Stroke prevention strategies for women need to consider how pregnancy, use of the birth control pill and other factors unique to females can increase their risk, doctors say.

The American Heart Association and American Stroke Association jointly released their new guidelines Thursday on the stroke risks faced by women.

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New stroke guidelines are designed to help doctors and patients recognize stroke risk factors early, when there is time to act.

Women share many of the same risk factors for stroke as men but their risk is also influenced by hormones, pregnancy and other gender-related factors, said guideline author Dr. Cheryl  Bushnell of Wake Forest Baptist Medical Centre in Winston-Salem, N.C.

The recommendations include:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose Aspirin and/or calcium supplement therapy to lower pre-eclampsia risks.
  • Women who have pre-eclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, pre-eclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderately high blood pressure (150 -159 mmHg/100-109 mmHg) may be considered for blood pressure medication, and expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks slightly.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
  • Women over age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

Pre-eclampsia and eclampsia are blood pressure disorders during pregnancy that can cause major complications, including stroke during or after delivery, premature birth, and risk for stroke well after child-bearing.  

Stroke warning signs include:

Weakness: Sudden loss of strength, numbness in face, arm or leg, even if temporary.


Trouble speaking: Sudden difficulty talking or understanding spoken language, even if temporary.


Vision problems: Sudden trouble with vision, even if temporary.


Headache: Sudden severe or unusual headache.


Dizziness: Sudden loss of balance, especially with any of the above signs.

The Canadian best practice guidelines for stroke don’t include a separate section for women but do make specific comments for women when appropriate, a spokeswoman for the Heart and Stroke Foundation of Canada said.

Gender differences are more apparent at younger ages, the foundation said.

Stroke is the fifth-leading cause of death in men and the third-leading cause of death in women. High blood pressure, high cholesterol and smoking are risk factors common to both men and women.

Doctors recommend that women make healthy lifestyle changes like quitting smoking as early as possible to reduce their lifetime risk of both heart disease and stroke.

The U.S. guidelines are overdue, said Dr. Shazam Hussain, stroke section head at the Cleveland Clinic in Ohio, who was not involved in the study. 

"Certainly, there is something in common between men and women in terms of stroke risk factors. It's also been recognized there are differences," he said, noting that women tend to do worse after a stroke and are also more likely to die from stroke than men.
 
"I think recognizing that, putting that on the table as a group that needs more focus when we do studies and when we care for women is very important," he said.

With files from Reuters