AHA rolls out first Stroke Prevention Guidelines for Women

The American Heart Association (AHA) has issued its first stroke prevention guidelines for women based on risk factors unique to them.

Current guidelines for stroke prevention in both men and women focus on controlling hypertension, diabetes, quitting smoking, healthy diet, and exercise. The new AHA guidance focuses on women-specific issues such as hypertension during pregnancy, use of oral contraceptives, childbirth, menopause, hormonal replacement and other risk factors more frequently seen in women such as obesity and metabolic syndrome, atrial fibrillation and migraine with aura. [Stroke 2014; doi: 10.1161/01.str.0000442009.06663.48]

“Those risk factors need to be recognized and addressed,” said lead author Dr. Cheryl Bushnell from the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, US. “It is important to emphasize prevention and decrease women’s risks early in their childbearing years.”

The new guidelines recommend that women be screened for hypertension prior to taking oral contraceptives as the combination raises stroke risks. The risk increases in women aged 45-49 years and is even higher in those with migraine with aura and among smokers, Bushnell said.

For women with a history of hypertension prior to pregnancy, they should be considered for low-dose aspirin (about 81mg) after the first trimester and/or calcium supplement therapy any time to reduce the risks of preeclampsia.

Preeclampsia doubles the risk of stroke later in life and quadruples the risk of hypertension after pregnancy, hence preeclampsia should be recognized as a stroke risk factor well after pregnancy, said Bushnell.

Pregnant women with severely high blood pressure (160/110 mmHg or higher) should be treated with BP lowering medications but with caution as some antihypertensives may be unsafe during pregnancy. Expectant mothers with moderately high BP (systolic pressure, 150-159 mmHg; diastolic pressure, 100-109 mmHg) may be considered for treatment.

The guidelines also advise women >75 years of age to be screened for atrial fibrillation as the condition increases the risk of stroke.

As women live longer than men, they tend to have a higher lifetime risk of stroke, Bushnell explained.  Women also tend to do worse after a stroke and are more likely to stay in long-term nursing care, with worse quality of life.

A female-specific stroke risk score is therefore warranted to reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, the authors concluded.

The US Association of Neurological Surgeons and the Congress of Neurological Surgeons endorsed the new guidelines.

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