Pregnancy, childbirth, female hormones can all influence lifelong risk, experts say
THURSDAY, Feb. 6, 2014 (HealthDay News) -- For the first time, guidelines have been created to help prevent stroke in women.
The author of the new guidelines, published online Feb. 6 and in the May print issue of the journal Stroke, said women share a lot of stroke risk factors with men -- namely high blood pressure, high cholesterol, diabetes, smoking and obesity -- but they also have a set of unique concerns that need to be addressed.
Pregnancy, childbirth and hormones play a role in stroke risk for women, explained Dr. Cheryl Bushnell, director of the Stroke Center at Wake Forest Baptist Medical Center, in Winston-Salem, N.C.
"The basic message is that women live longer, and so they actually have a higher lifetime risk of stroke," Bushnell said. "They also tend to do worse after they have had a stroke. They're more likely to end up in long-term nursing care and have a worse quality of life. For those reasons, we thought it was important to emphasize prevention and to start those strategies early in the childbearing years for women."
A stroke happens when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or it bursts, keeping oxygen from reaching the brain, and killing brain cells, according to the American Stroke Association.
Each year, about 55,000 more women than men experience a stroke, and non-Hispanic black women are most at risk, the American Heart Association reports.
According to Dr. Andrew Russman, a neurologist at the Cleveland Clinic's Cerebrovascular Center, "They did a good job putting the guidelines on paper. I think it's terribly important that there's now a set of guidelines that help women understand some of their unique stroke risks, which change throughout life -- from pregnancy, through menopause and later in life."
Bushnell said she and colleagues scoured the existing scientific literature to develop the new guidelines, which include recommendations for women of all ages.
"There's risk across a woman's lifespan," said Bushnell. "Without a doubt, the highest risk is as women get older, especially as they accumulate other risk factors," such as high blood pressure.
But, she added, while complications from stroke are rare during pregnancy, that's when the first signs of vascular disease can appear. She said women who have eclampsia and preeclampsia during pregnancy (a dangerous condition marked by high blood pressure), for example, are at twice the risk for stroke later in life and four times the risk for high blood pressure later.
Bushnell added that taking birth control pills can raise a woman's risk for stroke, especially in middle age. And women who get migraines with aura are also at higher risk, so they need to consider preventive strategies earlier in life.
Some recommendations in the new guidelines include:
- Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin therapy or calcium supplementation while pregnant.
- Pregnant women with elevated blood pressure (150-159 mm Hg/100-109 mm Hg) should talk with their doctor about possible blood pressure medication.
- Pregnant women with severe high blood pressure (160/110 mm Hg or above) should take medication.
- Women should be screened for high blood pressure before taking birth control pills.
- Women who suffer from migraines with aura should quit smoking.
- Women over 75 should be screened for atrial fibrillation risks.
"There isn't a specific prevention strategy for women because we haven't studied it enough to find one," Bushnell said. "But all of the healthy lifestyle recommendations apply equally to men and women."
Dr. Suzanne Steinbaum, director of Women's Heart Health at the Heart and Vascular Institute at Lenox Hill Hospital in New York City, said she hopes the new guidelines will help women be more aware of stroke risk and cardiovascular health.
"Whenever I give a talk, I ask what people think is the greatest risk to women's health and they say breast cancer," Steinbaum said. "I don't think stroke is on the same level of consciousness. Awareness is the first step," she noted.
"The first step is, if you have any risks for cardiovascular disease, heart disease or stroke, it's important to visit your doctor," Steinbaum said. "Then, know your numbers: your blood pressure, your cholesterol, your blood sugar, your BMI [which is a score based on height and weight]. Knowing your family history is also very important. To prevent stroke it comes down to the basics, lifestyle changes. These are critical issues to address in order to reduce cardiovascular disease and prevent stroke."
To recognize the warning signs of stroke, learn about the acronym FAST ( http://www.strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_UCM_308528_SubHomePage.jsp ).
SOURCES: Cheryl Bushnell, M.D., M.H.S., associate professor, neurology, and director, Stroke Center, Wake Forest Baptist Medical Center, Winston-Salem, N.C.; Andrew Russman, D.O., neurologist, Cerebrovascular Center, Cleveland Clinic, Ohio; Suzanne Steinbaum, M.D., director, Women's Heart Health, Heart and Vascular Institute, Lenox Hill Hospital, New York City; May 2014, Stroke