Our expert is Cheryl Bushnell, MD, MHS, Director of the Comprehensive Stroke Center at Wake Forest Baptist Medical Center. Her clinical interests focus on prevention and treatment of stroke and other cerebrovascular diseases, particularly with respect to women.

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,
Mitzi Perdue
Mperdue@liebertpub.com


WOMEN ARE DISPROPORTIONATELY AFFECTED BY STROKE

Stroke is the third leading cause of death for women. For men, it’s the fifth leading cause. Further, women have a higher lifetime risk of stroke, and if they have a stroke, they are more likely to die from it. In addition, they are less likely to be aware of the three-hour window for administering the clot-dissolving drug tPA. Women are often less fully aware of their susceptibility to stroke and are surprised to learn that they are twice as likely to die from a stroke as from breast cancer.

WOMEN HAVE THEIR OWN GENDER-SPECIFIC RISK FACTORS

Although many of the risk factors are the same for men and women, there are a number of female-specific risks. Risk factors for both sexes include: high blood pressure, coronary artery disease, smoking, obesity, lack of exercise, and metabolic syndrome. Risk factors that occur in both men and women but where there’s a greater impact on women include: migraine with aura, atrial fibrillation, and diabetes. Female-only risk factors include: pregnancy, pre-eclampsia, gestational diabetes, migraine with aura during pregnancy, oral contraceptives, menopause, and hormone replacement therapy. One other risk factor: because women live longer, there’s more time to accumulate risk factors.

PREGNANCY IS A SERIOUS RISK FACTOR FOR STROKE

Because a woman’s body has to make adjustments to prevent her from bleeding out during delivery, pregnancy makes women more susceptible to blood clots. This is especially true at the time of delivery and the six weeks postpartum. While blood clots may affect the legs or lungs, they can also end up in the brain, causing a stroke. Another issue with pregnancy is if a woman has pre-eclampsia, her high blood pressure can put her at risk for stroke. A woman who had pre-eclampsia during pregnancy has a fourfold greater risk of developing hypertension over the next 30 years, and a twofold increase in her risk of stroke.

RECOMMEND LIFESTYLE CHANGES FOR PATIENTS WHO’VE HAD PRE-ECLAMPSIA

If a woman has had pre-eclampsia during pregnancy, this is the time to intervene and encourage lifestyle changes that can lower her risk for stroke later on. There’s a lot of evidence that physical activity and having a healthy diet can prevent the obesity and diabetes that lead to coronary artery disease and stroke.

LOW-DOSE ASPRIN MAY BE APPROPRIATE FOR A HEALTHY WOMAN AT AGE 65

We know that low-dose aspirin is appropriate for women who have risk factors, but should a healthy 65-year-old woman take aspirin to prevent a first stroke, just because of her age? A 10-year study in which health care professionals were randomized with half taking aspirin every other day and half receiving a placebo showed that this aspirin regimen did prevent some strokes. However, there’s a lot to be said for deferring the decision to the individual physician since he or she knows the patient’s situation best. However, as a guideline, if after using a risk assessment tool such as the one available at http://cvdrisk.nhlbi.nih.gov, it shows that the patient has a 20% chance of having a stroke in the next ten years, she would probably benefit from a low-dose aspirin regime. The existing risk factor tests are a good start, but they could be better, given that they don’t consider the female-specific risk factors such as pregnancy.

SOURCES FOR ADDITIONAL INFORMATION

The 2014 Guidelines for the Prevention of Stroke in Women from the American Heart Association/American Stroke Association summarize the data on stroke risks unique to women and the risks that are more common in women than men. http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48