A new guideline published in the American Heart Association’s journal Stroke focuses on preventing stroke in the more stroke-prone sex: Women. Though the risk factors for stroke are in large part similar for women and men, women have some additional variables that put them at slightly higher risk throughout their lives. Part of the reason that women are more susceptible than men is simply due to the fact that they live longer. But other factors are largely hormone-related, and relevant to all stages of life.
Stroke is the fifth leading cause of death for men, but for women it’s the third leading cause. Women also tend to have poorer recovery than men, and more residual effects of stroke. They’re also more likely be institutionalized after stroke. Stroke typically occurs when a blood clot forms in a blood vessel going to the brain, thereby depriving it of oxygen.
Changes in the levels of reproductive hormones at different stages of life can affect a woman’s risk of stroke, and this is true for contraceptive hormones at a young age and hormone replacement therapy during menopause. Certain conditions, like preeclampsia, which can significantly raise blood pressure during pregnancy, put a woman at higher risk of stroke both during pregnancy and beyond.
“Women have very unique risks,” said author of the guidelines Cheryl Bushnell, “and they include pregnancy and the complications that can occur with pregnancy, in addition to a high blood pressure during pregnancy, which is preeclampsia and eclampsia. Then there are the issues related to hormonal use such as oral contraceptives and hormones that are used to help treat the symptoms of menopause.”
- Women with a history of high blood pressure before pregnancy may be candidates for low-dose aspirin (81 mg) after the first trimester, and/or calcium supplements, to reduce the risk of preeclampsia – dangerously high blood pressure during pregnancy.
- Preeclampsia confers twice the risk of stroke and four times higher risk of high blood pressure later in life. Its stroke risks for stroke last well after pregnancy, so doctors should consider it a risk factor just like the classic ones: Cholesterol, smoking, and obesity.
- Doctors should consider treating pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) with medication. Pregnant women with severely high blood pressure (160/110 mmHg or above) should generally be treated (some medications are not safe during pregnancy, however).
- Before starting birth control pills, women should be screened for high blood pressure, since the hormones in birth control can increase the risk of stroke.
- Women who have migraines with aura should stop smoking to avoid higher stroke risks. Migraine headaches that are accompanied by aura have been linked to increased stroke risk.
- Women over the age of 75 should be screened for atrial fibrillation, as it is associated with higher stroke risk.
- Hormone therapy during menopause may increase the risk of stroke, although the data are conflicting. But hormone therapy should not be used to prevent stroke.
- Psychosocial stress and depression are more common in women than in men, and are associated with significantly higher risk of stroke.
The take-home message is that prevention should be started earlier than it often is – young women should be thinking about stroke prevention, and talking about it with their doctors. Tracking and managing high blood pressure from an earlier age is the key, according to the authors. So is treating high blood pressure somewhat more aggressively (within reason) during pregnancy.
As always, lifestyle changes are the best ways to reduce the risk of stroke. And these healthy behaviors – eating well, exercising, and not smoking – should be a lifetime endeavor.
“We have a sedentary society, unfortunately,” said Bushnell. “I would emphasis exercise, eating right, and the American Heart Association has the whole Life’s Simple 7. And that’s what I would emphasize for younger women – and all women – who may be at risk for stroke. We’re trying to improve the general health of the population. So all of those actions will help prevent stroke in the future – especially for women.”