May 15, 2023
308: How Women's Symptoms of Stroke Differ from Men: Understanding Female-Specific Factors and Symptoms | DOCTOR IN THE HOUSE

Each year, 55,000 more women than men have strokes in the United States. In this episode, Maya Acosta and Dr. Rizwan Bukhari discuss how women's stroke symptoms differ from men, emphasizing the importance of recognizing nonsp...

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Each year, 55,000 more women than men have strokes in the United States. In this episode, Maya Acosta and Dr. Rizwan Bukhari discuss how women's stroke symptoms differ from men, emphasizing the importance of recognizing nonspecific symptoms such as fatigue, nausea, vomiting, disorientation, and confusion. Women are at a higher risk of stroke compared to men, and this is due to various factors unique to women such as pregnancy,  pre-eclampsia, menopause, hormone replacement therapy, and atrial fibrillation. Women of color have a higher risk of stroke than white women, mainly due to more risk factors present.


Key Points:

  • Women can present differently from men when experiencing a stroke, and it's important to recognize nonspecific symptoms such as fatigue, nausea, vomiting, disorientation, and confusion.
  • Know the risk factors unique to women and what you can do to reduce those risks.
  • Prevention is key. This means you can optimize your health to experience pregnancy and menopause with fewer complications. 

Resources mentioned in this episode

About Dr. Rizwan H. Bukhari
Rizwan H, Bukhari, M.D., F.A.C.S., is a board-certified vascular surgeon who treats various vascular issues, including aneurysms, carotid artery stenosis, lower extremity arterial blockages, gangrene, dialysis access grafts, and varicose veins. He has seen the ravaging effects of poor lifestyle choices on his patients’ health. Cardiovascular disease and its risk factors, such as obesity, tobacco use, hypertension, and diabetes, are mainly diseases secondary to the foods we eat and our lifestyle choices.

Dr. Bukhari promotes food as medicine and lifestyle medicine to help his patients and the general public prevent, halt, and sometimes even reverse disease. He owns North Texas Vascular Center, where he offers diagnostic services and minimally invasive outpatient procedures largely related to amputation prevention and limb salvage.

Connect with Dr. Riz

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Dr. Rizwan Bukhari 00:00

What the high blood pressure is doing is it's stiffening our arteries. It's also making our heart work harder. You know, our heart is a pump, and it's a muscle and it works. It's beating 1000s of times a day. And if it's beating against a higher pressure, it has to work harder. Okay? And, and so it can wear out faster. And so that's one impact of high blood pressure on your heart.

Maya Acosta 00:27

This is the healthy lifestyle solutions podcast, and I'm your host, Maya Acosta. If you're willing to go with me, together, we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. All right. Welcome back to another episode of the healthy lifestyle solutions podcast. I'm your host, Maya Acosta, and

Dr. Rizwan Bukhari 00:47

I'm Dr. Rizwan Bukhari,

Maya Acosta 00:49

we're doing another segment of doctor in the house, we're continuing to speak about strokes, I'm going to do a quick review of last of the last conversation that we had on stroke prevention and really Stroke Awareness for the month of May, Dr. Su spoke to us a little bit about the two different types of strokes, one being ischemic, 87% of the strokes are ischemic. And then about 13% of the strokes are hemorrhagic hemorrhagic, which just means bleeding. And so we talked about, you know, the signs to look for when you're having a stroke, we talk about taking immediate action, and we used fast, which means f represents if your face is drooping, a if your arm is weak, you're feeling weakness, S is her speech difficulty. If you're like slurring and T, it's just time to call 911. And by the way, if you're watching the video, you'll see that puppy chiller min pin is part of the video. And he was excited, he usually settles in when we're recording. But he saw that we have a little animal here on the table. And so he's interested in that. The other thing that I did was I spoke with you guys about doing a stroke risk assessment, and I put a link in the show notes. And so I'm going to put the link again, one thing that I would invite you to do is just take a look at your risk. And you're going to be asked questions like Do you know your blood pressure? Or what is your number for blood pressure? Have you been diagnosed with atrial fibrillation? What about your blood sugar and body mass? And you know, how much saturated fat do you take in and what's your cholesterol level? And are you diabetic? I do exercise during the week. Do you have a history of family members with stroke, TIA or heart attack? And do you smoke or vape? Because now vaping is the latest thing that unfortunately is affecting everyone. And the younger generation as well. I thought that in this episode, Dr. Risk, we could talk about women. Okay, the risk associated with just being female. And also, what surprised me a lot as I did a little bit of reading is that women of color are even at a greater risk of having a stroke.

