Stroke Risk May Be Greater for Certain Migraine Sufferers: Studies

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — Migraine sufferers may face an increased risk of stroke if they suffer from visual symptoms called auras or if they take the female hormone estrogen, a pair of new studies suggests.

People who have migraine headaches with auras may be 2.4 times more likely to have a stroke caused by a blood clot, compared to migraine patients who don’t see auras, says one study scheduled for presentation Wednesday at the American Stroke Association’s annual meeting, in Los Angeles.

And, women with more severe migraines who take hormone-replacement therapy may be 30 percent more likely to suffer a clot-based stroke than women not taking medication containing estrogen, according to a second paper to be presented at the meeting.

The two risk factors could combine to pose a dangerous mix for some women, said Dr. Elizabeth Loder, chief of the headache and pain division at Brigham and Women’s Hospital in Boston.

“Women who have migraine with aura probably want to think more carefully about the potential risk of stroke associated with using estrogen,” Loder said. “I would not go so far as to say they should never use it, but they should think more carefully about it.”

Estrogen, a female hormone, is contained in birth control pills and hormone-replacement therapy.

It’s important to note, however, that the new research only found associations between migraines with aura, estrogen therapy and stroke risk. It did not prove cause-and-effect.

The two studies focused on strokes caused by blood clots, which account for about 87 percent of all strokes in the United States, according to the American Stroke Association.

One study took a closer look at migraines with aura, which have been established by earlier research as a risk factor for stroke, the researchers said in background information.

About one in five migraine sufferers experiences visual symptoms before and during a headache, said study author Dr. Souvik Sen, a neurologist at the University of South Carolina School of Medicine. These symptoms can include flashes of light, blind spots, or seeing zigzag or squiggly lines.

In a 25-year ongoing study of nearly 13,000 adults in four U.S. communities, researchers identified 817 participants who had suffered a blood-clot stroke.

They found that migraine patients who experience aura symptoms seem more likely to suffer a blood-clot stroke than typical migraine sufferers. Specifically, people who have migraine with aura appear to be three times more likely to have a stroke caused by a clot that forms in the heart, dislodges and travels to the brain, the study authors said.

They’re also seem twice as likely to have a stroke caused by a clot that develops in a clogged part of the blood vessel supplying blood to the brain.

Future research needs to look into blood flow patterns in the brains of migraine-with-aura patients, Sen said.

“The aura is an effect of migraine on the blood vessels of the brain,” Sen said. “When they have the vision symptoms, it could be an effect of the migraine on the blood vessels of the brain.”

The other study focused on another known risk factor for stroke — medications containing estrogen.

“Estrogen, which is contained in hormone-replacement therapy and in certain kinds of combination birth control pills, increases the likelihood of blood clots,” and thus increases stroke risk, Loder said.

Researchers analyzed data for more than 82,000 women 50 to 79 years old from the Women’s Health Initiative, a study begun by the U.S. National Institutes of Health in the early 1990s. All reported having some degree of migraines, and about 45 percent were using hormone replacement.

At a follow-up visit three years later, women completed a questionnaire to determine if their migraines had gotten better or worse.

Women who experienced worsening migraines while taking hormone-replacement therapy appeared to be 30 percent more likely to have a clot-based stroke than migraine sufferers who either stopped taking or never took hormone-replacement therapy, researchers concluded.

Study lead author Dr. Haseeb Rahman, a neurology resident at Houston Methodist Hospital in Texas, said the findings suggest women on hormone replacement therapy should notify their doctor of any migraine symptoms.

“You should not simply ignore an increasingly bad migraine,” said Rahman, who worked on the study with a research team from the Zeenat Qureshi Stroke Institute in Minneapolis. “You should also tell your doctor if you’re getting migraines for the first time while on hormone replacement therapy.”

However, Loder noted that the increased risk is “certainly higher than we would like it to be, but it’s not terribly high,” given that just 2,063 women experienced clot-based strokes out of more than 82,000 female migraine sufferers.

