U.S. group issues stroke prevention guidelines just for women
While stroke is common in both men and women, guidelines released on Thursday for the first time address factors such as pregnancy, birth control pills and menopause that put women at particular risk for the deadly condition.
Issued by the American Heart Association and the American Stroke Association, the guidelines are designed to help doctors and patients recognize stroke risk factors early, when there is time to act.
“If you are a woman, you share many of the same risk factors for stroke with men, but your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors,” said Dr Cheryl Bushnell, author of the new scientific statement published in the American Heart Association journal Stroke.
According to the report, stroke is the fifth-leading cause of death in men and the third-leading cause of death in women. Shared risk factors for stroke include high blood pressure, High cholesterol and smoking.
But other factors influence stroke risk in women. Many of these involve pregnancy. For example, women with a history of high blood pressure should take extra steps to control it during pregnancy, such as taking low-dose aspirin and possibly a calcium supplement. That helps reduce the risk of preeclampsia, a condition marked by high blood pressure and protein in the urine that can cause stroke during or after delivery and premature birth.
Likewise, women should be screened for high blood pressure before using birth control pills, because that combination raises stroke risks.
Other risk factors more common in women than men include migraine with aura, atrial fibrillation, diabetes, depression and emotional stress.
Stroke is a condition with high incidence and mortality rates, leaving a large proportion of survivors with significant residual physical, cognitive, and psychological impairments. The increasing number of older adults and the emergence of new therapies for acute stroke suggest there will be an increase in the number of stroke survivors living with disabilities. Furthermore, secular trends in stroke severity document a decrease in those most severely affected. This shift to more moderately affected survivors places increased demands on rehabilitation efforts and services, making the issue of how to best limit stroke-related disability and health risks a major concern for healthcare providers in rehabilitation. At this time efforts to prevent stroke must be balanced with the pragmatic effort to prevent disability and maximize quality of life for those who have suffered the consequences of stroke.
The rehabilitation process involves six major areas of focus: (1) preventing, recognizing, and managing comorbid illness and medical complications; (2) training for maximum independence; (3) facilitating maximum psychosocial coping and adaptation by patient and family; (4) preventing secondary disability by promoting community reintegration, including resumption of home, family, recreational, and vocational activities; (5) enhancing quality of life in view of residual disability; and (6) preventing recurrent stroke and other vascular conditions such as myocardial infarction that occur with increased frequency in patients with stroke. To attain these goals, rehabilitation interventions should assist the patient in achieving and preserving maximum feasible functional independence.
Stroke rehabilitation is an active process beginning during acute hospitalization, progressing for those with residual impairments to a systematic program of rehabilitation services, and continuing after the individual returns to the community. It is an organized effort to help stroke patients maximize all opportunities for returning to an active and productive lifestyle. Because the clinical manifestations of stroke are multifaceted and complex, stroke rehabilitation is best implemented through the coordinated efforts of a team of rehabilitation professionals.
These are signs 52-year-old Karen Rastenis from Solon, Ohio, wished she had been aware of a while back. Before her stroke two years ago, Rastenis was a smoker and more than 150 lbs overweight. When she woke up one morning with weakness on her right side, the busy single mother of two teenagers ignored the symptom. Then it kept getting worse.
By the time she went to the hospital a few days later, her blood pressure was dangerously high at 237 over 160. She had already had a stroke in her brain stem and “I was on the verge of having a massive stoke,” she said.
Rastenis says she had always been overweight but she did not know she had high blood pressure before the stroke.
Still, there had been warning signs. She had had migraines with aura from the start of puberty until she had her first child. During that pregnancy, she also had preeclampsia.
Since her stroke, Rastenis has taken several steps to prevent another. She has quit smoking and had weight loss surgery. She has already lost 60 lbs.
Still, she wishes she had known about the risks earlier.
Stroke prevention
You can’t control your family history, age, gender or ethnicity. But luckily, you can do something about other factors that could increase your risk of having a stroke, including obesity, diet, diabetes, smoking, high blood pressure and high blood cholesterol.
Stroke occurs when the blood supply to part of the brain is cut off. Without oxygen-rich blood, brain cells begin to die. If the blood supply is not restored, the affected part of the brain dies, causing disability or death.
Help prevent a stroke by learning more about the risk factors you can do something about, and those you can’t control.
Risk issues you can do something about
High blood pressure (hypertension)
High blood cholesterol
Atrial fibrillation
Diabetes
Being overweight
Excessive alcohol consumption
Physical inactivity
Smoking
Stress
Risk factors you can’t control
Age
Gender
Family History
Ethnicity
History of stroke or TIA
“It’s about time that they looked at the differences in stroke between males and females,” she said. “We’ve known that a woman’s heart attack will present differently than a man’s. It seems to follow that the same is true of stroke.”
Dr Shazam Hussain, stroke section head at the Cleveland Clinic in Ohio, who was not involved in the study, said the guidelines were long overdue.
“Certainly, there is something in common between men and women in terms of stroke risk factors. It’s also been recognized there are differences,” he said, noting that women tend to do worse after a stroke and are also more likely to die from stroke than men.
“I think recognizing that, putting that on the table as a group that needs more focus when we do studies and when we care for women is very important,” he said.
(Reporting by Julie Steenhuysen; editing by Gunna Dickson)
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By Julie Steenhuysen