Illustration of woman and brain

About the American Heart Association/American Stroke Association’s Womens’ Stroke Guidelines

Are these the first stroke prevention guidelines specific to women?

The 2014 stroke prevention guidelines are the first evidence-based recommendations for preventing stroke in women to be presented in one document. They are intended to help women and their primary care providers identify and treat risk factors unique to women.

What stroke risks are unique to women?

Men and women share many of the same risk factors for stroke, but women also have sex-specific risk factors. Pregnancy, preeclampsia, gestational diabetes (developing diabetes while pregnant), oral contraceptives, postmenopausal hormone use (and changes in hormonal status) can increase a woman’s risk of stroke.

In addition, these risk factors for stroke are more common in women than they are in men: migraine with aura (type of headache accompanied by distortions in vision and hearing), atrial fibrillation (abnormal heart rhythm), diabetes, high blood pressure, depression and psychosocial stress.


Pregnancy and Stroke

My blood pressure is normal and I am trying to get pregnant. Is there a risk that I might develop high blood pressure while pregnant and increase my risk of stroke?

High blood pressure – whether or not you are pregnant – increases your risk of stroke. Some women who have never had HBP develop it while they are pregnant. This condition is known as Pregnancy Induced Hypertension (PIH), which affects 6 percent to 8 percent of all pregnancies in the United States.

Almost 70 percent of these cases are in first-time pregnancies. If the mother is not treated, HBP is dangerous to both the mother and baby.

What is preeclampsia and how is it related to blood pressure and/or stroke?

Preeclampsia is the most common blood pressure disorder during pregnancy, affecting between 6 and 10 percent of pregnant women. It is characterized by high blood pressure and high protein levels in the urine. If preeclampsia progresses to eclampsia, dangerous seizures can occur. This disorder can endanger the lives of both mother and child.

For the first time, the guidelines have specific, scientifically based recommendations on how to prevent preeclampsia in women with pregnancy-related high blood pressure or a prior history of preeclampsia during pregnancy. For at-risk women, the guidelines recommend calcium supplementation and low-dose aspirin to prevent preeclampsia. However, you should not start taking either low-dose aspirin or calcium supplements during pregnancy without advice from your healthcare provider.

For women with a history of preeclampsia, your risk of stroke may be higher up to 30 years after you have had your child. The recommendations suggest that you and your healthcare provider continue to manage your risk factors to reduce the likelihood that you will have a stroke.

I have high blood pressure and I’m pregnant, but I’m afraid to take medication in case it harms my baby – what should I do?

It is important to manage your blood pressure during pregnancy to lower your risk of stroke and preeclampsia. It is also important that you have a discussion with your doctor as to the benefits and risks of treating high blood pressure during pregnancy. Remember, the objective is to prevention the complications of high blood pressure and prevent stroke.

If you have severe high blood pressure – 160/110 mm HG  the guidelines recommend medications that are known to be safe for both mother and baby – such as methyldopa, labetalol and nifedipine. If your high blood pressure is moderately elevated, you and your healthcare provider should discuss whether treating your high blood pressure with those drugs would be beneficial.

If you have high blood pressure and/or a history or preeclampsia, your healthcare provider may also suggest you take calcium supplements and low-dose aspirin to lower your risk of preeclampsia. You should not use any medications during pregnancy without talking to your healthcare provider.

Is stroke common during pregnancy?

Although it is not common, stroke does occur during pregnancy affecting 34 pregnant women out of 100,000, compared to 21 women out of 100,000 who are not pregnant. Since high blood pressure is a major risk factor for stroke, it is important to work with your healthcare provider to manage it during pregnancy.

I know that there are two types of stroke – ischemic stroke, caused by a buildup of a fatty substance (plaque) in the arteries, and strokes caused by bleeding in the brain – hemorrhagic stroke. Do these guidelines address both types of stroke?

