07:15am Monday 13 July 2020

American Heart Association/American Stroke Association Prevention Guidelines

For the first time, guidelines have been developed for preventing stroke in women.

“A thorough review of all published studies supports new guidelines for stroke prevention in women,” said Issam Awad, MD, director of neurovascular surgery at the University of Chicago Medicine, and co-author of the new scientific statement published in the American Heart Association journal Stroke.

“If a woman is pregnant and hypertensive, this will alter her management,” Awad adds. “Particularly for the prevention of eclampsia in pregnant women, a stroke that occurs during labor and delivery. Other findings defined areas of urgently needed research.”

The American Heart Association/American Stroke Association guidelines outline stroke risks unique to women and provide scientifically-based recommendations on how best to treat them, including:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks. Preeclampsia and eclampsia are blood pressure disorders during pregnancy that cause major complications, including stroke during or after delivery, premature birth, and raise stroke risk well after child-bearing. Preeclampsia is characterized by high blood pressure and high protein levels in the urine, and when seizure also occurs, this is called eclampsia.
  • Women who have had preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderate high blood pressure (150-159 mm Hg/100-109 mm Hg) may be considered for blood pressure medication, whereas expectant mothers with severe high blood pressure (160/110 mm Hg or above) should be treated.
  • Women should be screened for high blood pressure before being prescribed birth control pills because they raise blood pressure in some women.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks. Auras are visual, auditory or other types of disturbances that can precede migraine headaches.
  • Women over age 75 should be screened for the irregular heart rhythm atrial fibrillation due to its link to higher stroke risk.

High blood pressure, migraine with aura, atrial fibrillation, diabetes, depression and emotional stress are stroke risk factors that tend to be stronger or more common in women than in men. More studies need to be done to develop a female-specific score to identify women at risk for stroke, said study author Cheryl Bushnell, MD, director of the Stroke Center at Wake Forest Baptist Medical Center.

The guidelines are geared to primary care providers, including OBGYNs.

Additional co-authors include Louise McCullough, M.D., Ph.D..; Monique Chireau, M.D., M.P.H.; Wende Fedder, D.N.P., R.N.; Karen Furie, M.D., M.P.H.; Virginia Howard, Ph.D., M.S.P.H.; Judith Lichtman, Ph.D., M.P.H.; Lynda D. Lisabeth, Ph.D., M.P.H.; Ileana Piña, M.D., M.P.H.; Mathew Reeves, Ph.D., D.V.M.; Kathryn M. Rexrode, M.D., M.P.H.; Gustavo Saposnik, M.D., M.Sc.; Vineeta Singh, M.D.; Amytis Towfighi, M.D.; Viola Vaccarino, M.D., Ph.D.; and Matthew Walters, M.D., M.B.Ch.B., M.Sc.

Adapted from a release by the American Heart Association/American Stroke Association.

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