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
...Prevention of Preeclam...
...chronic primary or secondary hypertension o...
...entation (of ≥1 g/d, orally) shoul...
...Treatment of...
...evere hypertension in pregnancy should be treated...
...ion may be given to treatment of moderate...
...enolol, angiotensin receptor blocke...
...g birth, women with chronic hypertension shou...
...Prevention of Stroke i...
...ncreased risk of future hypertension and st...
...Cere...
...n patients with suspected CVT, routine blood stu...
Screening for potential prothrombotic conditions...
...prothrombotic conditions, including prote...
...ents with provoked CVT (associated with a...
...with unprovoked CVT, vitamin K an...
...with recurrent CVT, VTE after CVT, o...
...r women with CVT during pregnancy, LMWH in f...
...nable to advise women with a history of CVT t...
...is reasonable to treat acute CVT during pregn...
...en with a history of CVT, prophylaxis wit...
...Oral...
...ful in women with additional risk facto...
...users, aggressive therapy for strok...
...e screening for prothrombotic mutation...
...of BP before initiation of hormonal contrace...
...Postmenopaus...
...T (CEE with or without medroxyproges...
...en receptor modulators, such as raloxifen...
...Migraine Wit...
...an association between higher migraine frequenc...
...se of the increased stroke risk seen...
...Obes...
...althy lifestyle consisting of regular phy...
...estyle interventions focusing on d...
...Atria...
...ion tools in AF that account for age- and sex-spe...
...the increased prevalence of AF with ag...
...coagulation in women aged ≤65 years with A...
...therapy is a reasonable therapeutic optio...
...oral anticoagulants are a useful alternative to w...
...Strategi...
...asymptomatic carotid stenosis should be scre...
...e to undergo CEA, aspirin is recommended unless...
...lactic CEA performed with...
...en with recent TIA or IS within the past...
...h recent transient ischemic attack (TIA) or...
...ndicated for women with TIA or stroke, sur...
...y (75-325 mg/d) is reasonable in women with...
...risk (ie, 10-year predicted CVD risk...
...If BP is controlled and the benefit for IS and MI...
...y be reasonable for women...
...Table 2. Summary of Anti...
...Category Maternal Side Effects...
...acting α2-adrenergic agonist (eg,...
...(thiazide) Hypokalemia No ( B , )701...
...Blockers (atenolol) Headache Associated w...
...ers (pindolol, metoprolol) Headache...
...hannel blockers (eg, nifedipine) Headache; poss...
...-β blockers (labetalol) May provoke asthma exa...
...flex tachycardia, delayed hypotensi...
...nhibitors, angiotensin receptor block...