One in five women will have a stroke in her life. However, newly published stroke avoidance guidelines acknowledge that gender does make a difference and specifically address risk factors for women and try to prevent them. The guidelines, announced yesterday in the American Heart Association’s Stroke journal, emphasize the importance of controlling blood pressure starting in the childbearing years.
There are risk factors unique to women that need to be recognized, and addressed earlier than previously thought, even in a woman’s 20s and 30s, according to neurologist Cheryl Bushnell, who led the team that developed the guidelines. Bushnell, associate professor of neurology at Wake Forest Baptist Medical Center located in Winston-Salem, N.C., has been studying cardiovascular disease prevention in women for more than a decade.
A stroke occurs when the blood supply to the brain is blocked or a blood vessel in the brain bursts, according to the American Heart Association. When part of the brain is no longer getting the blood and oxygen it needs, it causes brain tissue to die.
The signs of stroke in women and men are similar. They include drooping of the face, sudden weakness or numbness in an arm, and difficulty with speech or understanding. Symptoms in women can be subtler.
Women have more than half of the 800,000 strokes each year. Stroke is the third-leading cause of death for women. It is the fifth-leading cause for men. About 30 percent of stroke victims survive but have a permanent disability afterwards such as being unable to walk or speak. Recognizing symptoms and getting help fast is the key to surviving a stroke, and limiting permanent disability.
Since women outlive men, their lifetime risk of stroke is higher. Additionally, since women more likely to be widows living alone when they suffer a stroke, they are more likely to need institutional care afterwards and have poorer recovery than men.
The stroke avoidance guidelines published recognize that complications from pregnancy and menopause are unique risk factors for women. For example, monitoring and treating blood pressure disorders during pregnancy that can cause major complications, including stroke during or after delivery, increase the risk later in life. The guidelines point out that women with pre-eclampsia during their pregnancy have twice the risk or stroke and have four times the risk of acquiring high blood pressure later in life.
Other risk factors more common in women include obesity, migraines with aura, depression and atrial fibrillation. Even factors that affect men and women equally, like high blood pressure, diabetes and elevated cholesterol levels, can require different treatment for women.
The guidelines published this week address women’s unique stroke risks and recommendations for stoke avoidance. These include recognizing that pre-eclampsia is a risk factor well after pregnancy. Other risk factors such as smoking, high cholesterol and obesity should be treated early. Before taking birth control pills, women should be screened for high blood pressure because the combination raises their stroke risk. The guidelines also recommend that women who have migraine headaches with blinking lights or moving dots stop smoking to avoid higher stroke risks. Additionally, they recommend screening women over age 75 for atrial fibrillation.
By Dyanne Weiss