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Originally published February 6, 2014 at 8:58 PM | Page modified February 7, 2014 at 3:18 PM

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New stroke-risk guidelines specifically for women

The American Heart Association has issued its first guidelines for preventing strokes in women.


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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 such as Denise Miller, who had 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 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. The latter is a combination of problems including high blood pressure, cholesterol abnormalities, insulin resistance and increased risk of clotting.

General guidelines for stroke prevention now focus on controlling blood pressure and diabetes, quitting smoking, exercising more and healthful diets.

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

Some key recommendations:

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.

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 pre-eclampsia, 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 after the first three months of pregnancy, and calcium supplements any time, to lower the risk of pre-eclampsia, 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.

In addition, women who have pre-eclampsia have twice the risk of stroke and a fourfold risk of high blood pressure later in life.

ASPIRIN: It’s usually recommended for anyone who has 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 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 older than 75 should be checked for atrial fibrillation.

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.”



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