 1990s, the use of clot-busting medications arrived on the scene. And then in about 2015 was the first demonstration that the interventional therapies were useful. And so that was the clot retrieval or clot removal from the brain circulation. And so that's really led to a massive change all across the country because now there are many hospitals which are so-called comprehensive stroke centers, which can have the clot retrieval available 24 hours a day. And if your local hospital is not a comprehensive stroke center, then at least they should be linked with a comprehensive stroke center so that patients can be transferred quickly when the symptoms develop and if it looks like a potentially large stroke. And that's how the system works. So the idea in that situation isn't that you need to figure out where the comprehensive stroke center is and get yourself there. It's just get into the system. Yeah, residents of Maryland are fortunate because the leaders within the state and the emergency medical services, they've given a lot of thought as to how to send patients to the best hospital for the particular circumstance. And so if it looks like a potentially large stroke and a devastating stroke, many times the paramedics will take you directly to a comprehensive stroke center and they'll bypass the smaller hospital nearby. And so that's been very useful in terms of allowing more patients to have access to proper therapies and to potentially have a life-saving treatment. Lastly, let's spend a second on TIA events and their predictive ability to say that somebody without treatment is at risk of a serious stroke. Yes, it's important for viewers to know about the concept of TIAs, which are also called mini-strokes. And that means that some patients will have temporary weakness or temporary loss of vision or temporary speech problems and the symptoms may last 5, 10, 15 or 30 minutes and then they'll resolve by themselves. And it's important not to ignore that because that can be a potential warning sign of a stroke and sometimes you may get only one warning before going on to develop the full blown stroke. And so if you have those symptoms and especially if you have risk factors that we've discussed like high blood pressure or diabetes or atrial fibrillation, it's important to go to the emergency room and seek medical attention and have evaluation by a neurologist. If not in the emergency room, then hopefully quickly as an outpatient. Dr. Seaman Chaturvedi is director of the University of Maryland Medical System stroke program. Dr. Thank you for your time. Yeah, thank you, Jeff. A pleasure to speak with you tonight. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.