New Stroke Guidelines for Women

Stroke is now more common in women than men in the United States, representing more than half of the 795,000 cases that occur each year, according to the American Stroke Association.

To improve awareness among women and physicians, guidelines have been specifically created for the first time to better help prevent stroke in women.

A stroke hits when a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot or bursts, restricting oxygen and destroying brain cells, according to the American Stroke Association (ASA).

Strokes are also deadlier for women, with about 60 percent of stroke deaths happening in women, says the ASA.

“The guidelines present a good opportunity to focus on women-centered needs,” says Paul Damski, M.D., a neurologist and Stroke Program Medical Director for Baptist Hospital and West Kendall Baptist Hospital. “Women’s issues that affect stroke risk include pregnancy, childbirth, hormonal imbalances and menopause.”

Women share many stroke risk factors with men — primarily high blood pressure, high cholesterol, diabetes, smoking and obesity. However, they also have a set of unique concerns that need to be addressed.

Health Conditions Specific to Women
Pregnancy, childbirth and hormones play a role in stroke risk for women, the new guidelines emphasize.

For example, of the nearly 4 million women who give birth each year, an estimated 6 percent to 10 percent develop preeclampsia, a dangerous spike in blood pressure that occurs late in pregnancy. Preeclampsia doubles the risk for stroke and quadruples the risk for high blood pressure later in life, according to the committee of physicians who wrote the guidelines.

Other vulnerabilities that women share include common pregnancy complications, use of birth control pills, hormone replacement therapy and a higher prevalence of migraines with visual disturbances. Additionally, women age 75 or older with atrial fibrillation — a common heart rhythm disorder — have a higher risk for strokes.

“There are different audiences targeted with these guidelines, particularly older women with blood pressure and heart rhythm abnormalities, and younger women with pregnancy and migraine issues,” Dr. Damski says. “While no specific finding here is groundbreaking, this is a good narrative for women and physicians to review and understand.”

The New Guidelines
Here are new stroke prevention recommendations for women based on the most current scientific research, according to the American Heart Association and the American Stroke Association:

  • 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 — beginning with the second trimester through delivery —to lower preeclampsia risk.
  • Expectant mothers with severe high blood pressure (160/110 mmHg 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 over 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.
  • Women should consult with their doctor regarding any concerns tied to those recommendations.

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