Women Now Have Their Own Stroke Risk Guidelines

Pregnancy, birth control pills, migraines among factors

The first-ever guidelines for stroke prevention tailored specifically for women were released Thursday, offering  new strategies to reduce the risk of the third-leading cause of death for females.

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The guidelines, by the American Heart Association and the American Stroke Association, also pave the way for researchers to develop a female risk score so physicians can better assess stroke risk for their patients.

While the major risks of stroke are very similar between men and women – smoking, high blood pressure and cholesterol – the guidelines say that stroke risk in women also is influenced by female-only factors such as hormones, childbirth, pregnancy, birth control pills and migraine headaches with aura, among others.

In addition, high blood pressure, migraine with aura, atrial fibrillation, diabetes, depression and emotional stress are stroke risk factors that tend to be stronger or more common in women than in men.

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“It’s necessary to have guidelines for women,” says Dolora Wisco, MD. “The major risk factors for men and women are very similar. But for women, you add another layer and that’s the more gender-specific risks.”

The guidelines outline stroke risks unique to women and provide scientifically based recommendations on how best to treat them, including:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower risks of preeclampsia, a serious high blood pressure pregnancy disorder.
  • Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderately high blood pressure (150 to 159 /100 to 109 mmHg) may be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
  • Women older than 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

“I think the most important thing with these new guidelines is to know your risk factors,” Dr. Wisco says. “If you have high blood pressure, diabetes, cholesterol, or you’re smoking – those are major risk factors that you need to be paying attention to if you are a female.”

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The good news, Dr. Wisco says, is that some of these factors can be changed.

“If you have high-blood pressure,  see your doctor, have it checked out and see what you can do to lower your blood pressure via life style modification and/or medication,” Dr. Wisco says. “If you’re on oral contraceptive pills and you are smoking, try to think about quitting smoking. That helps out not only for your cerebrovascular and cardiovascular health, but in a whole lot of things for your health in general.”

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