“Other risk factors like smoking and high blood pressure are much more important,” Loder said. “It’s important to put the risk into context.”

Migraine sufferers or women taking estrogen should address more important risk factors, Loder said, by quitting smoking, controlling their blood pressure, treating their diabetes or lowering their cholesterol.

Data and conclusions presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

For more about migraine and stroke, visit the Stroke Association (UK).

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For Stroke Patients, Temporary Easing of Symptoms Can Be Deceiving

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — A quick improvement in symptoms before a stroke patient arrives at the hospital doesn’t necessarily mean a better outcome, a new study finds.

“Patients with very early rapid neurological improvement when first examined at the hospital still need to be considered for therapy to dissolve blood clots, given the high rate of unfavorable outcome,” study author Dr. Clotilde Balucani said in a news release from the American Stroke Association (ASA).

Her team was slated to present the findings on Wednesday at the association’s annual meeting, in Los Angeles.

The study included 1,700 stroke patients, average age 70, who were assessed for symptoms such as facial droop, difficulties with speech, weak hand grip and arm strength.

However, about a fifth of the patients showed a rapid improvement of stroke symptoms like these. Those patients were less likely to have high blood pressure and diabetes than others with stroke, the researchers noted.

Patients whose symptoms rapidly improved before they arrived at the hospital were more likely to be discharged home, Balucani’s team reported. But not all of them fared so well: A third to nearly half of them remained hospitalized.

“A significant percent of patients with rapid neurological improvement do not have a good outcome,” said Balucani, who is research assistant professor in neurology at the State University of New York Downstate Medical Center in Brooklyn.

She believes that doctors “should strongly consider giving these patients intravenous medication to dissolve blood clots” for these cases.

Two experts in stroke care agreed that when it comes to initial stroke symptoms, looks can be deceiving.

In the past, patients whose symptoms quickly resolved “were not given ‘clot-buster’ medications,” said Dr. Paul Wright, chair of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y. “However, physicians noted that there were patients who initially improved, only to ultimately worsen.

“The importance of this study is to consider a shift in the mindset — to now consider treatment with the clot-buster medications, whereas in the past this would not be done,” Wright said.

“This would especially hold true if the patient has a low likelihood of bleeding with the clot-busting therapy,” he said.

In the end, Wright said, “there is nothing worse than holding off on giving a patient clot-buster treatment due to rapid improvement, only to see them worsen the following day. By that time, the horse has left the barn.”

Dr. Rafael Ortiz is director of stroke at Lenox Hill Hospital in New York City. He stressed that certain patients are also more prone to a bad outcome after stroke than others.

“Hypertension and diabetes correlated with the poor outcome of the patients [in this study], so it is important that patients are well-educated and treated for prevention of these conditions,” Ortiz said.

Stroke is a leading cause of disability and the fifth most common cause of death in the United States. When a stroke occurs, immediate treatment is critical.

Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians has more about stroke.

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Testosterone Therapy May Boost Sex Drive in Older Men …

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — Testosterone therapy may restore some sexual desire and function in older men whose natural hormone levels have declined, clinical trials suggest.

However, the treatments didn’t do much to improve vitality or physical function in men 65 or older, as many have believed, said co-researcher Dr. Thomas Gill.

“Men who are experiencing low desire or low sexual activity and are interested in improving in those areas, testosterone treatment would be reasonable to consider,” Gill said.

But, “a physician probably wouldn’t be encouraged to prescribe testosterone solely for problems with physical function or solely for low energy, based on these results,” he added. Gill is a professor of geriatrics and epidemiology at Yale University and director of the Yale Program on Aging in New Haven, Conn.

The use of testosterone replacement therapy has nearly doubled in recent years, from 1.3 million patients in 2009 to 2.3 million in 2013, according to the U.S. Food and Drug Administration.

The results of the latest trials “really help to put the effects of testosterone in some quantifiable context,” said Dr. Eric Orwoll, associate dean for clinical sciences at Oregon Health & Science University in Portland.

