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New Guidelines Pinpoint Women's Stroke Risks

Image: A doctor checks a patient's blood pressure.

A doctor checks the blood pressure of a patient at the J.W.C.H. safety-net clinic in the center of skid row in downtown Los Angeles July 30, 2007. High salt intake is linked to high blood pressure, or hypertension, a key risk factor for strokes, heart attacks and other cardiovascular diseases. Together those rank as the world's number one killers. The World Health Organisation (WHO) puts cutting salt intake alongside quitting smoking as one of the top 10 "best buys" in public health. Picture taken July 30, 2007. To match Special Report SALT/REUTERS/Lucy Nicholson/Files (UNITED STATES - Tags: HEALTH SOCIETY) LUCY NICHOLSON / Reuters file

The odd sensations started one morning just a few months after Karen Rastenis turned 50. At first it was just a weakness in her right leg. After a few days, she lost the use of her right hand and started to slur her words. By the time Rastenis went the hospital ER — five days after her initial symptoms — her blood pressure had skyrocketed to a dangerously high 237/167.

Doctors told her she’d had a stroke and “was on the verge of another stroke, and probably a massive one,” she said.

Rastenis, a Cleveland-area single mother of two teenagers, had initially ignored the symptoms because her life was so hectic, not realizing she had multiple risk factors for a stroke, including preeclampsia during her first pregnancy and obesity.

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The Cleveland mom's case is hardly isolated. Because doctors often underestimate the risks in their female patients, on Thursday the American Heart Association released the first guidelines for the prevention of stroke in women.

While men and women share many of the same risk factors, doctors are being alerted to those specific to women, including:

  • Pregnancy
  • Preeclampsia
  • Gestational diabetes
  • Birth control pills

Other risk factors are more common in women than in men:

  • Migraine with aura
  • Atrial fibrillation or abnormal heart rhythm
  • Diabetes
  • High blood pressure
  • Depression and psychosocial stress

The gender-specific guidelines “are long overdue,” said Dr. Lawrence Weschler, a professor and chairman of the department of neurology at the University of Pittsburgh School of Medicine.

Stroke is the third leading killer of women and 60 percent of all stroke-related deaths in 2010 occurred in women, according to the AHA. Many of those strokes could have been prevented, said lead author of the guidelines Dr. Cheryl Bushnell, an associate professor of neurology and director of the stroke center at Wake Forest Baptist Medical Center.

For example, few realize preeclampsia, a pregnancy related condition that comes with dangerously high blood pressure, affects a woman’s stroke risk for many years after the child is born.

Some of the women-specific risk factors are significant only if coupled with others. Birth control pills become an issue if a woman smokes or has high blood pressure, Bushnell said. “If you’re healthy, taking birth control pills shouldn’t be something you worry about,” she added. “They do increase blood pressure a little, and that’s something you need to watch.”

Uncontrolled high blood pressure is a stroke risk factor for both sexes, but hypertension is more common in women over 55 than it is in men and the condition often isn’t managed as well in women, studies indicate.

It’s possible women don’t take prescribed medications because they’re unhappy with the side effects, such as fatigue and the need to urinate frequently. Or “women may not be treated as aggressively as men,” Bushnell said.

While the guidelines were aimed mostly at physicians, women need to be more aware of their risks. “The take home message for women is: Know your risk factors and be your own advocate,” said Dr. Joy Gelbman, an assistant professor of medicine at NY-Presbyterian/Weill Cornell Medical Center.

Rastenis was left with irreversible damage in her brain stem that has led to balance problems. Still, she says, “I was very lucky. When the neurologist showed me the MRI, she said, ‘Look at where the stroke was, that is vegetable land.’ So a millimeter off and I wouldn’t be here.”

The symptoms of stroke are the same in men and women, and they come on suddenly:

- F: face drooping

- A: arm weakness

- S: speech difficulty

- T: Time to call 9-1-1 if someone shows any stroke symptoms