February 7, 2014
News Review From Harvard Medical School -- Guidelines Focus on Stroke Risk for Women
Women face a higher lifetime risk of stroke than men. And they have unique health issues that can increase their risk of stroke. Recognizing all of this, experts have published the first set of stroke prevention guidelines for women. The new advice comes from the American Heart Association and the American Stroke Association. Many of the same health conditions increase risk for both women and men. Both need to control blood pressure, cholesterol and weight. Both can decrease risk by avoiding smoking and diabetes. But the guidelines note that women's risk of stroke also is affected by pregnancy and hormones. Women should pay attention to their blood pressure before deciding on birth control or getting pregnant, the guidelines say. Taking birth control pills can increase the risk of stroke, especially for women with high blood pressure. And pregnant women with high blood pressure may need treatment to prevent preeclampsia. This dangerous problem in pregnancy also doubles the risk of stroke later in life. Smoking particularly increases stroke risk for women who have migraine with aura, take birth control pills or have high blood pressure, the guidelines say. The journal Stroke published the guidelines online February 6.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
The release of a new set of guidelines rarely gets the kind of mass media attention that this one has. But it's well deserved.
The new guidelines are the first ones to focus on stroke prevention for women. And stroke has a more significant impact on health in women than in men. For example, today in the United States, 3.8 million women are living after a stroke, compared with 3.0 million men. Stroke is the third leading cause of death in women. In men, it's the fifth leading cause of death.
The guidelines identify factors that increase the risk of stroke. They also note which factors are:
- Specific to women
- Stronger or more common in women than men
- Similar in both sexes
Risk factors specific to women include:
- Preeclampsia (high blood pressure, leg swelling from edema and protein in the urine during pregnancy)
- Gestational diabetes (new diabetes during pregnancy)
- Birth control pills
- Hormone replacement after menopause
Risk factors that are stronger or occur more commonly in women include:
- Migraine with aura (seeing flashing lights or having other neurological symptoms just before the headache)
- Atrial fibrillation (irregular heart beat)
- High blood pressure
These risk factors are similar in both sexes:
- History of coronary artery disease or peripheral arterial disease
- Large waist size
- Abnormal blood fat profile
- Lack of exercise
What Changes Can I Make Now?
The guidelines are loaded with advice. They include the usual steps suggested for both sexes:
- Control high blood pressure.
- Don't smoke.
- Maintain a healthy weight.
- Stay physically active.
- Limit sugary drinks and foods.
- Strive for a Mediterranean-style diet.
For women, some key recommendations deserve special emphasis.
Young women need to know their blood pressure. Young women have a greater risk of stroke from high blood pressure than young men. And it's especially important for women to treat high blood pressure before getting pregnant. High blood pressure before conception increases the risk of preeclampsia. Preeclampsia adds even more to stroke risk.
Both women and men with atrial fibrillation have an increased stroke risk, but it is higher for women. So they must either have their heart rhythm restored to normal or take a "blood thinner" to help prevent stroke.
Avoiding tobacco products reduces your chance of a stroke. But smoking is especially risky in women who:
- Have migraine with aura
- Take birth control pills
- Have high blood pressure
Women ages 65 through 79 should consider taking a daily baby aspirin (81 milligrams). Blood pressure needs to be controlled and the risk of internal bleeding is small. Always talk to your doctor first before starting regular aspirin therapy.
What Can I Expect Looking to the Future?
Besides a reduced risk of stroke, women who take aspirin appear to have a lower risk of developing ovarian and colorectal cancers. Some studies suggest that aspirin may help prevent other cancers as well.
If you add up all these potential benefits, perhaps in the future a daily aspirin for older women will be recommended more strongly than it is now.