“I would hope this would bring a more rational approach to the decision,” said Orwoll, who wrote an editorial accompanying the trial results. “You certainly can’t paint testosterone supplementation as a panacea. The effects were either not present or modest. This is not going to give a lot of impetus for people to take testosterone.”

The new findings, published in the Feb. 18 issue of the New England Journal of Medicine, come out of the Testosterone Trials — a federally funded set of seven clinical trials being conducted at 12 sites in the United States.

A total of 790 men 65 or older were enrolled in the Testosterone Trials, and were assigned to use either testosterone gel or a placebo gel for one year. All of the men had to have low testosterone due to aging, and had to have at least one health problem resulting from their testosterone deficiency.

The three main clinical trials assessed the potential positive benefits of testosterone therapy on sexual function, physical function and vitality. Four other trials studied the effects of testosterone on heart health, bone density, mental abilities and anemia; those results will be published later.

Men who used testosterone gel for one year experienced modest but measurable improvements in sexual activity, sexual desire and erectile function, compared to those who were given a placebo gel, Gill said.

Testosterone appears to be most useful as a therapy for reduced sexual activity or desire, since there currently are no alternative treatments for those problems, Gill added.

However, testosterone did not outperform medications already on the market for treating erectile dysfunction, such as Viagra or Cialis, and would not be an appropriate therapy for erectile problems alone, he said.

Results were mixed when it came to the benefits for vitality and physical function, the study authors said.

Testosterone did not significantly improve men’s vitality, although some men reported a slightly better mood and less severe depression, the trials found.

Also, the hormone therapy did not significantly improve the walking distance of men specifically assigned to the physical function portion of the trials. But when researchers lumped together all of the men in all three main trials, they found some benefit — 20.5 percent of testosterone users improved their walking distance compared with 12.6 percent of men who received a placebo.

Based on these results, doctors might consider testosterone therapy for men having problems with sexual function, with the understanding that the hormone could potentially increase their vitality and physical function as well, Gill suggested.

“You might consider it something like ‘value added,’ ” he said.

On the other hand, men would do better sticking with existing medical treatments for physical function and vitality rather than resorting to testosterone, Gill said.

Long-term safety also remains a concern with testosterone treatments, Gill and Orwoll said.

Although these trials showed no significant health risks over a year, health experts are concerned that extended use of testosterone could increase a man’s risk of prostate cancer or heart problems.

In 2015, the FDA issued a warning that testosterone treatments could raise a man’s risk of heart attack or stroke.

“The trial was reassuring that there weren’t major risks over a year, but some of these outcomes need to be assessed over a longer period,” Orwoll explained.

There’s also some concern that some men receiving testosterone therapy don’t really need it. Currently, approximately 70 percent of men who receive testosterone prescriptions through retail pharmacies are between 40 and 64 years old, according to the FDA.

“Our results, which were modest, really only pertain to men who are 65 years or older,” Gill said. “Younger men are less likely than older men to have low levels of testosterone solely due to their age.”

More information

For more about testosterone therapy, visit the U.S. Food and Drug Administration.

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Pregnancy After 40 May Boost Risk of ‘Bleeding’ Stroke Later: Study

By Kathleen Doheny
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — Women who become pregnant at age 40 or older may face a greater risk of a “bleeding” stroke later in life, new research suggests.

“Women who have a pregnancy after the age of 40 appear to have a higher chance, 15 or 20 years down the line, of having a stroke, particularly the hemorrhagic type of stroke, which is bleeding in the brain,” said lead researcher Dr. Adnan Qureshi. He is director of the Zeenat Qureshi Stroke Institute, in St. Cloud, Minn.

However, the study only uncovered an association between later pregnancies and potential stroke risk. It did not prove cause-and-effect.

Qureshi and colleagues reviewed data from more than 72,000 women, aged 50 to 79, enrolled in the Women’s Health Initiative, a large-scale study launched to look at ways to prevent health problems in women.

The researchers zeroed in on more than 3,300 women who had a pregnancy after the age of 40. The investigators looked at their rates of stroke, heart attack and death from cardiovascular disease over the next 12 years, and then compared them with women who had a pregnancy at a younger age.

