According to the American heart Association (AHA), stroke is now more common in women than men. More than 50% of the 795,000 strokes that occur in the US each year occur in women. In addition, the disease is also more deadly for women: 60% of stroke deaths occur in women. To address this troubling situation, the AHA and the American Stroke Association issued their-first-ever guidelines for reducing stroke risk in women on February 6. The guidelines, which are based on the most current scientific research, note that controlling high blood pressure and other risk factors related to pregnancy as well as the use of birth control can significantly reduce a woman's chance of suffering a stroke later in life.
The guidelines recommend that the millions of women with a history of preeclampsia (toxemia of pregnancy) should be screened and treated for high blood pressure, obesity, smoking, and high cholesterol to reduce their risk for stroke. It notes that among the approximately 4 million women who give deliver a child each year, experts estimate that 6-10% of them develop preeclampsia. Preeclampsia doubles the risk for stroke and quadruples the risk for high blood pressure later in life, noted Cheryl Bushnell, M.D., a neurologist and director of the Stroke Center at Wake Forest Baptist Medical Center who chaired the committee that wrote the guidelines. She explained, “Many women and even clinicians are not aware of this association. Women who may think of themselves as very healthy may have this little blip of vascular disease during their childbearing years. What happens during those years is extremely important.”
Throughout the guidelines, the importance of nonsmoking is stressed. Smoking is the leading cause of preventable death in the US; a recent Surgeon General’s report found that stroke risk from secondhand smoke exposure increases the risk by an estimated 20-30%. Women share many of the same risk factors for stroke as men, such as high blood pressure, smoking and diabetes; however, women have other risk factors that make them uniquely vulnerable, noted Monique Chireau, M.D., an obstetrician/gynecologist at Duke University Medical School who helped author the guidelines. Those vulnerabilities include common pregnancy complications, use of birth control pills, hormone replacement therapy and a higher prevalence of migraines with visual disturbances and atrial fibrillation after age 75.
The new stroke prevention guidelines for women and 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.
- Pregnant women with severe high blood pressure (160/110 mm Hg 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 older than 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.
Dr. Chireau noted that scientific evidence linking preeclampsia, gestational diabetes, and other pregnancy complications with future cardiovascular disease is getting stronger. She added, ”The big concern I have as an obstetrician is that we’re seeing increasing rates of cardiovascular disease in younger women. The most important thing is for women to understand their risk factors, especially pregnancy-related ones.” She recommended that, in addition to heeding the risk factors, women should work with their primary care physicians to reduce their risks through dietary changes, increased physical activity, and medications if needed. Dr. Bushnell added that all women should discuss their stroke risk with a physician. She explained, “If we can help women understand more about stroke and cardiovascular risk, they could jump-start healthy living at an earlier age. That’s going to prevent a lot of strokes in the future.”
The complete guidelines are available at this link.