First stroke guidelines for women created

Stroke is the fourth-leading cause of death for all Americans, and 60 percent of strokes occur in women, according to the American Stroke Association.

"Men are physiologically different from women, so preventive tips cannot be one-size-fits-all," explained Virginia Howard, Ph.D., co-author of the new scientific statement Guidelines for the Prevention of Stroke in Women, published from the American Heart Association and American Stroke Association Council on Stroke in the AHA journal Stroke.

"There are many considerations about stroke that might be different for women: Reproductive factors and risk factors more common or stronger in women, like diabetes and atrial fibrillation, might get lost in a general guidelines document," said Howard, UAB professor of epidemiology and a lead investigator for the long-running Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the nation's largest study aimed at exploring racial and geographic differences in stroke risk factors and stroke occurrence.

The guidelines report stroke risks unique to women and provide scientifically based recommendations on how best to treat them, including:

• Women should be screened for high blood pressure before being prescribed birth control pills, which raise blood pressure in some women.

• 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 had pre-eclampsia have twice the risk of stroke and a fourfold 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 mm Hg/100-109 mm Hg) may be considered for blood pressure medication, whereas expectant mothers with very high blood pressure (160/110 mm Hg or above) should be treated.

"Getting these preventive measures to doctors is exciting because it's an opportunity to start the conversation early; people think stroke is just an 'old person's disease,'" Howard said. "While it generally is, it's also preventable. There are many things women can do at younger ages, during child-bearing years, which can impact stroke risk later in life, so it's an important message to have physicians -- especially OB/GYNs, who may be the only doctors some women see at younger ages -- involved in stroke-prevention care early on."