Hemorrhagic stroke was 60 percent more likely to occur in women who had a pregnancy after age 40, the study authors reported. The findings held even after taking into account age, race, the presence of congestive heart failure, high blood pressure and other factors that might boost stroke risk.

The risk of a stroke caused by a clot (“ischemic stroke”), a heart attack and death from cardiovascular disease also rose in those who were pregnant after age 40. However, after taking other factors into account, the increased risks for those events were no longer statistically significant, Qureshi added.

For all but the hemorrhagic strokes, risk factors such as high blood pressure explained the increased risk, Qureshi said. But pregnancy later in life seems to be a risk factor for hemorrhagic stroke by itself, he said.

Qureshi said he can’t explain the possible link with certainty. It is known that women who become pregnant later in life have a higher risk of developing high blood pressure and diabetes during pregnancy. So, perhaps women who get pregnant later are predisposed to these problems, he suggested.

Or, “the pregnancy itself in later life may cause stress on the cardiovascular system,” Qureshi added.

The link between later pregnancies and stroke risk is a new topic in the medical community, said Dr. David Liebeskind. He is director of the Neurovascular Imaging Research Core at the Ronald Reagan UCLA Medical Center in Los Angeles. However, “you would want to see confirmatory evidence” from additional studies, he said.

Liebeskind also reiterated that the researchers behind the new studies did not prove a cause-and-effect relationship between later pregnancies and stroke risk. “It doesn’t mean that if you become pregnant above a certain age, you are going to have a hemorrhagic stroke,” he said. “This is simply an association that has been found.”

In future studies, researchers must “provide a rational basis for the underlying biology,” Liebeskind said. “If it reaches that stage, perhaps there are underlying things that could be managed,” he suggested. Or, ongoing research may identify a specific group of women who are vulnerable to stroke if they become pregnant after age 40.

Qureshi said that the finding suggests that women, when planning later-life pregnancies, should be aware of these risks. Once pregnant, they should be carefully monitored, as guidelines already recommend, he added.

“What the study suggests is, perhaps that rigorous monitoring should continue for years afterwards,” Qureshi said.

The study findings are scheduled for presentation Wednesday at the American Stroke Association’s annual meeting, in Los Angeles.

Studies presented at medical meetings are viewed as preliminary until published in a peer-reviewed journal.

More information

To learn more about pregnancy after age 35, visit the March of Dimes.

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Parenthood May Alter Immune System, Research Suggests

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — While most people know that parenting is a stressful, sleep-depriving undertaking, new research suggests it may also rewire the immune system.

The study found that parenting seems to have a more significant effect on the immune system than the flu vaccine or gastroenteritis, commonly called the stomach flu.

“That’s at least something for prospective parents to consider — the sleep deprivation, stress, chronic infections and all the other challenges of parenting does more to our body than just gives us grey hairs,” study co-leader Dr. Adrian Liston said in a news release from the Babraham Institute in the United Kingdom.

“I think that any parents of a nursery- or school-age child can appreciate the effect a child has on your immune system,” added Liston, a researcher at VIB and KU Leuven in Belgium.

For the study, researchers compared the immune systems of 670 people, aged 2 to 86 years. The investigators also looked at participants’ gender and weight to help see which factors influence the immune system from one person to the next.

The study volunteers’ immune systems were monitored over the course of three years. People were generally able to maintain a stable immune system, the findings showed. And that was true even after they’d been exposed to seasonal flu vaccine or the stomach flu.

These findings suggest the immune system can bounce back after it is forced to kick into action, the researchers explained.

However, the study revealed that parenting had the strongest effect on people’s immune system, more than any other contributing factor.

Those who lived with a partner and co-parented a child had a 50 percent reduction in the variation between their immune systems, compared to the general population, the study found.

“This is the first time anyone has looked at the immune profiles of two unrelated individuals in a close relationship,” said Liston.

