Women suffer more disabling strokes than men and need to become more aware of their unique risks, such as pregnancy complications and the use of oral contraceptives, according to a new set of recommendations released on Thursday by the American Heart Association and the American Stroke Association. The stroke prevention guidelinesthe first to be released specifically for womenalso point to risk factors more common in women like migraines with aura, type 2 diabetes, and obesity; such differences could point to why strokes are the third leading cause of death in women but only the fifth leading cause of death in men.
These new guidelines are a call to action that doctors really need to be focusing more on women when it comes to stroke prevention, said Dr. Shazam Hussain, head of the Stroke Section at the Cleveland Clinic., who was not involved with the guideline.
About 3 percent of Americans have lived through strokes, but as a result many suffer from permanent health problems such as impaired speech, memory loss, or paralysis. Women who develop dangerous hypertension during pregnancy, known as preeclampsia, have twice the risk of having a stroke later in life compared to those who had healthy pregnancies.
The new guidelines, published in the journal Stroke, directs doctors to consider preeclampsia to be a stroke risk factor akin to smoking, high cholesterol, and obesity because its likely to lead to hypertension years after the pregnancy.
Internists should document this pregnancy complication as part of a womans medical record, yet many women report that their doctors never ask about their pregnancy history, said the guideline lead author Dr. Cheryl Bushnell, a neurologist at Wake Forest Baptist Medical Center in Winston-Salem, NC.
Doctors should also screen for high blood pressure before prescribing oral contraceptives, the guideline states, since the estrogen they contain has been associated with a small increased risk of blood clots that could lead to a stroke if a clot blocks off the brains blood supply.
Stroke risk is a discussion many of us already have with our patients before prescribing the pill, especially among smokers over age 35 since theyre at greatest risk, said Dr. Errol Norwitz, chair of the obstetrics and gynecology at Tufts Medical Center. I also check blood pressure after a woman starts the pill and will take her off if theres an increase because of stroke concerns.
Women who have migraines with visual auraswhich occur four times more frequently in women than in menalso have an increased stroke risk and need to make concerted efforts to stop smoking, the guidelines recommend, because the two in combination can be particularly dangerous.
Migraines, like preeclampsia, dont likely cause strokes, Norwitz said, but could be a sign that theres a predisposition for cardiovascular disease.
Since strokes are rare in younger women, even a doubling in risk from preeclampsia or migraines means the likelihood remains pretty low. A 40 year-old womans risk of having a stroke by age 45 may rise from 3 in 10,000 to 6 in 10,000 if she has a single risk factor, Bushnell said. But if you add in oral contraceptive use, a history of high blood pressure, and a diagnosis of type 2 diabeteswhich all increase the risk of strokeit becomes a substantial increased risk.
Here is the original post:
Stroke prevention guidelines highlight unique risks in women