AHA/ASA首次發表降低婦女中風風險之指引


  【24drs.com】美國心臟協會與美國中風協會(AHA/ASA)首度發表降低中風風險之指引,特別是針對女性。
  
  撰寫委員會副主席、康乃狄克大學健康中心的Louise McCullough醫師表示,這是首次有指引特別論及女性的中風風險,AHA/ASA多年來一直探討女性和男性的中風風險有何差異,因此,經過長時間的演變後終於獲得此版本指引。
  
  這次的指引也提到專屬女性的中風風險分數評估。
  
  撰寫委員會結論指出,為了更準確地反映各年齡女性的中風風險,以及現行風險評估分數的不足,我們相信,相當需要專屬女性的中風風險分數。
  
  這份適用於一線照護醫師和婦產科醫師的指引,線上刊載於2月6日的中風期刊。
  
  McCullough醫師報告指出,美國每年的婦女中風病例比男性多55,000例;中風是男性的第五大死因、女性的第三大死因,且比率隨著年齡增加而增加。
  
  指引中提到,我們的社會如何因應預期增加的女性中風盛行率是相當重要的,更勝於以往的重點是,確認女性的中風風險較高且啟動適當的預防策略。
  
  McCullough醫師解釋,某些中風風險因素是女性獨具的,例如懷孕、服用口服避孕藥、荷爾蒙替代療法。某些醫療狀況則是比較會增加婦女的中風風險,包括先兆偏頭痛和形成腦靜脈血栓,因此,我們真的需要將這些因素納入中風風險考量。
  
  這次的指引包括更多的懷孕和中風風險資訊,特別是發生先兆子癇時。
  
  McCullough醫師表示,懷孕時先兆子癇和晚年中風風險加倍有關,即便是產後血壓恢復到正常範圍也是如此。先兆子癇時在血管發生的一些狀況,在懷孕結束之後並不會恢復正常。
  
  因此,評估年長婦女的中風風險時,問她懷孕時是否發生過先兆子癇是很重要的,不論那是30、40、甚至50年前,如果曾發生過,那她的中風風險就比較高,必須更常篩檢血壓狀況和其他風險,甚至需要更早就開始篩檢。
  
  這次指引的新建議之一是,懷孕前有高血壓史的婦女應考慮給予低劑量阿斯匹靈和/或補充鈣質,以降低先兆子癇風險;另也建議,中度高血壓(150-159 mmHg/100-109 mmHg)的孕婦應考慮血壓藥物,嚴重高血壓(160/110 mmHg或以上)的準媽媽則應予以治療。
  
  其他建議還包括,在婦女開始服用避孕藥之前,為其篩檢高血壓,以免中風風險增加;另應鼓勵先兆偏頭痛婦女戒菸,以免風險增加。
  
  McCullough醫師表示,許多建議其實是已知的,新版指引則是彙整了這些資訊。
  
  她表示,我們要求醫師對中風風險提高警覺,並思考有哪些風險因素加成。例如,如果婦女有抽菸且有先兆偏頭痛,就不建議開立口服避孕藥給她。
  
  對於75歲以上的年長婦女,這次的指引建議篩檢心房顫動(atrial fibrillation,AF)。
  
  McCullough醫師表示,75歲以上婦女患有心房顫動的風險高於男性,但有時候是完全沒有症狀的,我們必須更積極地對這些年長婦女進行篩檢。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7051&x_classno=0&x_chkdelpoint=Y
  

First AHA/ASA Guidelines to Reduce Stroke Risk in Women

By Sue Hughes
Medscape Medical News

The American Heart Association/American Stroke Association (AHA/ASA) has issued the first guidelines for reducing stroke risk specifically in women.

Vice-chair of the writing committee, Louise McCullough, MD, University of Connecticut Health Center, Farmington, told Medscape Medical News this is first time that guidelines have specifically addressed stroke risk in women.

"How men and women differ in stroke risks has been on the minds of many of us at the AHA/ASA for years, so this guideline has been a long time in evolution," she said.

The guidelines also call for a stroke risk score specific to women.

"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," the writing committee concludes.

Geared to primary care physicians and obstetrician-gynecologists, the guidelines are published online February 6 in Stroke.

More Strokes in Women

Dr. McCullough reported that each year in the United States, 55,000 more strokes occur in women than in men. Stroke is the fifth leading cause of death for men but the third leading cause for women, and with the aging of the population, numbers continue to rise.

"How our society adapts to the anticipated increase in stroke prevalence in women is vitally important. Now more than ever, it is critical to identify women at higher risk for stroke and initiate the appropriate prevention strategies," the guidelines document states.

Dr. McCullough explained that certain risk factors for stroke are unique to women, such as pregnancy, use of oral contraceptives, and hormone replacement therapy. Some medical conditions increase stroke risk are much more common in women. These include migraine with aura and cerebral vein thrombosis. "So we really need to take gender into account when assessing stroke risk," she said.

The guidelines contain much information on pregnancy and stroke risk, particularly if pre-eclampsia has occurred.

"Pre-eclampsia during pregnancy is associated with a doubling in the risk of stroke later in life, even if blood pressure returns to normal after delivery. Something happens to the vasculature when pre-eclampsia occurs that doesn't return to normal at the end of pregnancy," said Dr. McCullough.

"So it is important to ask older women when assessing their stroke risk whether they had pre-eclampsia during pregnancy, even if this was 30, 40, or even 50 years ago. If they did, then they are at higher stroke risk so will need to be screened for blood pressure and other risks more often, or they may need to start screening earlier," she added.

Preventing Pre-eclampsia

One of the new recommendations in the guidelines is that women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to decrease pre-eclampsia risks.

The guidelines also recommend that pregnant women with moderately high blood pressure (150 to 159 mmHg/100 to 109 mmHg) may be considered for blood pressure medication, whereas expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.

Other recommendations include screening women for high blood pressure before they begin taking birth control pills because the combination raises stroke risk. Women with migraine headaches with aura should also be encouraged to stop smoking in order to avoid increased risk.

Although many of the recommendations may already be known, the new guidelines centralize the information, said Dr. McCullough.

"We are asking doctors to be more aware of stroke risk and think about how the risk factors add up. For example, if a women smokes and has migraine with aura, then prescribing oral contraceptives is not a good idea," she said.

At the other end of the age spectrum, the guidelines recommend screening for atrial fibrillation (AF) in women older than age 75 years.

"Women over the age of 75 have a higher risk than men of having AF. But sometimes they are completely asymptomatic. We need to screen these older women more aggressively," said Dr. McCullough.

Stroke. Published online February 6, 2014.

    
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