Dr. Rizwan Bukhari 03:06

Yes. At least that's what I see in my clinical practice. And I think we generally think that in, in, in, in the medical society as well,

Maya Acosta 03:14

yeah. So, okay, one of the things we'll start off with is just talking about women and you know, self-care. You know, we're used to having so many things on our lists. As a matter of fact, one thing that I was reading said that women in general wake up with a to do list. So we wake up with this idea of what we need to do that day, and we go to sleep, wishing that we could have crossed off. One more thing off that list is just how we're thinking we're always feeling the need to get work done. If we're at home. Home calls us to do chores. If we you know, with our children, cooking, taking care of our husband, our marriage and all that and usually taking care of ourselves is the last thing on our mind. Now we're going to talk about how being a woman means that you have an increased risk for high blood pressure, and therefore a risk of stroke, being pregnant, going through menopause or just being a woman of color are part of those increasing risks that we're going to talk about. And the good news is, we will cover this in part three is that 80% of strokes can be prevented. What I found at the American Stroke Association is they say that one in five women will have a stroke. That's about 55,000 More women than men a year have a stroke. Stroke is the number three cause of death in women among women. Black women have the highest prevalence of stroke, pregnant women are three times more likely to have a stroke as non-pregnant women of the same age. Having pre-eclampsia that's you know, the dangerous condition of having high blood pressure during the pregnancy. It doubles stroke. Risk later in life taking birth control pills. I think we've known this for quite a while. And he's I remember hearing that this doubles the risk of stroke, especially in women with high blood pressure. So we're gonna definitely talk about blood pressure and what people can do. Okay, hormone replacement therapy. So strokes are more common in women who have migraines with aura, and smoke compared with other women having atrial fibrillation or a regular heartbeat can increase stroke risk, fivefold, I wanted to know if you could tell me Dr. Risk, what is a migraine with aura?

Dr. Rizwan Bukhari 05:38

Well, I mean, we've all heard of the term migraine is it's kind of what we think of as a really, really bad headache. Many people are afflicted with migraines, and the thing called Aura is, is a harbinger are some feelings people might have that are associated with a migraine, it might be a funny feeling in their head, a buzzing, it might be lights that they see, it might be funny sensations. So we call that or aura is just kind of the associated symptoms that people might recognize before they have a migraine. So someone might say, Oh, I've got I'm starting to have this, I've got an aura, and then they know that that migraine is coming on.

Maya Acosta 06:25

And then what always surprises me is that people still continue to smoke, after all of these years, and what we now know about just tobacco, just causing all sorts of damage in the body. This information also gives us what women can do in terms of reducing the risk, because they have these additional risk factors. So for example, in pregnancy, it's advice just mainly to talk to your health professional to determine the safest medication. If you're dealing with high blood pressure, the

Dr. Rizwan Bukhari 06:58

way I look at it, it's very similar to the way you a woman might have gestational diabetes, it's that that woman may be more prone to a lifetime of hypertension as well. And that the pregnancy, the stress that it puts upon the body brings that hypertension to the forefront. And so you begin to see that it's there. And so of course, when a woman has gestational hypertension, then, of course, she's going to have a higher risk for stroke than a woman who does not have hypertension. But then when the when the when the pregnancy goes away and the hypertension goes away. That doesn't mean that whatever was behind the scenes that caused the hypertension hasn't gone away. So that may mean that that woman over the course of her lifetime, has a higher risk of hypertension. Okay, so for me, I would certainly say to a woman who's had gestational hypertension, you need to be more aware of hypertension, you need to be watching your blood pressure. You need to be doing things to prevent getting high to high blood pressure.