“Since parenting is one of the most severe environmental challenges anyone willingly puts themselves through, it makes sense that it radically rewires the immune system. Still, it was a surprise that having kids was a much more potent immune challenge than severe gastroenteritis,” Liston said.

The researchers also reported that age seems to take a toll on the immune system response, too.

“What is different between individuals is what our individual immune systems look like,” study co-leader Dr. Michelle Linterman, a researcher at the Babraham Institute, said in the news release. “We know that only a small part of this is due to genetics. Our study has shown that age is a major influence on what our immune landscapes look like, which is probably one of the reasons why there is a declining response to vaccination and reduced resistance to infection in older persons.”

Findings from the study were published in the Feb. 15 online edition of Nature Immunology.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about the immune system.

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Study Sees Possible Link Between Antibiotics and Delirium in Patients

By Maureen Salamon
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — Delirium in hospitalized patients might be linked to common antibiotics more often than once believed, according to new research.

Delirium — mental confusion that may be paired with hallucinations and agitation — is often caused by medications. But, antibiotics are not typically the first type of drug suspected, said study lead author Dr. Shamik Bhattacharyya, a neurologist at Brigham and Women’s Hospital in Boston.

Reviewing case reports going back seven decades on patients given antibiotics who later developed delirium and related issues, the scientists found that nearly half suffered delusions or hallucinations. Seven out of 10 were found to have abnormal electrical activity in the brain.

“A key point in the study is that different antibiotics caused different types of confusion,” Bhattacharyya said. “The fact that antibiotics can cause confusion has been recognized for many years, but it doesn’t come into the consciousness of many doctors simply because there are many causes of confusion in patients with infection. So being able to find distinct patterns was not something we anticipated.”

But one doctor not involved with the study said using case studies that spanned 70 years may not have produced an accurate assessment of antibiotics and their relationship to delirium.

Delirium strikes up to half of hospitalized patients and up to eight in 10 patients in intensive care units, according to study documents. Those with delirium are more likely to have longer hospital stays and suffer other complications such as falls and death, and are also more likely to enter a nursing home.

More than 262 million courses of antibiotics are prescribed each year in the United States, according to the U.S. Centers for Disease Control and Prevention. This equates to more than five antibiotic prescriptions written each year for every six people in the United States.

Bhattacharyya and his colleagues combed through case reports going back to 1946, finding 391 cases where patients given antibiotics developed delirium and other brain problems. While nearly half suffered delusions or hallucinations, 14 percent had seizures, 15 percent had involuntary muscle twitching and 5 percent lost control of body movements. One quarter of those with delirium also suffered kidney failure.

A total of 54 different antibiotics from 12 classes were involved in the cases, ranging from commonly used antibiotics such as sulfonamides and ciprofloxacin (Cipro) to intravenous penicillin and cefepime (Maxipime). Patients’ average age was 54.

Three types of antibiotics-related delirium and other brain problems were identified by Bhattacharyya and his team, apparently the first time these patterns were delineated, he said.

“We don’t know the rate at which antibiotics cause confusion,” said Bhattacharyya, also a neurology instructor at Harvard Medical School. “We don’t have a good sense of how prevalent this is, but it’s thought to be under-recognized in health care circles and even less well-known in the general population.”

The study authors noted that the elderly would likely be most susceptible to harmful effects from antibiotics. When patients develop delirium, doctors should consider whether an antibiotic drug is the culprit. The sooner a problem drug is discontinued, the faster the patient will return to a normal mental state, the researchers said.

The study findings were published online Feb. 17 in the journal Neurology.

Dr. Waimei Amy Tai, a neurology hospitalist at Christiana Care Health System in Wilmington, Del., said that using case studies that dated back 70 years may have skewed the results. Penicillin use was just starting to become prevalent at that point, she said, and it may have been harder to tease out whether a patient’s infection caused confusion instead of an antibiotic used to treat it.

Tai agreed with Bhattacharyya that delirium can be highly dangerous to patients.

