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.
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.
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.
The new guidelines add gender-specific advice, said Dr. Cheryl Bushnell, stroke chief at Wake Forest Baptist Medical Center in Winston-Salem, N.C. She led the panel that wrote the guidelines, published in Stroke, a Heart Association journal.
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.
PREGNANCY: Strokes 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.
MIGRAINES: Women 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.
IRREGULAR HEARTBEAT: Women over age 75 should be checked for atrial fibrillation. Doctors do this by taking a pulse or listening to the heartbeat.
MENOPAUSE: Hormone 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.”