Maya Acosta 08:04

Yes, yeah. Okay. And when you say gestational hypertension, you're talking about preeclampsia. Yeah,

Dr. Rizwan Bukhari 08:11

I mean, preeclampsia is is is hypertension during, during pregnancy and pregnancy. Unfortunately, many women get put at bed rest for months at a time just because of that, because they don't have good treatments for it. A lot of the medications that they might want to give a woman crosses the placenta and can affect the baby. So one of the main treatments is bedrest.

Maya Acosta 08:34

Okay. And so I can already say, you know, I've had OB gens on the show who also focus on preconception health. That's everything that you can do to care for your body before you even consider pregnancy. Because everything that you do before that will affect not only your pregnancy, but you the overall health of your child and your health. Yeah, from that point? Absolutely.

Dr. Rizwan Bukhari 08:58

I mean, Pregnancy is a stress on the body. And the better shape you are, when you go into it, the better your pregnancy is going to be, the better your baby's going to be and the better you're both going to be on the back end when you come out of it.

Maya Acosta 09:13

Okay, that's great to know. In the case of preeclampsia, the recommendation is just again to discuss this with your health care professional about, you know, lower dose aspirin. And the guidelines for that starting in the second trimester week 12 to lower pre eclampsia risk.

Dr. Rizwan Bukhari 09:33

Well, I think the idea behind the aspirin is that it reduces the risk of a thrombotic event or a blood clot forming and that blood clot then forming and causing a blockage in the brain the relative risk reduction of taking aspirin is so low that it prevents very, very few pregnancy related strokes.

Maya Acosta 09:58

Okay, birth control pills. Again, just get blood pressure checked before taking birth control pills and monitor every six months. Those are the recommendations to reduce your risk of strokes,

Dr. Rizwan Bukhari 10:13

birth control pills are known to increase hypercoagulability. What does that mean, they can make a person more prone to forming blood clots. And so, especially in women who smoke, their risk of forming blood clots is very high. One of the things where I see a lot of deep vein thrombosis, that's blood clots in the veins of the legs is in women who smoke who take birth control pills. So if you take that another step, women who are pregnant, who smoke who were taking birth control pills may be more prone to blood clots in the same way that might cause a stroke. Okay, if a woman were going to take birth control pills, knowing that there's that slight increased risk of stroke because of it, then the best thing to do is to optimize your health to lower that risk.

Maya Acosta 11:06

That's right. All right, HR T, also known as hormone replacement therapy. According to the recommendations here, you want to review the risk and the benefits of hormone replacement therapy with your healthcare professional and discuss if the benefit outweighs the risk. And for some women, it might not. I know that sometimes women take hormone replacement therapy because they don't want to feel all the side effects, all the symptoms of going through menopause, but with the recommendations that we're going to make in terms of nutrition, and exercise, really lifestyle recommendations, women do reduce a risk their experiences with hot flashes and other discomforts associated with menopause. Yes, some of the things that we covered before in the previous episode were the risk factors that people can control, high blood pressure, which we've already mentioned several times smoking, diabetes, high cholesterol, physical inactivity, then the weight issues carotid artery and just really other artery diseases, atrial fibrillation, excessive alcohol intake, illegal drug use and sleep apnea. I'm going to start with high blood pressure. So a common misconception is that high blood pressure rarely affects women. So, but nearly half of all adults with high blood pressure are women. In fact, women that are just 20 pounds or more overweight, have a family history of high blood pressure or have reached menopause are known to have an increased risk for strokes.

Dr. Rizwan Bukhari 12:46

That does not surprise me. I don't think blood pressure discriminates. There is some thought that prior to menopause, men have more blood, and blood pressure problems and women. But I think that women catch up very quickly by menopause. And in the age population that I treat blood pressure problems are equally prevalent in men and women.

