Stroke Prevention for Women: Start Early

As new guidelines take hold, doctors are focusing on cutting risk at a younger age

Tuesday, June 17, 2014

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TUESDAY, June 17, 2014 (HealthDay News) -- Stroke typically affects women in their later years, but doctors are now beginning to focus on helping them cut their risk earlier in life.

This increased attention to risk factors in early adult years was recommended by new guidelines that were released earlier this year by the American Heart Association and the American Stroke Association.

Those guidelines are now being phased into practice by primary care doctors, experts say. For women, that translates to more screening for risk factors during office visits and more interventions to ensure a healthy lifestyle to reduce stroke risk, said Dr. Louise McCullough, director of the Stroke Center at the University of Connecticut in Farmington.

McCullough is the co-author of a summary of the guidelines that was published June 16 in the Annals of Internal Medicine.

Stroke is a serious interruption or reduction of blood flow to the brain, and McCullough said women have "unique risk factors."

Among them are the use of birth control pills and hormone replacement therapy after menopause, which both increase stroke risk. Pregnancy-associated disorders also may have long-lasting effects on a woman's health and her stroke risk, she added.

Here's why all that is important: An estimated 6.8 million persons in the United States have had a stroke, 3.8 million of whom are women, according to the summary. Women have poorer recovery and worse quality of life than men after a stroke, the summary says.

And here's what women can expect if their primary care doctor adheres to the new guidelines.

Your doctor will screen for high blood pressure. It is the most changeable risk factor, and it's more common in women than in men.

Depending on your age, your doctor may screen for atrial fibrillation, an abnormal heart rhythm, by measuring pulse rate and doing an electrocardiogram.

Your doctor may ask you about any history of headaches. Migraine headache with aura can increase stroke risk, and McCullough said reducing the frequency of migraine should be the goal as a possible way to reduce stroke risk.

Certain pregnancy-related conditions affect risk, McCullough said. "If you have pregnancy-induced high blood pressure, you are fourfold more likely to develop high blood pressure in adulthood and two times more likely to have a stroke," she said. Keeping blood pressure under control is crucial.

Stroke during pregnancy is not common, but experts have found the risk is highest in the 12 weeks after giving birth. So women who have a new headache, blurred vision or other unusual symptoms should be checked out.

Depression and emotional stress also boost stroke risk, McCullough said, so your doctor should ask about that, too.

The guidelines also recommend focusing on a healthy lifestyle that helps prevent stroke. These measures include keeping weight at a healthy level, eating a healthy diet, not smoking, getting regular physical activity and keeping alcohol intake moderate, if women drink.

"This article is going to be very helpful in getting the message out to the primary care physicians," said Dr. Ravi Dave, director of interventional cardiology at the University of California Los Angeles Medical Center in Santa Monica.

He noted that some of the risk factors for stroke may be news to women, such as the link between depression and stroke. "I would encourage these patients with depression to get treated for it," he said.

In recent years, Dave said, researchers have been pinpointing differences in heart attack symptoms between men and women. Now, the same thing is happening with risk factors for strokes, teasing out the gender differences. For women, the message is clear, he said: Alert your doctor if you have any of these stroke risk factors, or suspect you do.

SOURCES: Louise McCullough, M.D., Ph.D., director, stroke center, and professor of neurology, University of Connecticut, Farmington; Ravi Dave, M.D., director of interventional cardiology, University of California Los Angeles Medical Center, Santa Monica, and clinical professor of medicine, David Geffen School of Medicine, UCLA; June 16, 2014, Annals of Internal Medicine

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