Prevention of Stroke In Women
Key Points
Key Points
Most (87%) strokes are ischemic (IS), with the remainder hemorrhagic (10% intracerebral [ICH] and 3% subarachnoid [SAH]).
Table 1. Stroke Risk Factors, Categorized by Those That Are Sex-Specific, Stronger or More Prevalent in Women, or Similar Between Women and Men
| Risk Factor | Sex-Specific | Stronger or More Prevalent in Women | Similar Prevalence in Men and Women but Unknown Difference in Impact |
|---|---|---|---|
| Pregnancy | X | ||
| Preeclampsia | X | ||
| Gestational diabetes | X | ||
| Oral contraceptive use | X | ||
| Postmenopausal hormone use | X | ||
| Changes in hormonal status | X | ||
| Migraine with aura | X | ||
| Atrial fibrillation | X | ||
| Diabetes mellitus | X | ||
| Hypertension | X | ||
| Physical inactivity | X | ||
| Age | X | ||
| Prior cardiovascular disease | X | ||
| Obesity | X | ||
| Diet | X | ||
| Smoking | X | ||
| Metabolic syndrome | X | ||
| Depression | X | ||
| Psychosocial stress | X |
Figure 1. US stroke mortality rates for women, 2009a
Figure 2. Female-male US stroke mortality ratio, 2009a
Treatment
Treatm...
...ntion of Preeclamps...
...chronic primary or secondary hypertens...
...lementation (of ≥1 g/d, orally) should...
...ypertension in Pregnancy and Postpartum...
...ension in pregnancy should be treated wit...
...sideration may be given to treatment of mode...
...otensin receptor blockers, and direct...
...er giving birth, women with chronic hyper...
...n of Stroke in Women With a History of Pr...
...use of the increased risk of future hypertension a...
...rebral Venous Thrombosis (C...
...ith suspected CVT, routine blood studies co...
...ening for potential prothrombotic conditions...
...or prothrombotic conditions, including...
...th provoked CVT (associated with a transient ri...
...h unprovoked CVT, vitamin K antagonists ma...
...ents with recurrent CVT, VTE after CVT, or...
...omen with CVT during pregnancy, LMWH in full ant...
...ble to advise women with a history of C...
...easonable to treat acute CVT during pregna...
...women with a history of CVT, prophylaxis with...
...ontraceptives (OCs...
...ful in women with additional risk factors (e...
...ng OC users, aggressive therapy for s...
...utine screening for prothrombotic mutations...
...P before initiation of hormonal contra...
...enopausal HT
...(CEE with or without medroxyprogesterone)...
...en receptor modulators, such as raloxifen...
...raine With A...
...is an association between higher migraine f...
...of the increased stroke risk seen in women wit...
Obesity, Metabolic Syndrome, and Lifestyle F...
...ifestyle consisting of regular physical act...
...erventions focusing on diet and exercise are re...
...ibrillation (AF)...
...fication tools in AF that account for age- an...
...ering the increased prevalence of AF with age an...
...anticoagulation in women aged ≤65 years with A...
...let therapy is a reasonable therapeutic op...
...oagulants are a useful alternative to warfarin f...
...s for Prevention of Stroke in Women...
...asymptomatic carotid stenosis should be scre...
...women who are to undergo CEA, aspirin is r...
Prophylactic CEA perfor...
...with recent TIA or IS within the past 6 m...
...h recent transient ischemic attack...
...CEA is indicated for women with TIA or stro...
...herapy (75-325 mg/d) is reasonable...
...igh-risk (ie, 10-year predicted CVD risk ≥10...
...ntrolled and the benefit for IS and MI prevention...
...y be reasonable for women
...mmary of Antihypertensive Drugs Use...
...Category Maternal Side Effects...
...lly acting α2-adrenergic agonist (eg, methyl...
...ics (thiazide) Hypokalemia No ( B , )70...
β-Blockers (atenolol) Headache Associa...
...-Blockers (pindolol, metoprolol) Headache P...
...channel blockers (eg, nifedipine)...
...β blockers (labetalol) May provoke...
...e Reflex tachycardia, delayed hypotension Neo...
...s, angiotensin receptor blockers, renin inhi...