Stroke affects more women than men, yet little education exists

WASHINGTON — A woman is more likely to die from a stroke than a man, yet prevention and treatment guidelines have always been targeted toward male patients, until now.

The American Heart Association/American Stroke Association has just released the first set of stroke prevention guidelines specifically for women.

“Stroke affects women in ways that are different from men,” says Dr. Alex Dromerick, a professor of neurology at the Georgetown University School of Medicine.

Hormones, birth control, pregnancy and other sex-related factors can influence a woman’s risk of stroke. But with monitoring and treatment, that risk can be lowered.

The recommendations — published in the American Heart Association journal “Stroke” — take aim at one of the main causes of cardiovascular problems: hypertension.

Women who plan to take birth control pills should be tested for high blood pressure first, and that goes double if they smoke or get severe migraines.

The guidelines also stress the importance of keeping blood pressure in check during pregnancy.

Dromerick, who is also vice president for research at MedStar National Rehabilitation Network, says good prenatal care is essential.

“One of the complications that can be associated with childbirth is called preeclampsia — that is high blood pressure and problems with the kidneys during pregnancy,” he explains. “And that can go on to cause a stroke and harm the baby.”

And here is where a bit of irony comes in: for many years, research on strokes was conducted almost exclusively on men because researchers did not want to inadvertently include a woman who might be pregnant.

“Men were thought to be safer to study because there is no issue around the pregnancy and maintaining the health of an unborn child,” says Dromerick.

Federal policy began to change with the adoption of the Women’s Health Equity Act of 1993. And over the last 15 years or so, there has been a wealth of new information on women’s cardiovascular health, enough for the American Heart Association to finally put together the stroke prevention guidelines for women.

Stroke victims, like WTOP’s Jamie Forzato, are urging other women to pay attention.

“If it can happen to me, it can happen to anyone,” says Forzato, who suffered a stroke in her dorm room at the University of Maryland on the eve of her 19th birthday.

It happened shortly after she started taking birth control pills to treat menstrual problems. Dromerick says while birth control pills on their own have not been proven to cause strokes, they can heighten the impact of other risk factors, such as smoking, migraines and age.

He says any woman contemplating birth control pills needs to have a good long talk with her health care provider. The same holds true for an older woman considering hormone replacement therapy at menopause.

“A frank conversation with your doctor about the risks and benefits of hormone treatment is needed at both times of life,” he emphasizes.

Dromerick also says everyone — male and female, young and old — should have their blood pressure checked at regular intervals. He says that is “the No. 1 thing you can do to minimize your chances of having a stroke or heart attack.”

Forzato says another big weapon is knowledge.

“Women need to be extremely careful and aware of what the stroke symptoms and signs are,” she says.

Her best advice is something she learned from her doctors:

“If anything happens to you suddenly — if you suddenly can’t see, if you suddenly lose your ability to speak, if you suddenly lose feeling in your arms of legs — call 911.”

Forzato says time is of the essence, and getting treatment for a stroke quickly is essential for recovery.

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