Maya Acosta 13:06

Okay, what is your understanding of what contributes to high blood pressure,

Dr. Rizwan Bukhari 13:10

the number one contributor to blood pressure problems in the United States and in most westernized countries is sodium intake. And I don't think people realize it. We have an RDA, the recommended daily allowance of 1500 milligrams of sodium a day. And you know, through your normal diet, you can get that much sodium, yet we add sodium, we add salt, a lot of our foods, and then we eat a lot of high sodium foods. If you look at the canned foods and packaged foods and processed foods that we eat, they're all very high in salt. And the companies do that on purpose because salt is very tasty, and it makes us enjoy the food. But the they say that the average American gets over three times the amount of recommended daily allowance of sodium. So I don't think people really realize how much sodium contributes to hypertension. Probably half of the hypertension that's out there is due to our diet. And if people would cut the sodium out of their diet, they could get rid of their hypertension.

Maya Acosta 14:16

Yeah. Now when most of us eat out, and I include myself because I don't I don't want to say that I don't eat out either. Of course we all eat out. When we go to a restaurant we actually don't ask the waiter how much sodium is in the food. It's included you get it free of charge, actually, you get you get it as part of having someone else prepare your food. Sodium is added into everything. The sauces, the dressings, the gravies you name it, it's in there. Unfortunately, we don't really know how much sodium because we don't actually get the label for the restaurant food right like when we eat out. However, I do know that 75% of our sodium comes From eating out, and from eating processed foods, and when I say processed foods, I'm talking about the food that you get from the, for example, the frozen food section that comes to the label in the back, and it tells you how much of everything is found in there. Canned foods, whether it's a soup, beans, you name it, if it comes in a can, or a carton, it has some it has added ingredients. So for example, a can of soup can have about 1000 milligrams, just a small kind of eight ounce can of soup can have about 1000 milligrams of sodium. If you prepare that same soup at home, you have control of how much sodium you add. And most likely, you're not going to add that much.

Dr. Rizwan Bukhari 15:46

Absolutely. You don't have to add any if you don't want yeah,

Maya Acosta 15:48

frozen foods, packaged foods, crackers, cookies, chips, and you know I have a weakness for chips, all of those things have added sodium. So again, when you go to the restaurant, you have no idea how much sodium you're getting in, all you have to do is look at what you're eating, and then you can determine whether it's a healthier option or not. And we will go into detail about that. So you're saying in terms of high blood pressure in terms of having a high blood pressure, food is a main contributor to that? Absolutely. And what is happening when we have high blood pressure, what's happening to our heart?

Dr. Rizwan Bukhari 16:24

Well, what the high blood pressure is doing is it's stiffening our arteries, it's also making our heart work harder. And so, you know, our heart is a pump, and it's a muscle and it works, it's beating 1000s of times, hundreds of 1000s of times a day. And if it's beating against a higher pressure, it has to work harder, okay, and in so it can wear out faster. And so that's one impact of high blood pressure on your heart. But high blood pressure has multiple other effects as well. It has a negative impact on your kidneys, it can kill your kidneys. It's one of the main causes of kidney failure. We talked about it and diabetes, or diabetes is one of the main causes Well, so is hypertension. And if you have somebody with hypertension and diabetes, they're at extremely high risk for kidney failure over the course of their lifetime. Wow. And then hypertension is a significant risk factor for atherosclerosis, because it stiffens the arteries and make the makes the arteries unhealthy as well.

Maya Acosta 17:31

And again, high blood pressure is a risk factor that we can actually manage and control.

Dr. Rizwan Bukhari 17:38

Yes, it's it's something that we have a lot of we can have a significant impact on.

Maya Acosta 17:42

So on the topic of preeclampsia and high blood pressure, it's usually characterized by the onset of high blood pressure that is lasting they can lead to various complications. It affects one in 25 pregnancies in the US. That's high.

Dr. Rizwan Bukhari 17:59

That is a surprisingly high number that surprises me. Yeah.

Maya Acosta 18:03

Okay, menopause, and high blood pressure. So menopause and high blood pressure. While you have had normal blood pressure most of your life, maybe your chances of developing high blood pressure increase considerably after menopause. Heart disease risk rises for everyone as they age. But for women symptoms can become more evident after the onset of menopause, high blood pressure at home, we're going to talk about this using a home monitor to check your blood pressure and just really pay attention to that. So how home monitoring South measured blood pressure is not a substitute for regular visits to your health care professional, but it can be useful for managing your blood pressure.

