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U.S. group issues stroke prevention guidelines just for women

By Julie Steenhuysen

CHICAGO (Reuters) - While stroke is common in both men and women, guidelines released on Thursday for the first time address factors such as pregnancy, birth control pills and menopause that put women at particular risk for the deadly condition.

Issued by the American Heart Association and the American Stroke Association, the guidelines are designed to help doctors and patients recognize stroke risk factors early, when there is time to act.

"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 Dr Cheryl Bushnell, author of the new scientific statement published in the American Heart Association journal Stroke.

According to the report, stroke is the fifth-leading cause of death in men and the third-leading cause of death in women. Shared risk factors for stroke include high blood pressure, high cholesterol and smoking.

But other factors influence stroke risk in women. Many of these involve pregnancy. For example, women with a history of high blood pressure should take extra steps to control it during pregnancy, such as taking low-dose aspirin and possibly a calcium supplement. That helps reduce the risk of preeclampsia, a condition marked by high blood pressure and protein in the urine that can cause stroke during or after delivery and premature birth.

Women who have had preeclampsia have twice the risk of a stroke and four times the risk of high blood pressure later in life. As a result, they should address issues such as smoking, high cholesterol and obesity, which heighten their stroke risk even more.

Likewise, women should be screened for high blood pressure before using birth control pills, because that combination raises stroke risks.

Other risk factors more common in women than men include migraine with aura, atrial fibrillation, diabetes, depression and emotional stress.

These are signs 52-year-old Karen Rastenis from Solon, Ohio, wished she had been aware of a while back. Before her stroke two years ago, Rastenis was a smoker and more than 150 lbs overweight. When she woke up one morning with weakness on her right side, the busy single mother of two teenagers ignored the symptom. Then it kept getting worse.

By the time she went to the hospital a few days later, her blood pressure was dangerously high at 237 over 160. She had already had a stroke in her brain stem and "I was on the verge of having a massive stoke," she said.

Rastenis says she had always been overweight but she did not know she had high blood pressure before the stroke.

Still, there had been warning signs. She had had migraines with aura from the start of puberty until she had her first child. During that pregnancy, she also had preeclampsia.

Since her stroke, Rastenis has taken several steps to prevent another. She has quit smoking and had weight loss surgery. She has already lost 60 lbs.

Still, she wishes she had known about the risks earlier.

"It's about time that they looked at the differences in stroke between males and females," she said. "We've known that a woman's heart attack will present differently than a man's. It seems to follow that the same is true of stroke."

Dr Shazam Hussain, stroke section head at the Cleveland Clinic in Ohio, who was not involved in the study, said the guidelines were long overdue.

"Certainly, there is something in common between men and women in terms of stroke risk factors. It's also been recognized there are differences," he said, noting that women tend to do worse after a stroke and are also more likely to die from stroke than men.

"I think recognizing that, putting that on the table as a group that needs more focus when we do studies and when we care for women is very important," he said.

(Reporting by Julie Steenhuysen; editing by Gunna Dickson)

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