“I think it’s important for physicians as well as family members to think about the possible reversible causes of delirium and try to minimize them as much as possible,” said Tai, who wasn’t involved in the new study. “By avoiding certain antibiotics or reducing their use, that might really help the patient.”

More information

The Hospital Elder Life Program has more about delirium.

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Diabetes Drug May Help Prevent Second Stroke: Study

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — The diabetes drug Actos (pioglitazone) appears to protect people who’ve already had a stroke from suffering a second stroke, a new study finds.

Along with standard treatment after a stroke — including blood thinners, and blood pressure and cholesterol medication — the addition of Actos reduced the odds of another stroke by 24 percent compared to a placebo, the researchers said.

“Actos represents a new option for patients who have had a stroke to help prevent a future stroke,” said lead researcher Dr. Walter Kernan, a professor of medicine at Yale School of Medicine in New Haven, Conn.

For the study, Kernan and colleagues randomly assigned nearly 4,000 patients who had suffered a stroke or a mini-stroke to Actos or a placebo. None of the patients had diabetes but they did have evidence of insulin resistance, putting them at risk for the blood-sugar disease.

Over nearly five years of follow-up, 9 percent of those taking Actos had another stroke or heart attack, compared with nearly 12 percent of those receiving placebo, the researchers found.

Nearly 4 percent of those taking Actos developed diabetes, compared with nearly 8 percent of those taking the placebo, the study showed.

The report was published online Feb. 17 in the New England Journal of Medicine. The study was also scheduled to be presented Wednesday at the American Stroke Association’s annual meeting, in Los Angeles. Funding for the study was provided by the U.S. National Institutes of Health.

No one knows how Actos works to prevent stroke, Kernan said. The best guess is that the drug reduces inflammation, improves insulin resistance, helps manage fats in the body and “favorably affects the function of blood vessels,” he said. “These could explain its effects on recurrence of stroke and heart attack.”

Insulin resistance may also play a part in the risk for stroke, Kernan said. “This trial provides fairly strong evidence that insulin resistance is an important new target for prevention of stroke,” he said. “This trial takes preventive neurology in a new direction and opens up new opportunities for the care of patients.”

Whether Actos will ever be used to prevent stroke depends on how these findings are evaluated by the medical community, Kernan said.

“Actos may be an option for patients who have had a stroke or mini-stroke, but its role will have to emerge from a debate among scientists about our results,” he said.

Dr. Richard Libman is vice chairman of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y. He said this new finding may add to the ability to prevent recurrent strokes, but it needs to be confirmed before the drug can be widely used.

“This is the first study to show that treating these patients with a medication which improves insulin resistance can also decrease the risk of having a subsequent stroke or heart attack,” he said. “It is only a single study, but it is compelling.”

Dr. Gerald Bernstein is an endocrinologist at the Friedman Diabetes Institute and Lenox Hill Hospital, both in New York City. “This is a straightforward look at a few thousand people over a reasonable period showing the benefits and liabilities of Actos,” he said. “The question we are left with is whether we have something that is all upside and no downside.”

The drug was linked to some serious side effects. People who took Actos in the study were more likely to gain 10 pounds or more, have swelling of the feet and ankles, and broken bones that required surgery or hospitalization, the researchers found.

One day Actos may be a drug used to help prevent stroke, but more knowledge is needed before it can become a regular part of stroke treatment, Kernan said.

More information

For more information on stroke, visit the American Stroke Association.

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Diabetes Drug May Help Prevent Second Stroke: Study

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Feb. 17, 2016 (HealthDay News) — The diabetes drug Actos (pioglitazone) appears to protect people who’ve already had a stroke from suffering a second stroke, a new study finds.

Along with standard treatment after a stroke — including blood thinners, and blood pressure and cholesterol medication — the addition of Actos reduced the odds of another stroke by 24 percent compared to a placebo, the researchers said.

“Actos represents a new option for patients who have had a stroke to help prevent a future stroke,” said lead researcher Dr. Walter Kernan, a professor of medicine at Yale School of Medicine in New Haven, Conn.

