Strokes

Women have more risk factors for strokes

 

Signs of a stroke

Remember, getting medical help right away (usually, within four hours of the onset of symptoms) can help mitigate the long-term impacts of a stroke — and in some cases even prevent death.

The acronym FAST is a good way to remember the major signs:

F: Face drooping. If one side of someone's face suddenly droops, they might be having a stroke. Ask them to smile, and see if it is uneven.

A: Arm weakness. If one arm (or leg) suddenly becomes weak or numb, that person may be having a stroke. Ask them to raise their arms, and see if one floats downward.

S: Speech difficulty. If someone's speech suddenly becomes slurred or difficult to understand, ask them to repeat a simple sentence. See if it is repeated correctly.

T: Time to call 911. If someone shows any of these symptoms, even if they go away, get them to a hospital immediately and note the time at which the symptoms appeared.


An estimated 6.8 million Americans alive today have suffered a stroke, and a majority are women.

Although the biggest risk factors are shared between men and women – such as smoking, obesity, and high blood pressure or cholesterol – a subset of risks are either exclusive to women or more likely to occur in women.

For the first time, stroke prevention guidelines have been developed by the American Heart Association / American Stroke Association to address these risk factors.

The sex-specific guidelines, published February in the AHA journal Stroke, are geared chiefly toward primary-care providers. They suggest prevention strategies and indicate the need for further research regarding the added risk factors linked to pregnancy, migraines with aura, birth control, atrial fibrillation, depression and hormone therapy, among others.

“Now we’re recognizing out that there are huge sex differences, not just in neurology, but in all of medicine…Women and men may need different prevention strategies, although 90 percent of them are the same,” said guideline co-author Louise McCullough, a professor of neurology and neuroscience at the University of Connecticut Health Center.

The guidelines spend considerable time on the hormone-related risk factors, but their biggest headline may be the role that simple longevity plays in women’s increased risk for stroke.

“Because women tend to live longer, their lifetime risk of stroke is higher than men. But on an age-by-age basis, a 50-year-old man is more likely to have a stroke — not by a lot, but some — than a woman,” said Dr. Sachin Rastogi, an interventional neuroradiologist at Mount Sinai Medical Center’s comprehensive stroke center in Miami Beach.

He thinks one of the most valuable things the new guidelines do is pick up on the under-diagnosis and under-treatment of atrial fibrillation, the most common type of arrhythmia (irregular heartbeat), especially in elderly women.

A-fib, as it is commonly called, increases the risk for ischemic stroke, which is caused by a blockage, such as a clot, that impedes blood flow to the brain. They account for about 87 percent of all strokes, and are linked to higher death and disability. While there are about the same number of men and women with A-fib overall, the risk of stroke because of A-fib increases with age, and older patients with AF are more likely to be women.

A-fib is “actually one of the more common causes of stroke that we actually intervene on in patients, and often it’s undiagnosed or diagnosed but inadequately treated,” Rastogi said.

The guidelines recommend better and more frequent screening for A-fib, and that when diagnosed in a patient with certain other risk factors, that blood thinners be prescribed.

The guidelines also note that the effect of strokes – from A-fib or otherwise – tend to have more severe consequences for women. Largely because women tend to have strokes later, they tend to be more disabling, and because women are more likely to have outlived their partners and to live alone, a stroke is more likely to lead to an expensive institutionalization.

The guidelines also elaborate on the increased risk of stroke borne of hypertensive disorders of pregnancy, and preeclampsia in particular. They note that preeclampsia not only carries an increased risk of stroke during pregnancy, but even decades after delivery.

The guidelines recommend that women of childbearing age with a history of high blood pressure be considered for low-dose aspirin to lower preeclampsia risks. They also recommend that pregnant women with moderately high blood pressure be considered for treatment, and that pregnant women with high blood pressure be treated. They also advise that preeclampsia be better recognized – and publicized – as an important risk factor for strokes even later in life.

According to McCullough, questions about preeclampsia are “not something that would typically be part of the history in an internal doctor’s appointment for a 60-year-old woman,” something she says needs to change.

The guidelines also note that hormone therapy, recently advertised to post-menopausal women as something which might reduce the risk of stroke, may in fact do just the opposite and increase that very risk.

They also reiterate that women need to be consistently screened for high blood pressure before being prescribed birth control pills, and that smoking as well as other risk factors (especially migraine with aura) may act synergistically with hormonal birth control to increase the likeliness of stroke.

The increased risk for stroke linked to depression is also noted – as is the marked lack of research elucidating the connection between the two.

McCullough emphasizes that “we still have a lot to learn about unique risk factors in women,” and the guidelines repeatedly indicate current research gaps that will need to be filled if a reliable female-specific score for stroke risk is to be developed.

Read more Health stories from the Miami Herald

  • Nutrition

    Seven ways to help kids eat healthy

    Well, isn’t that good timing? Right when my daughter and grandkids are here for a visit, I learn that August is Kids Eat Right Month (kidseatright.org). And along with this proclamation, the Academy of Nutrition and Dietetics (AND) has released a new position paper on feeding kiddos in the 2 to 11 year-old age range.

  •  
 <span class="cutline_leadin">SLEEP SPECIALIST:</span> Dr. Belen Esparis, medical director at Mount Sinai Medical Center’s Sleep Disorder Center and Laboratory.

    Sleep deprivation

    Lack of sleep leads to weight gain and vicious cycle

    A cascade of side effects from a lack of sleep can lead to runaway weight gain, which itself can trigger even more unhealthy physiological events.

  •  
 <span class="cutline_leadin">IN STUDY:</span> Bruce Daily of Kendall is a patient in a clinical trial of a stroke treatment using stem cells.

    Medical research

    Stem cells are being tested to determine if they help mobility after a stroke

    When Bruce Daily woke up after having lumbar surgery a year ago, he realized he couldn’t move the right side of his body.

Miami Herald

Join the
Discussion

The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

The Miami Herald uses Facebook's commenting system. You need to log in with a Facebook account in order to comment. If you have questions about commenting with your Facebook account, click here.

Have a news tip? You can send it anonymously. Click here to send us your tip - or - consider joining the Public Insight Network and become a source for The Miami Herald and el Nuevo Herald.

Hide Comments

This affects comments on all stories.

Cancel OK

  • Marketplace

Today's Circulars

  • Quick Job Search

Enter Keyword(s) Enter City Select a State Select a Category