In what amounts to a massive literature review cum meta-analysis, a special, joint panel of the American Heart Association and the American Stroke Association just issued a 33-page, 449-reference tome trying to fill in knowledge gaps regarding stroke risk in women. It was published in Stroke: Journal of the American Heart Association.
The Guideline covers issues important to the demographic not often considered in discussing stroke risks and preventive measures: younger women. Those topics include pregnancy-related risk factors, especially preeclampsia and blood pressure in younger women (especially when prescribing hormonal treatments including oral contraceptives). The authors (led by Chairperson Dr. Cheryl Bushnell of Wake Forest Baptist Health Center in Winston-Salem, NC) do not neglect the older population, of course, since the large majority of strokes among women do occur in the senior age group. They point out that certain risk factors for stroke are greater in women than in age-matched men, including atrial fibrillation, obesity and its concomitant metabolic syndrome, and migraine with aura.
Among its numerous foci, two noteworthy recommendations are:
*prevention of preeclampsia with low-dose aspirin in women with chronic primary or secondary hypertension or previous pregnancy-related hypertension;
*calcium supplementation for women with a low dietary intake of the nutrient to prevent pre-eclampsia.
ACSH s Dr. Gil Ross had this perspective: It s not widely known, but while stroke is the 5th overall cause of death in men, it s the 3rd leading cause among women. Of the almost 7 million American survivors of stroke, 56 percent are women. This is, to some extent, due to the longer lifespan of women, since stroke incidence and prevalence both increase with age. Whatever the reasons, more attention to stroke prevention among women, young and old, is long overdue. Hopefully healthcare practitioners whose patient population includes women will pay attention to the lessons included in this very-well-researched guideline.