New guidelines for preventing stroke in women

According to newly released guidelines, women have unique risk factors for stroke that should be monitored no matter their age.

The guidelines, released by the American Heart Association (AHA) and the American Stroke Association, calls specific attention to risk factors that separate women’s risk of stroke from men, risk factors that include high blood pressure during pregnancy, use of birth control pills and migraine headaches. The AHA says more strokes occur in women, with 60 percent of all deaths by stroke being women.

Specific attention in the guidelines is paid to the increased stroke risk to the millions of women with a history of preeclampsia, a dangerous spike in a woman’s blood pressure that may develop late in pregnancy. An estimated 6 to 10 percent of women who give birth each year develop the condition.

In fact, preeclampsia puts women at such greater risk, the guidelines recommend screening and treatment for high blood pressure, obesity, smoking and high cholesterol to reduce their risk for stroke.

Preeclampsia doubles a woman’s risk for stroke and quadruples her risk of developing high blood pressure, says Dr. Cheryl Bushnell, neurologist and director of the Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, NC, who chaired the guideline committee.

“Women who may think of themselves as very healthy may have this little blip of vascular disease during their childbearing years,” says Dr. Bushnell in this month’s issue of the medical journal Stroke. “What happens during those years is extremely important.”

According to the guidelines, the new recommendations for women include:

• All women with a history of preeclampsia should be regularly evaluated and treated for cardiovascular risk factors such as high blood pressure, obesity, smoking and high cholesterol. Screening for risk factors should start within one year after delivery.
• Pregnant women with high blood pressure or who experienced high blood pressure during a previous pregnancy should talk to their healthcare providers about whether they should take low-dose aspirin starting the second trimester until delivery to lower preeclampsia risk.
• Expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated with blood pressure medications that are safe during pregnancy.
• Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for safe blood pressure medications.
• Women should be screened for high blood pressure before starting birth control pills because the combination increases stroke risk. Women should not smoke, and they should be aware that smoking while taking birth control pills increases the risk of stroke.
• Women smokers who have migraines with aura (visual impairments) should stop smoking to avoid a higher stroke risk.
• Women over age 75 should be screened for atrial fibrillation. Women in this age group are more likely than men to develop the heart rhythm disorder, which increases stroke risk five-fold.

According to Dr. Raina Gupta, neurologist with Advocate Illinois Masonic Medical Center in Chicago, these new guidelines are an important step for preventing stroke in women.

“We know that approximately 30 percent of stroke patients may become disabled; therefore, it’s imperative to address prevention,” Dr. Gupta says. “These guidelines help us to assess women’s unique stroke risk factors that can be very common issues tied to an elevated overall stroke risk.”

Dr. Gupta says that identifying women with these increased risk factors early on and with more aggressive treatment may be of enormous benefit later in life.

“I think this information will allow physicians to be better prepared to address these risk factors earlier in a patient’s life to aid in stroke prevention.”

Dr. Gupta stresses that the key to surviving a stroke and reducing possible long-term disability is recognizing the signs and symptoms and immediately calling 911. She says everyone should learn to keep the acronym FAST in mind when you think a friend or loved one may have had a stroke. Key symptoms may include confusion, dizziness, slurred speech, difficulty speaking, weakness or numbness and facial droop.