First guideline on stroke prevention that specifically focuses on women

Dr. Yolande Appelman (cardiologist, VUmc, Amsterdam, The Netherlands) about the new guideline:

News - Feb. 11, 2014

“Stroke has an enormous impact on the life of a patient and his/her surroundings; women are more often affected by a cerebrovascular accident (CVA) than men, and this difference will only be larger in the future, since females live longer. In this new guideline, for the first time, it is taken into account that differences exist between men and women with respect to genetic factors, hormonal factors and reproductive factors, including pregnancy/childbirth and social factors. In this guideline specific recommendations are done with regard to primary and secondary prevention, which go beyond the current guidelines on cardiovascular prevention. In addition, the guideline panel calls for a unique sex-specific risk score in order to determine the risk for both women and men in the most realistic way.”

The American Heart Association (AHA) and the American Stroke Association have published the first guideline for the prevention of stroke specifically focussing on women. It zooms in on stroke risk factors that are unique to or more common in women than men, such as reproductive factors, migraine with aura, obesity, metabolic syndrome, depression, emotional stress, and atrial fibrillation.

Many risk factors are shared between men and women, but women are disproportionally affected by stroke: women have extra risk factors on top of those that are commonly seen in the population. Stroke risk in women is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-specific factors. Hence, a guideline that takes into account these factors unique to women was warranted. To that extent, the relevant medical literature was reviewed by a panel of experts in the field. The available evidence is classified according to the joint AHA/American College of Cardiology (ACC) methods of classifying the level of certainty and the class and level of evidence.

The new guideline summarises currently available evidence, and research gaps and scientifically-based recommendations are given. Recommendations are given on risk of stroke in relation to preeclampsia, oral contraceptives, menopause and hormonal replacement, as well as on risk factors that are more often seen in women. The panel gives lifestyle recommendations to reduce risk factors, as well as guidance on therapeutic strategies to prevent stroke.

The guideline panel believes that a female-specific stroke risk score is warranted, to more accurately reflect the risk of stroke in women across the lifespan. Thus, more research is needed to be able to  develop a female-specific score to identify women at risk for stroke,


Bushnell C, McCullough LD, Awad IA et al.; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014 Feb 6.

Find the guideline on Pubmed

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