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Stroke Strikes Women More: Guideline

The American Heart Association/American Stroke Association publishes new guidelines for prevention of stroke in women

Women are more prone to stroke than men, according to a recently published report (Stroke. 2014;45:000-000). It is estimated that stroke and it’s after effects will affect more than 200,000 women in the US by the year 2030. Therefore appropriate preventive measures taken now could reduce this disease burden in women. For the first time, the American Heart Association (AHA)/American Stroke Association guideline has been prepared by key opinion leaders for factors associated with stroke risk and prevention in women.

It is known that older women, smokers, and those with hypertension, diabetes mellitus, obesity, hypercholesterolemia, migraine with aura, atrial fibrillation in older women, or, prothrombotic mutations are deemed to be at a higher risk for stroke.

Other risk factors mentioned in the guideline are of interest especially to obstetrician-gynecologists and are discussed in depth. Risk factors unique to women mentioned include preeclampsia, oral contraceptive use, menopause, and hormone replacement therapy that increase the risk for stroke.

The guideline stresses on the role of preeclampsia during pregnancy as an important factor, and if present, could double the risk of stroke in later life. Preventing preeclampsia during pregnancy has been recommended. Recommended measures to be taken include low-dose aspirin from the 12th week of gestation, calcium supplement therapy (≥1 g/d, orally in women with low dietary intake of calcium (<600 mg/d), and screening and treating women for increased blood pressure (BP) levels during pregnancy. Safe anti hypertensive use during pregnancy has been advocated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and direct renin inhibitors being mentioned as unsafe. Oral contraceptive (OC) use increases the risk for cerebral venous thrombosis, and measuring BP levels before advising OC is also recommended. Since these risk factors are exclusive to women, the writing committee would like future research to focus on the development of a female-specific stroke risk score.

The complete content is available at http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009...