The American Stroke Association (ASA) has released new stroke prevention guidelines for the first time in a decade. This latest edition notably includes a section on sex- and gender-specific risk factors, such as endometriosis, early menopause, and pregnancy.
The new guidelines are for primary prevention—that is, to prevent someone’s first stroke and they align with the AHAs “Life’s Essential 8” guide for patients on optimizing cardiovascular and brain health. The ASA is a division of the American Heart Association (AHA). In these ASA guidelines, the authors write, “Many recommendations … were updated, new topics were reviewed, and recommendations were created when supported by sufficient-quality published data.”
According to the guidelines, pregnant and postpartum individuals have approximately triple the risk of stroke compared with women of a similar age. Although pregnancy-associated maternal stroke is rare, occurring in approximately 30 per 100,000 deliveries, stroke is a leading cause of maternal morbidity and mortality. In addition, there is significant racial disparity in morbidity and mortality rates, suggesting there is room for improvement in how these cases are managed.
Patients with hypertension represent a particularly high-risk group for maternal stroke, and stroke is a leading cause of death in these individuals. The authors note there are no randomized trials on optimal primary stroke prevention strategies in pregnancy and postpartum; however, evidence supports blood pressure control as critical for the prevention of maternal morbidity, including fatal and nonfatal stroke.
The authors listed additional risk factors for maternal stroke including: older age, history of migraine, use of assisted reproductive technology, obesity, heart disease, and infections.
There were some surprising gender-specific conditions. For example, “among those with endometriosis, studies have shown a consistently increased risk of stroke, young individuals with endometriosis are a subgroup who might benefit from enhanced attention to cardiovascular risk assessment and prevention strategies.”
Over 12 million people worldwide are expected to have their first stroke this year and 6.5 million will die as a result, according to the World Stroke Organization. More than 795,000 people in the United States alone have a stroke every year, with one in six deaths from cardiovascular disease caused by stroke, according to the CDC.
About 87% of strokes are ischemic. The blockage is usually caused by a piece of plaque or a blood clot in the brain. But many strokes are preventable through lifestyle or careful control of other health issues, such as diabetes.
Notably, research from the AHA shows that strokes among young people have been on the rise for the past 30 years. Every year, between 10–15 percent of the roughly 795,000 people in the country who have a stroke are between the ages of 18 and 45, according to the AHA. Those rising stroke rates could be linked to rising rates of diabetes, high blood pressure, obesity, COVID infection, and physical inactivity.
