Start early to reduce stroke risk

Women are at greater risk for strokes than men, and for the first time women and their doctors have evidence-based guidelines on how to reduce that risk.

The first-ever guidelines on stroke prevention for women were published February 2014 in Stroke, a journal of the American Heart Association. “The take-home here is really about starting prevention earlier,” says , an associate professor, Dr. Cheryl Bushnell, at Wake Forest Baptist Medical Center in Winston-Salem, N.C., and lead author.

For the most part the focus of our guideline is for women who are thinking about getting pregnant. That includes women who are trying to avoid getting pregnant by using birth control pills, and women who are trying to become pregnant. That’s years earlier than most women typically start thinking that they should worry about high blood pressure or stroke.

Women who are considering using birth control pills should get screened for high blood pressure, the guidelines say, because oral contraceptives increase the risk of blood clots and stroke. The guidelines also suggest more aggressive use of medicines in pregnant women with high blood pressure (which may differ from obstetricians’ current recommendations). This is because blood pressure medications can restrict a fetus’s growth. However, hypertension can greatly increase a woman’s risk of and stroke both while pregnant and for the rest of her life. The new guidelines suggest considering blood pressure medication for pregnant women with blood pressure starting at 150 over 100. Pregnant women with severe high blood pressure, 160 over 100 or above, definitely should be given medication, the guidelines state. Women who have a history of high blood pressure during pregnancy may need to work with their healthcare provider and take action to reduce their risk of pre-eclampsia, a condition that can cause dangerously high blood pressure, and stroke during pregnancy and that increases risk of high blood pressure afterward.

But women whose childbearing days are behind them aren’t left out of the recommendations. Risk factors like high blood pressure, diabetes, migraine with aura, atrial fibrillation, depression, and emotional stress tend to increase women’s risk of stroke more than they do for men. Furthermore, in several studies hormone replacement therapy in postmenopausal women is associated with an increased risk of stroke.

Each year, 55,000 more women die of stroke than men, according to the American Heart Association, and they die younger. It used to be that women were thought to be at lower risk because they weren’t as likely as men to carry excess belly fat. But now that women are becoming obese younger, those numbers have reversed. In 2008, 62 percent of women ages 20 and above had abdominal obesity, according to the national NHANES survey, compared with 44 percent of men. Women’s increased obesity may cancel out gains made in reducing stroke risk. The guidelines list quitting smoking, regular exercise and healthful eating with programs such as the DASH diet as the best way to reduce risk overall.


Adapted from blog by Nancy Shute on NPR’s Health News “shots“.


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