For the study, Kernan and colleagues randomly assigned nearly 4,000 patients who had suffered a stroke or a mini-stroke to Actos or a placebo. None of the patients had diabetes but they did have evidence of insulin resistance, putting them at risk for the blood-sugar disease.

Over nearly five years of follow-up, 9 percent of those taking Actos had another stroke or heart attack, compared with nearly 12 percent of those receiving placebo, the researchers found.

Nearly 4 percent of those taking Actos developed diabetes, compared with nearly 8 percent of those taking the placebo, the study showed.

The report was published online Feb. 17 in the New England Journal of Medicine. The study was also scheduled to be presented Wednesday at the American Stroke Association’s annual meeting, in Los Angeles. Funding for the study was provided by the U.S. National Institutes of Health.

No one knows how Actos works to prevent stroke, Kernan said. The best guess is that the drug reduces inflammation, improves insulin resistance, helps manage fats in the body and “favorably affects the function of blood vessels,” he said. “These could explain its effects on recurrence of stroke and heart attack.”

Insulin resistance may also play a part in the risk for stroke, Kernan said. “This trial provides fairly strong evidence that insulin resistance is an important new target for prevention of stroke,” he said. “This trial takes preventive neurology in a new direction and opens up new opportunities for the care of patients.”

Whether Actos will ever be used to prevent stroke depends on how these findings are evaluated by the medical community, Kernan said.

“Actos may be an option for patients who have had a stroke or mini-stroke, but its role will have to emerge from a debate among scientists about our results,” he said.

Dr. Richard Libman is vice chairman of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y. He said this new finding may add to the ability to prevent recurrent strokes, but it needs to be confirmed before the drug can be widely used.

“This is the first study to show that treating these patients with a medication which improves insulin resistance can also decrease the risk of having a subsequent stroke or heart attack,” he said. “It is only a single study, but it is compelling.”

Dr. Gerald Bernstein is an endocrinologist at the Friedman Diabetes Institute and Lenox Hill Hospital, both in New York City. “This is a straightforward look at a few thousand people over a reasonable period showing the benefits and liabilities of Actos,” he said. “The question we are left with is whether we have something that is all upside and no downside.”

The drug was linked to some serious side effects. People who took Actos in the study were more likely to gain 10 pounds or more, have swelling of the feet and ankles, and broken bones that required surgery or hospitalization, the researchers found.

One day Actos may be a drug used to help prevent stroke, but more knowledge is needed before it can become a regular part of stroke treatment, Kernan said.

More information

For more information on stroke, visit the American Stroke Association.

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This Is the Secret to a Long and Happy Marriage, According to Research

Photo: Getty Images

The single best predictor of marital longevity is that both partners are kind and emotionally generous to each other, per pivotal research from The Gottman Institute in Seattle. Do you treat each other with consideration, versus being frequently critical and biting? Do you tend to see the good in your partner and want to increase his happiness? Little day-to-day interactions that reflect this rapport are common among couples who stay happily married.

RELATED: 20 Ways to Fall In Love All Over Again

A recent study out of the University of Georgia found that another essential ingredient to lasting love is gratitude; those who feel appreciated and valued by their spouse may feel more committed to their marriage and have a more positive outlook overall.

Lastly, joint decision making—and shared domestic duties—are also key to a long and satisfying partnership, according to a study in the Journal of Family Issues. So maybe he loads the dishes haphazardly and you order takeout more than you cook. As long as you’re both pitching in and coming together on the tough stuff, you’re in good shape.

RELATED: 19 Ways Your Body Changes When You Fall in Love

Gail Saltz, MD, is a psychiatrist and television commentator in New York City who specializes in health, sex, and relationships.

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5 Times Ronda Rousey Got Real About Her Body

Courtesy of Sports Illustrated

It’s been a big week for Ronda Rousey. On Sunday the MMA fighter was crowned one of three cover models for this year’s Sports Illustrated Swimsuit Issue, and became the first athlete ever to be featured on the cover. Then on Monday, she appeared on The Ellen Degeneres Show and bravely revealed that she experienced suicidal thoughts after her shocking UFC title loss to Holly Holm last fall. “I was sitting in the corner and I was like, What am I anymore if I’m not this?” she explained in the emotional interview.

