New guidelines for stroke prevention in women highlight sex-specific risk factors

1. The 2014 American Heart Association (AHA) and American Stroke Association (ASA) guidelines for preventing stroke in women highlight hypertension, atrial fibrillation and migraine headache with aura as stroke risk factors more prevalent among women and recommend strategies for reducing their frequency. 

2. The guidelines identify pregnancy and its complications as well as hypertension in pregnancy as potential early risk factors for the development of stroke and outline recommendations for risk stratification and treatment. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Recent studies have revealed important gender differences in the risk factors for stroke. For example, studies have shown not only that certain established stroke risk factors are more prevalent in women than men but also that women are subject to a number of unique sex-specific risk factors. Given the implications of these sex differences in stroke prevention, the American Heart Association and the American Stroke Association performed a review of the relevant literature and developed sex-specific guidelines for primary and secondary prevention of stroke in women. The guidelines identify hypertension, atrial fibrillation, migraine with aura, and depression as risk factors for stroke that are more prevalent in women. They also identify hormonal contraception, hormone replacement during menopause, pregnancy and its complications, and hypertension during pregnancy as risk factors unique to women. The guidelines are limited by multiple knowledge gaps that exist with respect to this area of research.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: Sex differences in quality of life after ischemic stroke

In-Depth [review]: The AHA/ASA conducted a review of the literature published between 1990 and May 2013 regarding risk factors for stroke in women.   Hypertension, atrial fibrillation, and migraine headache with aura, and depression or psychosocial stressors, were all identified as risk factors more prevalent in women. The panel recommended the reduction of these risk factors although specific recommendations were generally not made given the lack of evidence. The authors did recommend that women older than 75 should be actively screened for atrial fibrillation with electrocardiogram or pulse rate measurements (Level B), and that women aged 65 or younger with lone atrial fibrillation receive antiplatelet medications. The panel also identified the sex-specific risk factors of oral contraception or postmenopausal hormone use as well as pregnancy and its complications (pre-eclampsia and hypertension). The panel recommended continued identification of risk factors in women considering oral contraceptive or hormonal therapy. Additionally, they recommend documenting preeclampsia as a risk factor for stroke, and the treatment of women with new onset hypertension during pregnancy. Finally, the authors advocate for the development of age- and sex-specific risk stratification tools to further identify women at greatest risk for stroke.

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