Dr. Rizwan Bukhari 18:47

Yeah, and, and that's an important thing, because many people go for many years with unrecognized high blood pressure. And those years or even decades of unrecognized high blood pressure can be doing so much damage, that by the time you start to get treated, so much has already happened. Yeah. So if you if you regularly monitor your blood pressure at home, and you start to see that it's going up, early recognition is a great way to manage your blood pressure. But then also early recognition is a great way to say well, I might need to make some lifestyle changes that might positively impact and lower my blood pressure true.

Maya Acosta 19:26

And you know how when we talked about diabetes, type two diabetes, we talked about the continuous glucose monitoring system.

Dr. Rizwan Bukhari 19:33

It's a very thin device about the size of a quarter, maybe a little thicker than a quarter and it attaches to your skin and is able to check your your blood sugar.

Maya Acosta 19:43

Well just like you can have that device attached to your body and you are in control of managing how and really seeing how your blood sugar changes as a result of what you eat and your exercise. Having a monitor to check your blood pressure also good You have the ability to be in control of your blood pressure. And I say that because there are people that don't like going to the doctor. And so perhaps you even avoid checking your blood pressure because you don't want to go to the doctor. I was reminded by Lee the other day that you can go to a local pharmacy to when you're picking up prescription and sit there and have your your blood pressure taken out one of those chairs.

Dr. Rizwan Bukhari 20:22

Yeah, I mean, I used to just for fun, when I would go there, stick my arm in the blood pressure cuff machine just to check my blood pressure.

Maya Acosta 20:29

Me too. And I never realized how important it is now symptoms of a stroke and men and women and I want to cover this once again, we've already gone over you know fast, how what to look for to know that you are having a stroke. But I want to talk about a little bit, again how women present differently as opposed to men. So women still can have the numbness in the face, arm the leg, they can still have trouble speaking, or understanding speech, vision problems, trouble walking, or lack of coordination, or even just a severe headache, like we talked about without a known cause. In addition to that, women can have just general weakness, it reminded me of heart disease in women, women feel tired. Because we're used to feeling tired, we don't pay attention. Because it we present a little differently than men that way. There's also the disorientation and confusion or memory problems. There's also fatigue, like we talked about can be like the general weakness or overall fatigue, nausea and vomiting. So that those are just some of the other ways that women present differently for men.

Dr. Rizwan Bukhari 21:41

So unfortunately, those are very nonspecific.

Maya Acosta 21:44

However, if you already have risk factors, like we talked about, so you're you're a smoker, you're on birth control, you may have weight issues, maybe you're pregnant, and you have high blood pressure, all of that. And you have general weakness, vomiting and fatigue, feeling disoriented, perhaps you should go to the doctor or to emergency just to get check, because you might have a stroke coming on.

Dr. Rizwan Bukhari 22:15

Certainly, if you have a plethora of risk factors, yes. And the symptoms show up by it's worthy to seek medical Yeah,

Maya Acosta 22:25

I wanted to go more specifically into menopause just a little bit more, because a lot of my listeners are 45, and up and up, and they're women. And so I always want to make sure that we cover that in more detail. So menopause, as we know, is a natural thing that happens to women biological, it can happen between ages 45 and 50. during menopause, a woman's body experiences a decrease in estrogen production, which can lead to changes in the body's blood vessels, and an increase in cholesterol levels. Now, these changes can increase a woman's risk of developing atherosclerosis, that can lead to blockages which then increase the risk of stroke and women who experienced menopause at an earlier age or have surgical menopause, which means that you had to have your ovaries removed for whatever reason, are also at an increased risk of stroke.

Dr. Rizwan Bukhari 23:21

Menopause is kind of the, the equalizer the final equalizer, women have some cardio protective effects, some, some protection against certain things because of the estrogen that they're producing. And then once they go through menopause, their ratio of testosterone to estrogen changes and it becomes more like a man. And then therefore the risk factors in suddenly go from being a little bit better to as bad as or maybe even worse than men at that point.

