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Washington - Women of all ages should pay more attention to the risk of stroke than the average man, watching their blood pressure carefully even before they think about taking birth control pills or getting pregnant, according to a new set of guidelines released Thursday.
Women are also more likely to have risk factors associated with stroke, such as migraines, depression, diabetes and abnormal heart rhythm known as atrial fibrillation.
The new guidelines from the American Heart Association were the first such recommendations to prevent strokes in women. Stroke is the fourth-leading cause of death for all Americans but the third-leading cause of death for women, after heart disease and cancer.
Women share many of the same risk factors as men for stroke, but they also have unique risks that come with pregnancy complications and hormone use, said Cheryl Bushnell, associate professor of neurology at Wake Forest Baptist Medical Center in Winston-Salem, N.C., who led a group of experts that developed the guidelines.
Previous guidelines about cardiovascular prevention in women have included some information about stroke. "But it was buried in there," said Bushnell, who has been studying the topic for more than a decade. "We wanted to take topics that are really women-specific and emphasize stroke and put it all in one guideline."
The recommendations, published in the journal Stroke, emphasize the importance of controlling blood pressure, especially in young women. They are aimed at a broader age range than most recommendations.
"We're talking about being aware of blood pressure before you ever take birth control medication, being aware of blood pressure before you even get pregnant," Bushnell said.
A stroke occurs when the blood supply to the brain is blocked or when a blood vessel in the brain ruptures, causing brain tissue to die.
The signs of stroke in women are similar to those in men, including face drooping, sudden numbness or weakness of the arm, and difficulty with speech or trouble understanding. But symptoms in women may be more vague or subtle, Bushnell said. Women are more likely to have a change in their consciousness or their ability to communicate with people, she said.
An estimated 6.8 million people in the United States are living after having had a stroke, including 3.8 million women, according to statistics from the American Heart Association. Each year, more than half of the estimated 800,000 people who have a stroke each year are women.
As women increasingly outlive men, their lifetime risk of stroke becomes higher. Women are also more likely to be living alone and widowed after suffering a stroke, and are more likely to be institutionalized, research shows.
"As the baby boomer generation ages, more people are at risk for stroke, and women in particular as they enter their 50s, 60s and 70s," said Alex Dromerick, a neurology professor at Georgetown University.
"Women are more adversely affected by stroke than men," according to the guidelines. "Now more than ever, it is critical to identify women at higher risk for stroke and initiate the appropriate prevention strategies."
In some instances, the recommendations call for common-sense precautions that doctors and consumers should already be doing. In others, the recommendations are more specific.
Among the guidelines:
- "Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks."
- "Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risk."
- "Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy."
Preeclampsia and eclampsia are blood pressure disorders during pregnancy that cause major complications, including stroke during or after delivery, premature birth, and risk for stroke well after child-bearing. Preeclampsia is characterized by high blood pressure and high protein levels in the urine, and when seizure also occurs, is called eclampsia, according to the American Heart Association.
The guidelines also recommend that women who have migraine headaches with aura-such as blinking lights or moving dots-stop smoking to avoid higher stroke risks. Women over age 75 should also be screened for atrial fibrillation.
But one that could be controversial recommends treating pregnant women with moderately high blood pressure (150 to 159 mmHg/100 to 109 mmHg) with blood pressure medication. That goes against recommendations by the American College of Obstetricians and Gynecologists, Bushnell said.
"We are going out on a limb," she said." We don't want women to develop severe blood pressure, and that has to be weighed with risks for the mom and the baby."