New Guidelines for Women Urge Early Attention to Stroke

By Melissa Healy
Los Angeles Times.

Long before a woman hits middle age, she and her doctor should be thinking about her risk of stroke and taking steps to reduce it, according to the first set of stroke guidelines aimed at women.

The overall stroke risk for women is higher than it is for men, in part because women live longer. But the new guidelines from the American Heart Assn. underscore that many other factors may increase their risk as well, and many of them are evident when a woman is in her 20s and 30s.

Some, like complications of pregnancy and menopause, are unique to women. Other risk factors — including obesity, migraine with aura, atrial fibrillation and depression — are more common in women than in men. Even risk factors that affect men and women equally, such as high blood pressure, smoking, diabetes and worrisome cholesterol readings, sometimes require different treatment in women.

Current measures of a woman’s stroke risk do not even consider her vulnerability before the age of 54, said Dr. Cheryl Bushnell, a neurologist at Wake Forest Baptist Health in Winston-Salem, N.C., and the lead author of the guidelines released Thursday. But since some risk factors occur when women are of childbearing age, “prevention strategies should start as early as that,” she said.

The new guidelines put forward a wide range of recommendations, including treating high blood pressure more aggressively in pregnant women; screening women for hypertension before they start taking birth control pills; and prescribing aspirin or other anti-platelet medications to women under 65 who have the irregular heart rhythms known as atrial fibrillation.

Women who have migraines with the visual and other sensory disturbances known as aura should be warned against smoking and consider medications to reduce the frequency of the episodes.

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