These guidelines are for both prevention of ischemic and hemorrhagic stroke. High blood pressure is the most common risk factor for stroke, and treating high blood pressure reduces the risk of both types of stroke.


Oral Contraceptives and Stroke Risk

Do birth control pillsraise my risk of stroke?

Yes. Oral contraceptives in and of themselves increase the risk of stroke in some women, especially if they have high blood pressure. You should be sure that your healthcare provider measures your blood pressure before he/she prescribes oral contraceptives. Smoking and oral contraceptives raise your risk of stroke, and if you smoke, you should not use oral contraceptives.


Post-Menopausal Hormone Replacement Therapy and Stroke Risk

Does hormone replacement therapyafter menopause have any impact on my stroke risk?

At one time, it was thought that hormone replacement therapy (HRT) might lower a woman’s risk of stroke. However, studies conclude that HRT does not lower stroke risk, and the American Heart Association recommends it only be used to reduce the symptoms of menopause.


Warning Signs of Stroke 

What are the signs of strokeand are they different for women and men?

The symptoms of stroke are the same in men and women, and the acronym F.A.S.T. is an easy way to remember common signs of stroke. Remember that stroke signs come on suddenly.

F – Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is their smile uneven?

A – Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S – Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like, “The sky is blue.” Is the sentence repeated correctly?

T – Time to call 9-1-1 – If someone shows any stroke symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately.

Additional stroke signs include: Sudden severe headache with no known cause; sudden trouble walking, dizziness, loss of balance or coordination; sudden trouble seeing in one or both eyes; or sudden confusion or trouble understanding.

The symptoms and severity of symptoms depend on the type of stroke and what part of the brain is being affected.
What should I do if I think I’m having a stroke, or if I see someone having stroke signs?

If you think you or someone else is having a stroke, call 9-1-1 immediately to get the patient to the hospital as quickly as possible. When you call, say “I think this may be a stroke.” Check the time so you’ll know when the first symptoms appeared. It’s important to get help quickly, even if the symptoms go away.


Can stroke be treated?

There are effective treatments for stroke, but getting to the hospital quickly is critical. For strokes caused by a narrowed or blocked artery, treatment with a clot-busting drug can save lives and limit disability if a patient reaches the hospital within four hours. Quickly recognizing a stroke and getting help fast from 9-1-1 will significantly improve the odds of a person surviving and recovering from a stroke.


American Heart Association/American Stroke Association Initiatives

What is the American Heart Association/American Stroke Association doing to reach women with stroke information?

An important way we reach women with stroke information is through Go Red For Women, the national movement to end heart disease and stroke in women. Go Red For Women shares information like the Women’s Stroke Prevention Guidelines, and tells the stories of heart disease and stroke survivors and activists to unite all women in the fight against their No. 1 and No. 4 killers. Go Red also advocates for research, provides health tools and creates an active community for women to champion cardiovascular health for themselves and others. Learn more and get involved.

Specific to stroke, the American Stroke Association’s Together to End Stroke initiative launched in 2013 to educate men and women that stroke is largely preventable, treatable and beatable. To further community education on stroke, Together to End Stroke maintains a stroke web resource center for healthcare professionals and community educators including a variety of free materials about stroke. Another new tool from Together to End Stroke is a free mobile application called “Spot a Stroke F.A.S.T.” that helps people to recognize the signs of stroke and find award-winning hospitals in their area. Sign up for the Together to End Stroke e-newsletter to get regular, updated stroke information and news.


How is the American Stroke Association affiliated with the American Heart Association?

The American Stroke Association was created in 1997 as a division of the American Heart Association to focus solely on stroke. The American Stroke Association joined with volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent, treat and beat stroke. For more information, visit the website or call 1-888-4-STROKE.

How were the guidelines created?

The American Heart Association and American Stroke Association’s statements and guidelines are based on an expert committee’s review of the most up-to-date scientific evidence which is then translated into guidance for healthcare professionals and the public.


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