Maya Acosta 24:00

So estrogen is protective. And when we lose our estrogen, we are at higher risk.

Dr. Rizwan Bukhari 24:05

It's not just the estrogen, it has to do with the ratio of estrogen to testosterone. Okay. And as women, women, women make testosterone as well, okay, it's essential to bodily functions within women, and they continue to make that testosterone, but as their estrogen level goes way down, the ratio of testosterone to estrogen goes up. Okay. And therefore, they began to experience more of the symptoms that the men the men had been experiencing at an earlier age. I

Maya Acosta 24:38

see. Okay, that makes really good sense. Thank you, Dr. Oz. Do you know who Toni Braxton is?

Dr. Rizwan Bukhari 24:44

No, of course I've heard of her. Okay. She was one of my favorite. I don't know if I can name any of her songs. But of course, I know who she is. She was really

Maya Acosta 24:50

popular, I guess in the 90s or so. She was one of my favorites. So she's been having a lot of health issues. She's living with lupus. has a lot of complications that has limited her career. Recently, she had, again health issues was presenting with the symptoms, was not going to go to the doctor. And I forget who insisted that she go chata Widowmaker. Now she did, she went to her doctors before she had the Widowmaker. It's it's amazing how these things happen, you usually hear that the person shows up one week before they could have died from a Widowmaker. And, and so now she's an advocate for speaking about heart disease and Widowmaker. And the reason I talk about that is because has she not in she's realizing the importance of making healthy lifestyle changes because she's at risk for many things now. And also her kidneys, it's I believe that the lupus has now affected her kidneys. But so I we're going to talk about how women of color are also at a higher risk for stroke, and more specifically, black women.

Dr. Rizwan Bukhari 26:04

Okay, well, first off for the audience, the term Widowmaker, many people may not know what that means, yes, it's a blockage in the left main coronary artery, and it's a severe blockage. And that main coronary artery then splits into two other arteries. And those two arteries supply the majority of the heart, especially the left ventricle, which is what's responsible for pumping blood out to the rest of the body. And if you have a blockage in that left main coronary artery, and and you have a heart attack as a result of it, there's a very high likelihood you're going to die. And they call it a Widowmaker. Because it's actually very common in men. And then, as I as you may have heard me speak in my lectures. In 50% of people, the first symptom of a heart attack is death. Okay, so a Widowmaker is a is a lesion in the heart that can lead to death. Yeah, okay. Yeah, so that's just in her case, it's just an example of how she had very bad atherosclerosis and in an artery that could have killed her. Yeah,

Maya Acosta 27:15

it's just amazing. And now she's, I mean, this recently happened, and she's already advocating for people to take care of their health, she went, even went on to say, just a few minutes of peeing in a cup can save your life, we, we think going to the doctor's is such an inconvenience, like, oh my god, I got to take the day off or set this, you know, the two hours or whatever, to make a doctor's visit, I gotta drive to the traffic and sit there in the lobby for X amount of time, that routine can save your life.

Dr. Rizwan Bukhari 27:50

Yeah, you know, a going to the doctor, I mean, as a doctor myself, I know going to the doctor is is is a hassle there is you have to take the day off or take a half a day off and there's paperwork and in waiting in the waiting area, and then sitting in the doctor's, in the in the exam room waiting for 20 minutes, in a silly gown when the doctor is taking their their sweet time. And, you know, there's all sorts of hassles. But I do think that part of taking care of your health, a healthy lifestyle is also is number one living a healthy lifestyle, but then also seeing the doctor in an appropriate manner. Even as a physician, we're classically bad at self care, but I tell people all the time, what's your health worth, we work so hard to make money to do all this and that and, and we should spend some effort and effort meaning not only our time, but some of our money on our own health care. And again, I don't mean that just mean going to the doctor, I also mean that on preventive health care and lifestyle issues. And create that right balance. And so that might mean you know, spending some money on the gym, or spending some money on yoga, and doing some things that are spent some money on some things that are preventive health, but also spend some money and effort and time on seeing the doctor when you need to.

