Each year, nearly 795,000 people in the U.S. have a stroke, which ranks as the third leading cause of death behind heart disease and cancer. Although stroke is more prevalent in men than in women, women accounted for slightly more than 60 percent of stroke deaths occurring in the U.S. during 2005. Now the American Heart Association journal Stroke has published for the first time a scientific statement outlining stroke risk factors that are unique to women. "If you are a woman, you share many of the same risk factors for stroke with men, but your risk is also influenced by hormones, reproductive health, pregnancy, childbirth, and other sex-related factors," said Dr. Cheryl Bushnell, associate professor of neurology at Wake Forest University Baptist Medical Center and director of the Medical Center’s stroke center, in a press release.

Stroke 101

To work properly, the brain needs oxygen and though it makes up a mere two percent of total body weight, it uses 20 percent of the total oxygen inhaled. Arteries deliver oxygen-rich blood to the tissues of the body, but when the flow of oxygen to the brain is interrupted and brain cells begin to die, this is called a stroke — and sometimes referred to as a brain attack. Symptoms, including difficulty talking, speaking, understanding, and seeing, as well as headache and paralysis, signal the advent of this medical emergency. Anyone experiencing such symptoms should get help immediately.

The new guidelines set forth by Bushnell and her co-authors indicate that some risk factors, including high blood pressure, migraine with aura, atrial fibrillation, diabetes, depression and emotional stress, tend to be stronger or more common in women than in men. In addition, preeclampsia and eclampsia are blood pressure disorders during pregnancy that cause major complications, including stroke during or after delivery, as well as risk for stroke well after child-bearing. The guidelines are intended for primary care providers, including OBGYNs, and outline not only risk factors unique to women but also provide, in some cases, recommendations for avoiding heightened danger. The authors include these stipulations:

  • Women who have preeclampsia have twice the risk of stroke and a fourfold risk of high blood pressure later in life. Therefore, preeclampsia 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.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) may be considered for blood pressure medication, whereas expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women who have migraine headaches with aura should stop smoking to avoid higher 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 risks.
  • Women over age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

Bushnell, who collaborated in 2011 on guidelines for the prevension of stroke in both men and women, suggested more studies be done to develop a female-specific score to identify women who may be at risk for stroke. For both men and women, the modifiable risk factors she previously documented included hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, obesity, metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, inflammation, and infection.

Source: Bushnell C, McCullough L, Awad I, et al. American Heart Association/American Stroke Association Prevention Guidelines. Stroke. 2014.