The American Stroke Association estimates 425,000 women suffer a stroke each year … 55,000 more than men. Although stroke has fallen to the fourth leading cause of death overall, it remains the third leading cause of death in women.

“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 Cheryl Bushnell, MD, MHS, author of the new scientific statement published in the American Heart Association journal Stroke. In fact, she added, preeclampsia doubles the risk for stroke and quadruples the risk for high blood pressure later in life.

For the first time ever, the American Heart Association has set guidelines geared to primary care providers, including OBGYNs, for preventing stroke in women. The recommendations take into account risk factors unique to women, and the AHA has crafted evidence-based actions to address to address them, including:

Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.

All women with a history of preeclampsia should be regularly evaluated and treated for cardiovascular risk factors such as high blood pressure, obesity, smoking and high cholesterol. Screening for risk factors should start within one year after delivery.

Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) may be considered for blood pressure medication, whereas 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 past age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

Preeclampsia and eclampsia during pregnancy increase the risk for stroke long after child-bearing years. Additionally, high blood pressure, migraine with aura, AFib, diabetes, depression and emotional stress are stroke risk factors that tend to be stronger or more common in women than in men. 

Bushnell, an associate professor of Neurology and director of the Stroke Center at Wake Forest Baptist Medical Center, said additional studies are needed to create a female-specific score to identify and stratify stroke risk in women.