First guidelines issued to prevent stroke in women

February 6, 2014 by Marilynn Marchione
Denise Miller poses on her front porch Thursday, Feb. 6, 2014, in Southington, Ohio. Miller suffered a stroke last year that fooled doctors at two Northeast Ohio hospitals before it was finally diagnosed at the Cleveland Clinic. She was 36 and had no traditional risk factors.The American Heart Association on Thursday issued its first guidelines for preventing strokes in women, focusing on birth control, pregnancy, depression and other risk factors that women face uniquely or more frequently than men do. (AP Photo/Tony Dejak)

Just as heart attack symptoms may differ between men and women, so do stroke risks.

Now, the American Heart Association has issued its first guidelines for preventing strokes in women. They focus on birth control, pregnancy, depression and other risk factors that women face uniquely or more frequently than men do.

The advice applies to patients like Denise Miller, who suffered a stroke last year that fooled doctors at two northeast Ohio hospitals before it was finally diagnosed at the Cleveland Clinic. She was 36 and had no traditional risk factors.

"There was nothing to indicate I was going to have a stroke," other than frequent migraines with aura—dizziness or altered senses such as tingling, ringing ears or sensitivity to light, Miller said.

These headaches are more common in women and the new guidelines issued Thursday flag them as a concern. Miller recovered but has some lingering numbness and vision problems.

Each year, nearly 800,000 Americans have a new or recurrent stroke, which occurs when a blood vessel to the brain is blocked by a clot or bursts. Stroke is the third-leading cause of death for women and the fifth-leading cause for men. The key to surviving one and limiting disability is getting help fast, and recognizing symptoms such as trouble speaking, weakness or numbness in one arm, or drooping on one side of the face.

Stroke risk rises with age, and women tend to live longer than men. Women are more likely to be living alone when they have a stroke, to have poorer recovery, and to need institutional care after one.

Certain stroke risks are more common in women—migraine with aura, obesity, an irregular heartbeat called atrial fibrillation, and metabolic syndrome—a combo of problems including blood pressure, cholesterol and blood sugar.

General guidelines for stroke prevention currently focus on controlling blood pressure and diabetes, quitting smoking, more exercise and healthy diets.

The new ones add gender-specific advice, said Dr. Cheryl Bushnell, stroke chief at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. She led the panel that wrote the guidelines, published in Stroke, a Heart Association journal.

Some highlights:

BIRTH CONTROL PILLS: Women should be checked for high blood pressure before starting on oral contraceptives because the combination raises stroke risks. The risk is small but rises steeply in women ages 45 to 49. More than 10 million American women use birth control pills.

PREGNANCY: Strokes are uncommon during pregnancy but the risk is still higher, especially during the last three months and soon after delivery. The big worry is preeclampsia, dangerously high blood pressure that can cause a seizure and other problems.

"It doubles the risk of stroke later in life and it quadruples the risk of high blood pressure" after pregnancy, Bushnell said.

Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin (around 81 milligrams) after the first three months of pregnancy, and calcium supplements anytime, to lower the risk of preeclampsia, the guidelines say.

Pregnant women with very high blood pressure (160 over 110 and above) should be treated with medications, and treatment may be considered for those with moderately high blood pressure (150 to 159 over 100 to 109). Certain blood pressure medicines are not safe during pregnancy, the guidelines note.

ASPIRIN: It's usually recommended for anyone who has already had a stroke unless the stroke was caused by bleeding rather than a clot, or if bleeding risk is a concern, Bushnell said. Aspirin also is often recommended for people with diabetes to lower the risk of stroke and other problems.

A low-dose aspirin every other day "can be useful" to lower stroke risk in women 65 and older unless its benefit is outweighed by the potential for bleeding or other risks, the guidelines say.

MIGRAINES: Women are four times more likely to have migraines than men, and they often coincide with hormone swings. Migraines alone don't raise the risk of stroke, but ones with aura do. Using oral contraceptives and smoking raise this risk even more, so the guidelines urge stopping smoking.

IRREGULAR HEARTBEAT: Women over age 75 should be checked for atrial fibrillation. Doctors do this by taking a pulse or listening to the heartbeat.

MENOPAUSE: Hormone therapy should not be used to try to prevent strokes.

The new guidelines put women's issues "on the table" so more doctors talk about them, said Dr. Shazam Hussain, stroke chief at the Cleveland Clinic. "Gender does make a difference. The medical community has neglected it for some time."

Explore further: High blood pressure during pregnancy could elevate the risk of a future stroke

Related Stories

High blood pressure during pregnancy could elevate the risk of a future stroke

October 18, 2013
High blood pressure during pregnancy could dramatically raise a woman's lifetime risk of stroke, according to a study presented today at the Canadian Stroke Congress.

Study finds black women most likely to have high blood pressure

December 23, 2013
(HealthDay)—Black women in the United States are much more likely to have high blood pressure than black men or white women and men, according to a new study.

High blood pressure during pregnancy may signal later heart disease risk

February 11, 2013
even once or twice during routine medical care—can signal substantially higher risks of heart and kidney disease and diabetes, according to new research in the American Heart Association journal Circulation.

Low vitamin D levels during pregnancy may increase risk of severe preeclampsia

January 27, 2014
(Medical Xpress)—Women who are deficient in vitamin D in the first 26 weeks of their pregnancy may be at risk of developing severe preeclampsia, a potentially life-threatening disorder diagnosed by an increase in blood ...

Stroke risk similar among men and women smokers worldwide

August 22, 2013
Smoking cigarettes may cause similar stroke risks for men and women, but women smokers may be at greater risk for a more deadly and uncommon type of stroke, according to new research in the American Heart Association journal ...

Young obese women could reduce their stroke risk

October 25, 2013
Sophia Antipolis, 29 October 2013: The global campaign to tackle stroke is highlighted today on World Stroke Day with the slogan "Because I care…". The phrase showcases the role of caregivers in supporting people who have ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.