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Examiner
  • Lori Boyajian-O'Neill: New guidelines for stroke and women

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  • Stroke strikes about 795,000 men and women annually. It is the third leading cause of death among women and the fifth among men. Last week the American Heart Association issued the first guidelines on stroke prevention in women.
    Stroke and women, what do you know, T or F?
    1. 1 in 10 has a stroke during her lifetime. 2. 60 percent of stroke deaths occur in men. 3. Pre-eclampsia in pregnancy decreases risk.
    According to the AHA, 1 in 5 women has a stroke during her lifetime and 55,000 more women than men suffer stroke annually. Non-hispanic black women are at greatest risk. Over 6.8 million in the U.S. have survived stroke and over 50 percent of them have some physical or cognitive deficit.
    Stroke occurs when there is a leak (hemorrhagic stroke) or clot (ischemic stroke) in a blood vessel. Eighty-seven percent of strokes are ischemic type. Clots form for many reasons, including changes in the lining of blood vessels. In the spirit of the winter Olympics, think of blood cells as bobsleds and blood vessels as the track. Irregularities in the track can cause the bobsled to weave and bob, not glide smoothly. Blood vessel walls can become narrow and irregular in conditions such as high blood sugar, pressure, and cholesterol. Blood cells tumble, collide, accumulate debris and basically stick together (clot) blocking vessels and impeding the flow of oxygen-carrying and nutrition-rich blood to brain cells, which then die.
    How do we prevent stroke? Step one is identifying risk factors. Step two is modifying risk factors. Men and women share some risk factors for stroke, including high blood pressure, sugar, cholesterol and weight. The presence of multiple risk factors in an individual can escalate risk. By 2030 it is estimated that 86 percent of adults will be overweight or obese, a significant risk factor for hypertension and diabetes which add to the overall risk for stroke.
    Women have some unique risk factors which change from child-bearing years through menopause and into senior years.
    Pregnancy, childbirth and hormones are factors in a woman's risk, according to Cheryl Bushnell, MD, one of the medical scientists who wrote the guidelines. The first warning of increased risk for stroke later in life may occur during pregnancy.
    Pregnancy-induced hypertension, pre-eclampsia and eclampsia (commonly called “toxemia”) are stroke risk factors. Those with pre-eclampsia are twice as likely to have a stroke and have four times as likely to develop hypertension later in life than women with normal pregnancies.
    The AHA recommends that women with history of high blood pressure before pregnancy should be considered for aspirin therapy during pregnancy. Women should be screened for high blood pressure before using hormonal contraceptive products including birth control pills and patches. Women with migraine with aura and who also smoke must stop smoking. Atrial fibrillation, a common heart rhythm abnormality, increases risk for stroke. The AHA recommends that women older than 75 years be checked for AF with clinical exam and electrocardiogram.
    Page 2 of 2 - The landmark document, “Guidelines for the Prevention of Stroke in Women” is published online in the medical journal Stroke. I have touched on a few of the recommendations. To learn more and map out a plan to identify and modify your risk factors access the document at www.heart.org and meet with your physician.
    Answer: 1. F; 2. F Women; 3. F.
    Dr. Lori Boyajian-O’Neill can be contacted at lori.boyajian-oneill@hcahealthcare.com.
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