New Guidelines to Prevent Stroke in Women

Stroke prevention guidelines for women focus on factors unique to them

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) More than half the strokes in the US occur in women. Addressing factors that uniquely increase their risk may help to change that statistic.

By analyzing published studies on strokes occurring in women, a panel of medical experts identified gender-specific factors that increased their risk of stroke. They also found a set of stroke risk factors seen more commonly in women than in men.

This panel of researchers produced the first guidelines on stroke risk and prevention in women adopted by the American Heart Association and American Stroke Association.

Among the recommendations was that women who smoked and had migraines with aura be strongly advised to quit smoking. The guidelines also recommended that women get regular exercise, eat a healthy diet, avoid smoking and to use alcohol in moderation.

"Ask your doctor how to lower your chances of stroke."

This panel of experts in many fields, such as nursing, internal medicine, neurology, obstetrics and gynecology and cardiology, were led by Cheryl Bushnell, MD, MHS, FAHA, from Wake Forest University in North Carolina.

The team reviewed research published through May 2013. They analyzed studies covering different conditions in which stroke occurred in women in order to develop risk scores and establish guidelines that included recommendations for prevention and treatment.

High blood pressure was found to be the biggest stroke risk factor, and some conditions unique to women cause high blood pressure.

Preeclampsia, a condition characterized by high blood pressure during pregnancy, increased the odds of stroke later in life by 55 percent compared to pregnant women without preeclampsia. Because of this, the new guidelines recommended taking a low-dose aspirin from the twelfth week of pregnancy until delivery.

The guidelines also recommended calcium supplements for women with low calcium to prevent preeclampsia. The new guidelines stated that high blood pressure in pregnancy and after delivery should be treated with antihypertensive medications known to be safe and effective for pregnant women.

The research team found that any increase in stroke risk from birth control pills was small but increased in older women, those who smoked, had high blood pressure, diabetes, were obese, had clotting problems or had high cholesterol. Because over 10 million women take birth control pills and many have conditions that increase risk, the new guidelines recommended that doctors consider these additional factors and screen for high blood pressure before prescribing birth control pills.

Routine blood tests for clotting disorders were not recommended.

Migraines are four times more common in women than men. Recent studies showed that women who had migraines with aura (migraines with a warning sign) had up to a 2.5-fold higher odds of stroke. Smoking increased the stroke risk nine-fold, and birth control pills increased the stroke risk seven-fold in women with this type of migraine.

The new guidelines recommended that women who smoke and have migraines with aura be advised to quit smoking.

Since obesity is more common in women than men, the new guidelines recommended regular exercise, a healthy diet, no smoking and alcohol in moderation to prevent stroke in these women and in any women with stroke risk factors.

Atrial fibrillation is the most common major risk factor for stroke that can be treated. While the number of men and women who have atrial fibrillation is mostly the same, 60 percent of atrial fibrillation patients over the age of 75 are women. 

The authors recommended that primary care doctors actively screen for atrial fibrillation in women over 75 years old, through pulse screening and KCG as appropriate.

According to Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas, "These are important and long-overdue guidelines that highlight some of the risk factors unique to women. For instance, many women and their doctors are unaware that a diagnosis of pre-eclampsia during pregnancy means a higher risk for hypertension and stroke later in life.

"As a cardiologist, this has become an important part of the medical history that I take from my patients. The impact of smoking on a woman's other risk factors is also a critical issue that is often not addressed, but which in some cases may increase the risk of stroke sevenfold," Dr. Samaan told dailyRx News.

"I think it's also important that the report highlights the importance of a healthy diet (especially the Mediterranean diet and the DASH diet) in reducing stroke risk, both by improving overall health, and probably by also being directly protective to the brain," she said.

"This guideline may empower women and their families to understand their own risk and how they can minimize the chances of having a stroke," the authors of these guidelines wrote.

The guidelines were published in the February issue of Stroke.

Four of the authors disclosed acting as a consultant to pharmaceutical companies and three authors disclosed accepting honoraria for lectures.

Dr. Bushnell received funding from the National Institutes of Health and from the World Federation of Neurology.

Review Date: 
February 5, 2014
Last Updated:
March 6, 2014