New Guidelines for Stroke Risks in Females Developed

You smoke, but only a few times a week. You lack exercise in your schedule. Your blood pressure is high. You have a family history of stroke. But you? No, not you. You are not at risk for having a stroke. Wrong. A general Stroke Risk guideline exists, but now, an even more specified guideline for Females has been released.

The American Heart Association and American Stroke Association developed the first stroke guidelines, unique to women, early this February. This list, which is geared toward primary care physicians and OB/GYNs, encourages women to educate themselves and be proactive with the new knowledge.

In past years, guidelines have been targeted to people separated by race, age and lifestyle factors but never by gender. The AHA and ASA wanted to create an outline specific to females. The new guidelines are supported by scientific research and includes recommendations on how to best treat these risk factors. 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 Cheryl Bushnell, M.D., M.H.S., in an interview with th American Heart Association, author of the new scientific statement published in the American Heart Association journal Stroke.

The guidelines released do not discount other factors such as smoking, or high blood pressure and especially not family history, but instead, includes other factors unique to women. According to the AHA and ASA the following risks are included: Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy (taking a daily calcium tablet) to lower preeclampsia risks. Preeclampsia occurs when women have high

blood pressure during pregnancy. 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, 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. Guidelines consider anything below 159/100 mmHg normal. 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, or in other terms severe headaches with light sensitivity, should stop smoking to avoid higher stroke risks. Women over age 75 should be screened for atrial fibrillation, a heart beat error, risks due to its link to higher stroke risk.

While these guidelines provide a new source of information, more research needs to be completed. For example, according to Bushnell, we need this research to develop a score that identifies female specific risks and evaluates them.

The guidelines should be used for primary care physicians and OB/GYNs to educate their patients, both healthy and at risk, and treat them appropriately.

According to Louise McCullough, MD, University of Connecticut Health Center, Farmington, many of these guidelines are well known, but the goal of the guidelines is to centralize the information for easy access for patients and health providers.