AHA issues stroke guidelines for women

For the first time, guidelines have been developed for preventing stroke in women.

The American Heart Association (AHA)-issued guidelines, published in AHA’s journal Stroke, focus on birth control, pregnancy, emotional stress, migraine headaches with aura, depression, and other risk factors that women uniquely face or more often than men do.

“This guideline will bring attention to the often neglected physiological differences between men and women,” said study coauthor Louise D. McCullough, departments of neurology and neuroscience, The University of Connecticut Health Center, The Stroke Center at Hartford Hospital, Farmington, Conn. “Many of the guidelines are also applicable to men, such as eating a low-fat diet, treating hypertension and cholesterol, but specifically have amassed data on features of stroke prevention that are unique to women in one resource that hopefully will be helpful for primary care providers, OB-GYNs, and neurologists. We include recommendations for the treatment of hypertension in pregnancy, medications to avoid, etcetera.”

Women may respond differently to certain medications-for example aspirin may reduce the risk of stroke in women to a greater extent than that of men, who benefit more from cardiac protective effects of aspirin, Dr McCullough told FormularyWatch.

“And although not mentioned in these guidelines-which are specific for the prevention of stroke-FDA has issued statements regarding the importance of gender in drug dosing,” she said. “For example, Ambien dosing may be too high in women. Interactions between oral contraceptives and migraine with aura is important to recognize-which in combination can increase stroke risk,” she said.

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

• 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 who have preeclampsia have twice the risk of stroke and a 4-fold 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.

• 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 should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.

• Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.

• Women over aged 75 years should be screened for atrial fibrillation risks due to its link to higher stroke risk.

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, this is called eclampsia.

“The recognition that women are at risk for stroke is important, especially in the peripartum period,” Dr McCullough said. “Women who present with new symptoms after pregnancy could be at risk for cerebral venous thrombosis and pre-eclampsia even well after delivery. They need to be thoroughly examined, and older women need to undergo a thorough examination for occult atrial fibrillation-a common cause of stroke in elderly women.”