Opening up about such a heartbreaking experience couldn’t have been easy. But Rousey’s honesty is just one of the many reasons we love her. Not only is she an incredible athlete, she’s also a feminist icon and an outspoken advocate for body positivity. Here, five of the quotes that have earned her legions of fans, and made her the role model we always wanted.

RELATED: The 10 Best Quotes from Ronda Rousey’s “Ask Me Anything” Reddit Interview

On why she wanted to model for SI

“[Sports Illustrated] has given me so much opportunity,” she said in a behind-the-scenes video at her SI cover shoot. “[They] set a precedent for what society expects out of women’s bodies, and they’re really setting a really healthy and positive standard for all women.” This isn’t the first time that Rousey has modeled for the Swimsuit Issue. In a similar behind-the-scenes video last year, she spoke about the importance of featuring women with diverse body types in the media. “I was so happy to have this opportunity because I really do believe that there shouldn’t be one cookie-cutter body type that everyone is aspiring to be,” she said. “I hope the impression that everyone sees in the next Sports Illustrated Swimsuit Issue is that strong and healthy is the new sexy. And that the standard of women’s bodies is going into a realistic and socially healthy direction.”

On her ideal weight

After the 2015 Swimsuit Issue hit newsstands, Rousey told Cosmopolitan.com that she chose to gain weight before she stripped down for the photo shoot. “I felt like I was much too small for a magazine that is supposed to be celebrating the epitome of a woman,” she said. “I wanted to be at my most feminine shape, and I don’t feel my most attractive at 135 pounds, which is the weight I fight at. At 150 pounds, I feel like I’m at my healthiest and my strongest and my most beautiful.”

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On being called “masculine”

Last August Rousey won the UFC 190 against previously undefeated fighter Bethe Correia. In a video promoting that fight, Rousey responded to body-shaming critics: “Listen, just because my body was developed for a purpose other than f—ing millionaires doesn’t mean it’s masculine. I think it’s femininely badass as f— because there’s not a single muscle on my body that isn’t for a purpose.”

On accepting her body

Despite her natural toughness, Rousey isn’t immune to body image issues. “I absolutely loathed how I looked until I was around 22 years old,” she said in an interview with ESPN.com last year. “What changed for me is I was always thinking I wanted to make my body look a certain way so I would be happy. But when I made myself happy first, then the body came after. It was a journey of self-discovery and trial and error.”

Rejecting the idea of a one-size-fits-all body type helped Rousey find self-acceptance: “The image in my head was the Maxim cover girl,” she said. “In the end, instead of making my body resemble one of those chicks, I decided to try to change the idea of what a Maxim chick could look like.”

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On developing a healthy relationship with food

In an Ask Me Anything on Reddit last year, the fighter mentioned her complicated history with food. “It feels very liberating to [be] free of the guilt that used to come with every meal,” she wrote. “I feel like I have so much extra space in my brain now that I’m not constantly thinking about the next meal and trying to eat as much as possible every day while still losing weight. I feel amazing. I (think) I look amazing. And I just ate some bomb-ass french toast this morning.”

Not long after, Rousey elaborated on her struggles with disordered eating in an interview with Elle.com. Participating in judo tournaments led her to develop an “unhealthy relationship with food” in her teenage years, she explained. She had to hit a certain number on the scale to compete. “I felt like if I wasn’t exactly on weight, I wasn’t good-looking,” she said. “It was a lot to get past, and now I can say that I’ve gotten through it, I’ve never been happier with how I look [or] more satisfied with my body. It was definitely a journey to get there.”

Rousey added that she hopes she can encourage others struggling with similar issues to seek help. “These are issues that I think every girl deals with growing up, and it’s something that’s largely ignored and unaddressed. I would like that to be different for girls growing up after me. It shouldn’t have been as hard as it was.”

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