First Stroke Guidelines for Women Emphasize Early Prevention

Feb 06, 2014 4:00 pm ET

Feb. 6 (Bloomberg) -- The first stroke guidelines to specifically target women emphasize prevention earlier in life and recognize unique female risks for the disorder, including pregnancy and birth control pills.

Women live longer than men, though suffer about 55,000 more strokes each year and have poorer health following an attack, according to a scientific statement by the American Heart Association and American Stroke Association in the journal Stroke. While women and men share many of the same risk factors, pregnancy, childbirth and hormones also affect a woman’s chance of stroke, sparking a need for gender-specific guidelines, the authors said.

“In the old way, we really kept everyone in the same bucket,” M. Shazam Hussain, head of the stroke center at the Cleveland Clinic in Ohio, who wasn’t an author of today’s paper, said in a telephone interview. “We treated everyone the same. More and more evidence has been accumulating that with women, there are things that are different.”

A stroke occurs when blood flow to the brain stops, according to the U.S. National Institutes of Health. Brain cells begin to die within minutes. Ischemic stroke, the most common, is caused by a blood clot, while hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.

Diabetes, depression, high blood pressure, migraine with aura, emotional stress and irregular heartbeats are more common or stronger stroke-risk factors in women than men.

Preeclampsia Risk

Researchers said today that pregnancy-induced high blood pressure, called preeclampsia, should be considered a risk factor for stroke later in life. That’s because women who have preeclampsia have double the risk of stroke and four times the risk of high blood pressure when they’re older, according to the paper. Doctors should treat other stroke risk factors like smoking, obesity and high cholesterol in these women early.

The research also suggests that doctors treat women with high blood pressure prior to pregnancy to lower their risk of developing preeclampsia. And doctors should consider treating women who have moderately high blood pressure during pregnancy with heart drugs, like beta blockers, said Cheryl Bushnell, the lead study author.

Women who are considering birth control pills should be screened for high blood pressure prior to use and women who have migraine headaches with aura should stop smoking, they said.

Early Prevention

“Prevention can start at a young age. We want to make sure both women and their doctors are aware of the factors that some of these pregnancy-related complications can be risk factors even after child bearing,” Bushnell, an associate professor of neurology and director of the Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, said in a telephone interview. “If younger women get started with prevention now, they can perhaps prevent themselves from having a stroke later in life.”

The paper also suggests that women exercise regularly, abstain from smoking, and eat a diet full of fruits, vegetables, grains, nuts, olive oil and foods low in saturated fats to help prevent stroke. Also, doctors should monitor women over the age of 75 years for the most common type of irregular heartbeats, which is associated with a fourfold to fivefold increased risk of stroke.

More studies are needed to better understand how much these gender-specific factors contribute to a woman’s total stroke risk, Bushnell said.

--Editors: Angela Zimm, Andrew Pollack