New Stroke Guidelines for Women

Women have a unique set of risk factors for stroke that haven’t been addressed previously

Men and women share many of the risk factors for stroke, but doctors often underestimate these risks in their female patients. So last week, the American Heart Association (AHA) released the first guidelines designed to prevent stroke in women.
Though high blood pressure, high cholesterol, diabetes, smoking and obesity are shared stroke risks, women have a unique set of concerns that haven’t been addressed before these guidelines. Pregnancy, childbirth and hormones all play a role in stroke risk for women, according to Cheryl Bushnell, M.D., director of the Stroke Center at Wake Forest Baptist Medical Center, and lead author of the guidelines.
“Women live longer, and so they actually have a higher lifetime risk of stroke,” Dr. Bushnell said. “They also tend to do worse after they have had a stroke. They’re more likely to end up in long-term nursing care and have a worse quality of life. For those reasons, we thought it was important to emphasize prevention and to start those strategies early in the childbearing years for women.”
Stroke, the third-leading killer of women (60 percent of all stroke-related deaths in 2010 occurred in women), occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or it bursts, keeping oxygen from reaching the brain, and killing brain cells. Its gender-specific risk factors include:
Pre-eclampsia—a pregnancy-related complication marked by dangerously high blood pressure that could affect a woman’s stroke risk for many years after they give birth; women who have pre-eclampsia have double the risk for a stroke later in life and have four times the risk for high blood pressure as they age.
Gestational diabetes
Birth control pills—only become an issue if a woman smokes or has high blood pressure. “If you’re healthy, taking birth control pills shouldn’t be something you worry about,” Dr. Bushnell said.
Some risk factors are more common in women than in men:
Migraine with aura
Atrial fibrillation
High blood pressure—a risk factor for both genders, but hypertension is more common in women older than age 55 than it is in men, and studies show the condition isn’t as well controlled in women.
Depression and psychosocial stress
The guidelines address risk factors for women at all ages and include these recommendations:
Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin therapy or calcium supplementation while pregnant.
Pregnant women with elevated blood pressure (150-159 mm Hg/100-109 mm Hg) should talk with their doctor about blood pressure medication.
Pregnant women with severe high blood pressure (160/110 mm Hg or higher) should take medication.
Women should be screened for high blood pressure before taking birth control pills.
Women who suffer from migraines with aura should quit smoking.
Women older than 75 should be screened for atrial fibrillation risks.
Each year, about 55,000 more women than men experience a stroke, and black women are most at risk, according to the AHA.

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