Just as heart attack
symptoms may differ between men and women, so do stroke risks.
Now, the American Heart
Association has issued its first guidelines for preventing strokes in women.
They focus on birth control, pregnancy, depression and other risk factors that
women face uniquely or more frequently than men do.
The advice applies to
patients like Denise Miller, who suffered a stroke last year that fooled
doctors at two northeast Ohio hospitals before it was finally diagnosed at the
Cleveland Clinic. She was 36 and had no traditional risk factors.
"There was nothing to
indicate I was going to have a stroke," other than frequent migraines with
aura – dizziness or altered senses such as tingling, ringing ears or
sensitivity to light, Miller said.
These headaches are more
common in women and the new guidelines flag them as a concern.
Miller recovered but has some lingering numbness and vision problems.
Read: How is a stroke diagnosed?
Key to surviving
Each year, nearly 800 000
Americans have a new or recurrent stroke, which occurs when a blood vessel to
the brain is blocked by a clot or bursts. Stroke is the third-leading cause of
death for women and the fifth-leading cause for men.
The key to surviving a stroke
and limiting disability is getting help fast, and recognising symptoms such as
trouble speaking, weakness or numbness in one arm, or drooping on one side of
Stroke risk rises with age,
and women tend to live longer than men. Women are more likely to be living
alone when they have a stroke, to have poorer recovery, and to need
institutional care after one.
Certain stroke risks are
more common in women – migraine with aura, obesity, an irregular heartbeat
called atrial fibrillation, and metabolic syndrome – a combo of problems
including blood pressure, cholesterol and blood sugar.
General guidelines for
stroke prevention currently focus on controlling blood pressure and diabetes,
quitting smoking, more exercise and healthy diets.
The new ones add
gender-specific advice, said Dr. Cheryl Bushnell, stroke chief at Wake Forest
Baptist Medical Center in Winston-Salem, North Carolina. She led the panel that
wrote the guidelines, published in Stroke, a Heart Association journal.
Read: Omega-3 prevents second stroke
Birth control pills: Women should be checked for high blood pressure before starting on oral
contraceptives because the combination raises stroke risks. The risk is small
but rises steeply in women ages 45 to 49. More than 10 million American women
use birth control pills.
are uncommon during pregnancy but the risk is still higher, especially during
the last three months and soon after delivery. The big worry is pre-eclampsia,
dangerously high blood pressure that can cause a seizure and other problems.
"It doubles the risk
of stroke later in life and it quadruples the risk of high blood pressure"
after pregnancy, Bushnell said.
Women with a history of
high blood pressure before pregnancy should be considered for low-dose aspirin
(around 81 milligrams) after the first three months of pregnancy, and calcium
supplements anytime, to lower the risk of pre-eclampsia, the guidelines say.
Pregnant women with high blood pressure (160 over 110 and above) should be treated
with medication, and treatment may be considered for those with moderately
high blood pressure (150 to 159 over 100 to 109). Certain blood pressure
medicines are not safe during pregnancy, the guidelines note.
usually recommended for anyone who has already had a stroke unless the stroke
was caused by bleeding rather than a clot, or if bleeding risk is a concern,
Bushnell said. Aspirin also is often recommended for people with diabetes to
lower the risk of stroke and other problems.
A low-dose aspirin every
other day "can be useful" to lower stroke risk in women 65 and older
unless its benefit is outweighed by the potential for bleeding or other risks,
the guidelines say.
Read: Low-fat dairy may prevent strokes
are four times more likely to have migraines than men, and they often coincide
with hormone swings. Migraines alone don't raise the risk of stroke, but ones
with aura do. Using oral contraceptives and smoking raise this risk even more,
so the guidelines urge stopping smoking.
Irregular heartbeat: Women over age 75 should be checked for atrial fibrillation. Doctors do
this by taking a pulse or listening to the heartbeat.
therapy should not be used to try to prevent strokes.
The new guidelines put
women's issues "on the table" so more doctors talk about them, said
Dr. Shazam Hussain, stroke chief at the Cleveland Clinic. "Gender does make
a difference. The medical community has neglected it for some time."
How women can prevent stroke
Diets for stroke patients
Know your risk – prevent a stroke