Women may have many of the same risk factors for stroke as men – diabetes, high blood pressure, smoking, high cholesterol – but they also can face separate issues such as high blood pressure during pregnancy, the use of birth control pills and other hormonal and lifestyle factors.
So for the first time, the American Heart Association and American Stroke Association on Thursday released new stroke prevention guidelines specifically for women.
"The risk factors that are unique to women need to be recognized, and women can start decreasing their risk much earlier than they thought, even in the childbearing years," says neurologist Cheryl Bushnell, lead author of the scientific statement with the guidelines, published in the American Heart Association journal Stroke.
A stroke occurs when a blood vessel to the brain is either blocked by a clot or bursts, the American Heart Association says. When that happens, part of the brain is no longer getting the blood and oxygen it needs, so it starts to die. Strokes can affect language, memory and vision as well as cause paralysis and other health issues, the group says.
Having a stroke can be a "devastating, life-changing" event, and more women are affected by it than men because women live longer, Bushnell says.
More than half of the estimated 800,000 strokes each year occur in women. An estimated 6.8 million people in the USA are living after having a stroke, including 3.8 million women and 3 million men, she says. Stroke is the fifth leading cause of death for men, and the third leading cause for women, she says.
So it's important to try to reduce the risk of having a stroke for women, she says. That includes monitoring and treating pre-eclampsia and eclampsia, blood pressure disorders during pregnancy that can cause major complications, including stroke during or after delivery, premature birth, and risk for stroke well after child-bearing. Pre-eclampsia is characterized by high blood pressure and high protein levels in the urine, and when seizure also occurs, it's called eclampsia, the heart association says.
Other stroke risk factors that tend to be stronger or more common in women than men include high blood pressure, migraine with aura (a visual phenomenon such as flashing lights or loss of vision before the headache), atrial fibrillation (a quivering or irregular heartbeat), diabetes, depression and emotional stress, the heart association says.
The new guidelines outline women's stroke risks and offer advice on treating them:
• Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower pre-eclampsia risks.
• Women who have pre-eclampsia have twice the risk of stroke and a four-times the risk of high blood pressure later in life. Pre-eclampsia should be recognized as a risk factor after pregnancy as well, and other risk factors such as smoking, high cholesterol and obesity in these women should be treated early. Bushnell says women who have had pre-eclampsia should be proactive in alerting their doctors to that fact and start the conversation of stroke-risk assessment.
• Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
• Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) may be considered for blood pressure medication. Expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated with medication during pregnancy.
• Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
• Women over age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.
When it comes to preventing obesity, the guidelines suggest women follow a healthy lifestyle consisting of regular physical activity, moderate alcohol consumption (less than one drink a day for non-pregnant women), abstention from cigarette smoking and a diet rich in fruits, vegetables, grains, olive oil and low in saturated fat.
About 30% of stroke patients have permanent disability after a stroke such as being unable to walk or speak, but many more have cognitive difficulties and other more subtle changes that keep them from doing what they did before, says Bushnell, an associate professor of neurology and director of the Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, N.C.
"Most of my female patients are way more concerned about preventing strokes than preventing heart attacks because of the significant disability associated with strokes," says preventive cardiologist Gina Lundberg, a spokeswoman for the heart association and an assistant professor of medicine at the Emory University School of Medicine in Atlanta. "Now for the first time we have these guidelines to instruct patients and physicians on preventing strokes. This should have real impact on the care of women."
The heart association and stroke association have a campaign called Together to End Stroke to raise awareness that stroke is largely beatable and treatable. It emphasizes the acronym F.A.S.T., which are ways to identify if a person is having a stroke:
• Face drooping. Does one side of the face droop or is it numb? Ask the person to smile.
• Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• Speech difficulty. Is speech slurred, are they unable to speak or are they hard to understand? Ask the person to repeat a simple sentence like "The sky is blue." Is the sentence repeated correctly?
• Time to call 911. If a person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.