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Cited by 941Acute Ischemic Stroke ManagementSex and Gender in HealthcareMenopause: Health Impacts and Treatments

Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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Bushnell, Cheryl, McCullough, Louise D., Awad, Issam A., Chireau, Monique V., Fedder, Wende N., Furie, Karen L., Howard, Virginia J., Lichtman, Judith H. +9 more·2014·Stroke
DOI 10.1161/01.str.0000442009.06663.48PMC PMC10152977
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Abstract

Purpose—: The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Methods—: Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results—: We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions—: To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.

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Crossref · 10.1161/01.str.0000442009.06663.48

Cites

489 of 489 references verified0 citation errors · 0 not checkable

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  • The American Heart Association recommends moderate to vigorous aerobic physical activity for at least 40 minutes per day, 3 to 4 days per week, to prevent stroke.

    “The American Heart Association (AHA) recommends moderate to vigorous aerobic physical activity at least 40 min a day, 3 to 4 days per week, to prevent stroke.12,13”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [13]

    The “Obesity, Metabolic Syndrome, and Lifestyle Factors: Recommendations” section recommends regular physical activity for primary stroke prevention in women with cardiovascular risk factors and diet-and-exercise interventions for people at high risk. It does not specify moderate-to-vigorous aerobic activity, 40 minutes a day, or 3 to 4 days per week. No page number is available in our copy. (LLM, conf=0.88)

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  • The AHA guideline for preventing stroke in women identified physical inactivity as a risk factor with similar prevalence in men and women but with an unknown difference in effect by sex.

    “The AHA guideline for preventing stroke in women identified physical inactivity as a risk factor with similar prevalence in men and women but with an unknown difference in effect by sex.13”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [13]

    The “Lifestyle” and “Obesity, Abdominal Adiposity, and Metabolic Syndrome: Summary and Gaps” sections associate physical activity with lower stroke risk and say little is known about sex differences in the effects of healthy lifestyle. The passages do not establish that physical inactivity has similar prevalence in men and women; searches for physical inactivity and its prevalence did not find that comparison. (LLM, conf=0.83)

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  • The review's results support stroke prevention guideline recommendations that moderate to vigorous physical activity at a moderate frequency of 3 to 4 times per week reduces stroke risk.

    “Our results also support recommendations found in stroke prevention guidelines,12,13 that moderate to vigorous physical activity at a moderate frequency (3–4 times per week) reduces risk of stroke.”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [13]

    The Obesity, Metabolic Syndrome, and Lifestyle Factors recommendations endorse regular physical activity for primary stroke prevention in women with cardiovascular risk factors. The guideline does not specify moderate-to-vigorous intensity or a frequency of 3–4 times per week, so it supports the general recommendation but not those particulars. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In women, AF is associated with worse symptoms and quality of life, and increased risk of complications such as stroke and mortality, compared with men.

    “in women, AF is associated with worse symptoms and quality of life,10–12 and increased risk of complications such as stroke13 and mortality,14 compared with men.”

    From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [14]

  • Multiple longitudinal studies have evaluated whether an interaction exists between sex and AF-related risk of mortality, but the results have not been consistent.

    “Multiple longitudinal studies have evaluated whether an interaction exists between sex and AF-related risk of mortality, but the results have not been consistent (Supplementary Table S10).”

    From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [14]

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Cites

2 retracted

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Research works printed but not linked: 2

  1. [208]Borhani Haghighi A, Edgell RC, Cruz-Flores S, Feen E, Piriyawat P, Vora N, Callison RC, Alshekhlee A. Mortality of cerebral venous-sinus thrombosis in a large national sample. Stroke. 2012; 43: 262– 264. 21998058
  2. [295]Vague J La differenciation sexuelle, feateur determinant des formes de l’obesite [in French]. Presse Med. 1947; 55: 339– 340. 18918084

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Authors
Bushnell, C., McCullough, L. D., Awad, I. A., Chireau, M. V., Fedder, W. N., Furie, K. L., Howard, V. J., Lichtman, J. H., Lisabeth, L. D., Piña, I. L., Reeves, M. J., Rexrode, K. M., Saposnik, G., Singh, V., Towfighi, A., Vaccarino, V., & Walters, M. R.
Affiliations
American Association of Neurological Surgeons (US)
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-05
Volume
45
Issue
5
Pages
1545-1588
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/01.str.0000442009.06663.48
PMC
PMC10152977
OpenAlex
W1988919748
Semantic Scholar
eba52923a80ca4f7c2a0eeb2fdb5bd1947338f64
Cited by
941
References
489
Citations by year
2026: 57 · 2025: 64 · 2024: 60 · 2023: 68 · 2022: 82 · 2021: 79 · 2020: 79 · 2019: 77 · 2018: 74 · 2017: 87 · 2016: 80 · 2015: 87 · 2014: 45
FWCI
75.31
Type
journal article
Language
en
Update notices
Open access
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • American Heart Association
  • National Institutes of Health (5k02ns058760-04)
  • National Institute of Neurological Disorders and Stroke (K02-NS058760)
  • Core Research for Evolutional Science and Technology
Topics
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
stroke prevention, women, stroke risk factors, reproductive factors, preeclampsia, oral contraceptives, menopause, hormone replacement therapy, obesity, metabolic syndrome, atrial fibrillation, migraine with aura
MeSH terms
American Heart Association, Female, Humans, Societies, Medical, United States, Women's Health, Guidelines as Topic, Stroke

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