Why Women’s Risk for Stroke is Different From Men’s

When it comes to stroke, women and men share the major risk factors: smoking, high blood pressure and elevated cholesterol.

But stroke risk in women also is influenced by female-only factors, such as hormones, childbirth, pregnancy, birth control pills and migraine headaches with aura, among others.

These female-only factors are why women have their own guidelines for stroke prevention tailored specifically for them. The guidelines offer women another set of strategies to reduce their risk for stroke, the third-leading cause of death for women (It’s the fifth-leading cause for men).

“It’s necessary to have guidelines specifically for women,” says neurologist Dolora Wisco, MD. “The major risk factors for men and women are very similar. But for women, you add another layer and that’s the more gender-specific risks.”

Scientifically based recommendations

The guidelines provide scientifically based recommendations on the best treatment options. For example:

• Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower risks of preeclampsia, a serious high blood pressure pregnancy disorder.
• Preeclampsia should be recognized as a risk factor well after pregnancy, because women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life.
• Other risk factors such as smoking, high cholesterol, and obesity in women with preeclampsia should be treated early.
• Pregnant women with moderately high blood pressure (150 to 159 /100 to 109 mmHg) may be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
• Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
• Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
• Women older than age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

Know your risk factors

“I think the most important thing with these new guidelines is to know your risk factors,” Dr. Wisco says. “If you have high blood pressure, diabetes, cholesterol, or you’re smoking – those are major risk factors that you need to be paying attention to if you are female.”

The good news, Dr. Wisco says, is that some of these factors can be changed.

“If you have high blood pressure, see your doctor, have it checked out and see what you can do to lower your blood pressure via life style modification and/or medication,” Dr. Wisco says. “If you’re on oral contraceptive pills and you are smoking, try to think about quitting smoking. That helps out not only for your cerebrovascular and cardiovascular health, but in a whole lot of things for your health in general.”