Maya Acosta 29:18

Yep, so black women in their 50s may have more than triple the risk of stroke compared with white women of the same age according to a 2019 study and the study also found that a healthy lifestyle could help curb much of the risk. Now in an earlier episode, I mentioned that I interviewed least Roy from the movie, a teachable moment about four stroke survivors. And he really wanted to emphasize that people of color are at a higher risk and we know lifestyle plays a huge role in all of this. So that's why I want to emphasize this so the findings suggest that strokes are impacting black women At a time in their lives when they are the most productive at the peak of their lives among women, black women have had the highest prevalence of stroke. And we're going to talk a little bit about why that may be, two thirds of African Americans have at least one risk factor for stroke. So that could probably be part of the reason high blood pressure we come to that again, over half have high blood pressure, overweight and obesity. 70% of black men and 80% of black women are overweight or obese. Diabetes is also very prevalent, so more likely to have diabetes than non Hispanic whites, high cholesterol, 30% of Black Americans have higher levels of bad LDL cholesterol. There's also sickle cell anemia that can contribute to it. Smoking 50% are smokers, which doubles the risk, eating too much salt. There is a thing that I read that African American community has a gene that increases our sensitivity to salt, and the effects of salt, and also stressors, daily stressors, you know, other doctors, African American doctors talk about the stressors of just being African American and living in this society. All of these things put African American women at a higher risk more so than white women.

Dr. Rizwan Bukhari 31:26

It's a very complex issue. You've listed a lot of risk factors. But the question is, why are those risk factors there? Some of it is genetic. You mentioned some genetic aspects to it. And you and if anybody's ever heard me talk, I talk about how genetics loads the gun, but it's lifestyle that pulls the trigger. Yeah. So yeah, we and many different ethnicities have predispositions to disease. mine included, for example, I'm very prone to diabetes and coronary artery disease, just because of my ethnicity. Your

Maya Acosta 32:07

Pakistani background? Yeah. South Asian. Yeah. Okay.

Dr. Rizwan Bukhari 32:10

Yeah. So it's, I don't make that distinction. Because it's, it's the whole South Asian area that is, is, is prone to that.

Maya Acosta 32:19

And I mentioned it in case listeners don't know what your background is. Yeah.

Dr. Rizwan Bukhari 32:23

And then, but so yeah, there are some genetic predispositions that different ethnicities have to different diseases. Yeah. And so in the African American population, there are certainly a predisposition to hypertension. Yeah. So there is some genetics. But again, I say this is very complex, because this, there's many things involved in this. And some of it is culture, there's also cultural disparities in access to health care. Okay, that's extremely important. There's also in the black community, a distrust of doctors. That's a long discussion, but maybe rightfully so. Because some of the things that we've seen some of the terrible things that we've seen in the past that have happened to the African American community, in the name of medicine and science, so there's a lot of factors that lead to, to this, but what what, what, what you've gotten down to these, you've talked about a lot of risk factors, that if an African American woman wants to, she can address those risk factors, and lower her risk?

Maya Acosta 33:31

Absolutely, because what I listed are risk factors that are controllable. And that's what

Dr. Rizwan Bukhari 33:36

many of them are, yeah, but there's so many things you can do to reduce your risk of hypertension, it's not uncommon for me to see African American women come in with a blood pressure of 200 over 140 Oh, wow. And that is, we don't feel comfortable sending those patients home, but we find out that that's where they live. And, and we we often say that's just a stroke waiting to happen. Okay, and and so there's those that are the kind of people that need to make significant lifestyle changes. Now I'm also I'm all about lifestyle, but I'm also about a my Western medicine specialists as well. So it's about combining both therapy therapies in order to achieve the best result. But it's, I don't believe in just taking a pill and thinking that that's going to cure your problem. I think you have to take your medications, but you also have to alter your lifestyle significantly, to make those changes that are going to reduce your blood pressure, right.

