AHA/ASA guideline recommendations for prevention of stroke in women overview

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Hemorrhagic stroke
Ischemic stroke

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Epidemiology and Demographics


NIH stroke scale
Glasgow coma scale

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]


The incidence of stroke, especially in women, is fast-rising. Stroke is the third leading cause of death in women and fifth in men.[1] Many studies have documented the fact that women are more adversely affected by stroke and its complications, in terms of functional recovery, quality of life when compared to men.[2][3][4] Therefore, it is important to provide guidelines to identify high-risk women for stroke, and also to provide recommendations regarding prevention of stroke.

Epidemioloogy and Dermographics

Ischemic Stroke

In general, women have a lower incidence of ischemic stroke than men. Women have a longer life expectancy than men, therefore, at ages 85 years and older, women have a higher[5] or similar incidences of stroke with men.[6] A population-based incidence study also noted a ≥2-fold increase in stroke incidence among blacks and Hispanics when compared with whites.[7]

Hemorrhagic Stroke

There is an increased prevalence of subarachnoid hemorrhage in women,[8][9] which has been linked to an increased prevalence of cerebral aneurysms.[10] Conversely, the incidence of intracerebral hemorrhage, in most cases, has been reported to be lower in women when compared with men.[11] The highest incidence of ICH was also observed among the black population as compared with hispanics and white population.

Risk Factors

Sex-specific Stronger or commoner in women Similar prevalence in both sexes
Pregnancy Migraine with aura Physical inactivity
Preeclampsia Atrial fibrillation Age
Gestational diabetes Diabetes mellitus Prior cardiovascular disease
Oral contraceptives Hypertension Obesity
Postmenopausal hormone use Depression[12] Diet
Changes in hormonal status Psychosocial stress Smoking
Metabolic syndrome

Adapted from AHA/ASA guideline recommendations for prevention of stroke in women (2014)[13]


  1. "Products - Health United States - Tables - 2011 Complete List". Retrieved 11 February 2014.
  2. Gall, SL.; Tran, PL.; Martin, K.; Blizzard, L.; Srikanth, V. (2012). "Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life". Stroke. 43 (7): 1982–7. doi:10.1161/STROKEAHA.111.632547. PMID 22569940. Unknown parameter |month= ignored (help)
  3. Gargano, JW.; Reeves, MJ. (2007). "Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry". Stroke. 38 (9): 2541–8. doi:10.1161/STROKEAHA.107.485482. PMID 17673706. Unknown parameter |month= ignored (help)
  4. Kim, JS.; Lee, KB.; Roh, H.; Ahn, MY.; Hwang, HW. (2010). "Gender differences in the functional recovery after acute stroke". J Clin Neurol. 6 (4): 183–8. doi:10.3988/jcn.2010.6.4.183. PMID 21264198. Unknown parameter |month= ignored (help)
  5. Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA (2009). "Gender differences in stroke incidence and poststroke disability in the Framingham heart study". Stroke. 40 (4): 1032–7. doi:10.1161/STROKEAHA.108.542894. PMC 2676725. PMID 19211484.
  6. Appelros P, Stegmayr B, Terént A (2009). "Sex differences in stroke epidemiology: a systematic review". Stroke. 40 (4): 1082–90. doi:10.1161/STROKEAHA.108.540781. PMID 19211488.
  7. Sacco RL, Boden-Albala B, Gan R, Chen X, Kargman DE, Shea S; et al. (1998). "Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study". Am J Epidemiol. 147 (3): 259–68. PMID 9482500.
  8. Shea AM, Reed SD, Curtis LH, Alexander MJ, Villani JJ, Schulman KA (2007). "Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003". Neurosurgery. 61 (6): 1131–7, discussion 1137-8. doi:10.1227/01.neu.0000306090.30517.ae. PMID 18162891.
  9. Sacco S, Totaro R, Toni D, Marini C, Cerone D, Carolei A (2009). "Incidence, case-fatalities and 10-year survival of subarachnoid hemorrhage in a population-based registry". Eur Neurol. 62 (3): 155–60. doi:10.1159/000226617. PMID 19571544.
  10. Wardlaw JM, White PM (2000). "The detection and management of unruptured intracranial aneurysms". Brain. 123 ( Pt 2): 205–21. PMID 10648430.
  11. Nilsson OG, Lindgren A, Ståhl N, Brandt L, Säveland H (2000). "Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden". J Neurol Neurosurg Psychiatry. 69 (5): 601–7. PMC 1763383. PMID 11032611.
  12. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P; et al. (2010). "Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study". Lancet. 376 (9735): 112–23. doi:10.1016/S0140-6736(10)60834-3. PMID 20561675.
  13. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL; et al. (2014). "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. doi:10.1161/01.str.0000442009.06663.48. PMID 24503673.