STROKE
March 6, 2014

Preventing Strokes: New Guidelines for Women

Women have a greater risk of stroke than men do. Pregnancy and birth control are two reasons for this. There is a lot you can do.

Women may be known as the fairer sex, but when it comes to stroke risk, things may not be so, well, fair. In addition to the risks everyone faces, women have a number of added risk factors unique to their sex.

To help women reduce that risk, the American Heart Association/American Stroke Association gathered a group of researchers and asked them to develop the first set of guidelines for the prevention of stroke in women.

“The American Heart Association has excellent stroke prevention guidelines, [but] there has never been one that has focused on the unique risks in women,” Louise McCullough, one of the authors of the guidelines, told TheDoctor.

Women with pregnancy-associated complications, such as pregnancy-induced diabetes and pregnancy-induced hypertension, need to be more aggressive about getting screened.

Women have multiple factors — hormones, pregnancy, and childbirth — that put them at increased risk for stroke, she explained, but too few women think about this as much as they should.

“What we wanted to do is get some prevention guidelines that address these risk factors that are unique in women, like pregnancy, or are more prevalent in women, like migraine with aura, atrial fibrillation, Hypertension (or high blood pressure), depression, and emotional stress,” said McCullough.

In addition to outlining the stroke risks that are unique to women, the guidelines also recommend ways women can address them.

For example, women with a history of hypertension should consider taking low-dose aspirin and/or calcium supplements to lower their risk of preeclampsia during pregnancy. In fact, preeclampsia should be recognized as a risk factor even long after a woman’s childbearing years are over. This is because those who have had it have twice the risk of stroke and quadruple the risk of hypertension later in life.

Women who have had preeclampsia and also have one or more conditions known to contribute to stroke — such as smoking, high cholesterol, and obesity — should be treated early.

The guidelines also recommend that blood pressure medication should be considered for pregnant women with moderately high blood pressure (150-159 mm Hg/100-109 mm Hg); those with very high blood pressure (160/110 mm Hg or above) should definitely be treated.

Before taking birth control pills, it's important to check your blood pressure because the combination of high blood pressure and the hormones in birth control pills raises stroke risk.

Likewise, for women who have migraine headaches with aura it's a good idea to quit smoking to avoid increasing your stroke risk; and women over age 75 should be screened for atrial fibrillation because it, too, is associated with an increased risk of stroke.

The best way for women to prevent stroke or reduce their risk is to follow the same prevention measures that are recommended for men, says McCullough, a professor of neurology and neuroscience and a physician at the stroke center at Hartford Hospital; and the most important thing is to be screened for high blood pressure, and treat it if you have it.

If you smoke, try to quit. If you don’t exercise regularly, or have diabetes, control these risk factors with weight loss and medications. And start walking.

Women who develop pregnancy-associated complications, such as pregnancy-induced diabetes and pregnancy-induced hypertension, are at greater risk for having a stroke later in life. If this is your situation you need to be more aggressive about getting screened.

If you have a history of those pregnancy complications, it might be a good idea to go to the doctor more frequently than once every two years, especially if your blood pressure is creeping up. And you should not take birth control pills if you smoke, or if you have a migraine with aura.

You should definitely tell your doctor if you have ever had pregnancy-associated hypertension, or pregnancy-associated diabetes, or if you are a smoker, or if you get migraines with aura, says McCullough. Be sure to tell your primary care physician, even if you are being treated by an obstetrician/gynecologist.

The guidelines were published online recently in Stroke.

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