Maya Acosta 34:38

Absolutely. And the good news is out of all the things that we've listed that put women in general and African American women at a higher risk for of stroke is that 80% of strokes may be prevented by making lifestyle changes and managing medical conditions and that's exactly what you just said it In the following episode, the last part of this conversation, we're going to talk about eating fruits and vegetables, reducing your salt intake, getting that physical exercise going. Those are the main ones, I'm going to teach people how to take their blood pressure so that they can have control in their home. And so those are the things that we're going to talk about in the next episode. Dr. Riz, do you have a message for our listeners about just our female listeners about taking care of their health in strokes,

Dr. Rizwan Bukhari 35:27

you know, what pops into my mind is that, in many respects, the household only runs because of the woman. And if if you begin to have health problems that debilitate you and slow you down, the whole household follow parts falls apart, there's this expression that the man might be the head, but the woman is the neck that controls the head. And, you know, of course, I think both men and women in the household should be as healthy as possible. But women should be very concerned about their health. I know that we all lead busy lifestyles, and that we have many responsibilities that we've got children to take care of, and cooking to do and cleaning to do and chores and careers

Maya Acosta 36:19

and careers. When women are CEOs. That's stressful.

Dr. Rizwan Bukhari 36:24

Yeah, I use this expression that women today are expected to be superwoman. Which means that they not only are they supposed to have a career and make money, but they're supposed to come home and, and run the household as well. And, but But where does that leave you time to take care of yourself. But if you don't take care of yourself, yeah, then you won't be there to take care of your family. That's fine. So I think that's really important.

Maya Acosta 36:51

Thank you so much. That's a wonderful message, I want to tell you guys take the assessment that I have been mentioning, to assess your risk of stroke. So the link is going to be in the show notes. I also would like you to download Dr. Reese's guide to prevent cardiovascular disease, the link is bid vi t dot L Y for slash join Dr risk. And then finally, if you get a chance go on YouTube. The link is in the show notes as well and watch the film a teachable moment. It's all about four stroke survivors. Dr. Neil Barnard is in it. Lee Stroy  who has been a guest on this show is in it. But it's a beautiful message about you know, everything we've been talking, talking about. Again,

Dr. Rizwan Bukhari 37:33

you know, we've talked a lot about stroke, and what stroke is and what stroke does to you. But the long term effects of stroke are also extremely debilitating. You never know whether you're going to have a stroke that you recover from, you know, a mini stroke or a minor stroke and you recover and you get better and you go on to be able to live your life or you're going to have some stroke that debilitate, you put you in the nursing home and you have to have a feeding tube and you have to have a catheter in your bladder and you have to someone has to, quite frankly, clean you up and change your diapers. And my patients tell me they would rather die than have a stroke. Okay. And so there are long term consequences of strokes. If you're bedridden, you get bed sores, you're you might lose your legs because you get gangrene of the feet and that can't be treated. There's so many downstream negative consequences of having a stroke that we're not you know, we've talked about that 130 or 140,000 strokes a year that kill you, or the 800,000 strokes that people have, but the 130 or 140,000 deaths, but we didn't even talk about all of the negative downstream effects of a stroke. We wouldn't wish upon our worst enemy. You don't want to have a stroke. So you want to do whatever you can to live a healthy lifestyle and prevent yourself from having a stroke.

Maya Acosta 39:01

Absolutely. Thank you Dr. Riz, again for this great conversation. Thank you. You've been listening to the healthy lifestyle solutions podcast with your host Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well at This helps us to spread our message. And as always, thank you for being a listener.

Dr. Rizwan BukhariProfile Photo

Dr. Rizwan Bukhari

Rizwan H, Bukhari, M.D., F.A.C.S., is a board-certified vascular surgeon who treats various vascular issues, including aneurysms, carotid artery stenosis, lower extremity arterial blockages, gangrene, dialysis access grafts, and varicose veins. He has seen the ravaging effects of poor lifestyle choices on his patients’ health. Cardiovascular disease and its risk factors, such as obesity, tobacco use, hypertension, and diabetes, are mainly diseases secondary to the foods we eat and our lifestyle choices.

Dr. Bukhari promotes food as medicine and lifestyle medicine to help his patients and the general public prevent, halt, and sometimes even reverse disease. He owns North Texas Vascular Center, where he offers diagnostic services and minimally invasive outpatient procedures largely related to amputation prevention and limb salvage.