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High blood pressure

High blood pressure, also called hypertension, is the most important risk factor for stroke. High blood pressure makes you four to six times more likely to have a stroke.

Blood pressure is the force your blood makes against your artery walls when your heart beats. If this force (pressure) is too high, it can damage your arteries.

You are more likely to have high blood pressure if you have a family history of high blood pressure. Other risk factors for high blood pressure include eating unhealthy food often, not exercising, and being overweight.

In the United States, African-American women are at the highest risk for high blood pressure. This may be because African-American women are more likely to be obese or have diabetes, which can cause high blood pressure. Research has also found a gene common in African-Americans that increases sensitivity to salt. In people who have this gene, just one extra half a teaspoon of salt a day could raise blood pressure.1 Also, studies show that blood pressure levels are higher among African-Americans in the United States even after controlling for other factors, and some of this difference may be due to the effects of discrimination.2

High blood pressure usually shows no symptoms. The only way to know you have it is to get your blood pressure measured. Measure your blood pressure to find out your numbers:

  • Systolic (siss-TOL-ihk) (the top number) is the pressure as your heart beats or pumps blood into your arteries.
  • Diastolic (deye-uh-STOL-ihk) (the bottom number) is the pressure when your heart is at rest.

To lower your risk of heart disease, try to lower your blood pressure to less than 120 systolic/80 diastolic.

Many women — more than men — get "white coat hypertension." This means that your anxiety or stress level goes up when you are at the doctor's office, and this can make your blood pressure go up. If medical visits increase your stress level, ask your doctor for a monitor to wear at home to get a more accurate blood pressure reading.

Learn more about high blood pressure.

Heart disease

Having other types of heart disease is a major risk factor for stroke. This is because heart disease, which can include blood vessel diseases, affects all the vessels in your body. Some conditions also make blood clots more likely.

Common heart problems that increase your risk for stroke include:

  • Atherosclerosis. This condition happens when plaque builds up on artery walls, making them stiff and hard. Atherosclerosis can affect the arteries supplying blood to the heart (coronary artery disease), legs and arms (peripheral artery disease), and brain (carotid artery disease).
  • Atrial fibrillation (AY-tree-ul fih-brih-LAY-shun) (AF or Afib). Afib is a type of arrhythmia, or irregular heartbeat. Afib symptoms include heart flutters, a fast heartbeat, dizziness, and shortness of breath. Afib makes it easier for your blood to clot because your heart cannot pump as well as it should. Women are more likely than men to have a stroke caused by Afib, especially women older than 75.3,4 If you have Afib, your doctor may give you medicine to prevent clots.
  • Heart failure. This happens when the heart is not able to pump blood through the body as well as it should. In heart failure your blood is more likely to form a clot that can cause a stroke. Heart failure symptoms include:
    • Shortness of breath
    • Swelling in feet, ankles, and legs
    • Extreme fatigue (tiredness)
  • Heart valve disease. Heart valve disease affects the valves that control blood flow in and out of different parts of the heart. A birth defect, older age, or an infection can cause your heart valves to not open fully or close completely. This causes the heart to work harder to pump blood. Heart valve disease can lead to stroke as well as heart failure, blood clots, or sudden cardiac arrest. Heart valve disease can cause problems during pregnancy, when your heart already has to work harder than usual to supply blood to your unborn baby. Your doctor can help you prevent problems during pregnancy if you know you have heart valve disease. But, some women do not find out that they have a heart valve problem until they get pregnant.5

High cholesterol and triglycerides

Cholesterol is a waxy, fat-like substance that is found in all cells of your body. Your body makes all the cholesterol you need. You also get cholesterol and saturated fat in foods such as meat and dairy products. Fruits and vegetables do not have any cholesterol or saturated fat.

The extra fat from the foods you eat can clog your arteries. A blood test can measure your levels of:

  • Low-density lipoprotein (LDL) or "bad" cholesterol. High LDL levels lead to cholesterol buildup in arteries, which can raise your risk for stroke.
  • High-density lipoprotein (HDL) or "good" cholesterol. High HDL levels are actually good. HDL cholesterol helps lower the total cholesterol level in your body.
  • Total cholesterol. This is the total amount of cholesterol in your blood, including LDL cholesterol and HDL cholesterol.
  • Triglycerides. Triglycerides are another type of fat in your blood. High triglycerides may raise women's stroke risk more than men's stroke risk.

There are no symptoms of high cholesterol. The only way to know whether you have high cholesterol is to talk to your doctor about a blood test. Your doctor can prescribe medicines and talk with you about other changes, like getting more physical activity, to help lower your cholesterol and triglyceride levels and your risk for stroke.

Overweight and obesity

Being overweight or obese raises your chance of stroke, especially when you carry extra body fat around your waist (apple-shaped body) rather than around your hips and thighs (pear-shaped body).

Women with an apple-shaped body may have a higher risk for stroke than women with a pear-shaped body.

Postmenopausal women with a high blood triglyceride level and a waist size larger than 35 inches are more likely to have a stroke than postmenopausal women with normal cholesterol levels and a waist size of 35 inches or less.

To lower your risk for stroke, your body mass index (BMI) should be between 18.5 and 24.9. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or higher is considered obese. Find your BMI using this BMI calculator from the Centers for Disease Control and Prevention.

Losing weight lowers your risk of stroke because your risk of high blood pressure, diabetes, high cholesterol, and metabolic syndrome goes down.

Diabetes

Women with diabetes are more likely to die after a stroke than men with diabetes.6 If they do survive, their risk of future health problems may be higher.

Uncontrolled diabetes can damage your arteries. Diabetes also makes you more likely to get high blood pressure and get blood clots that can cause a stroke.

About 28% of Americans with diabetes don't know that they have it.7 The only way to know for sure whether you have diabetes is to get a blood test.

Learn more at our Diabetes page and learn about the link between diabetes and the risk for stroke.

Metabolic syndrome

Metabolic (MET-ah-BOL-ik) syndrome is the name for a group of risk factors that happen together and are related to your metabolism. Metabolism is the process your body uses to convert food into energy. Having metabolic syndrome doubles your risk of heart disease. Metabolic syndrome is more common in women than men.8

Having metabolic syndrome raises your risk of stroke.9 You have metabolic syndrome if you have any three of these five risk factors:

  • Waist measurement of more than 35 inches
  • Triglyceride level greater than 150 mg/dL (milligrams per deciliter)
  • HDL cholesterol less than 50 mg/dL
  • Blood pressure of 130/85 mm Hg (millimeters of mercury) or higher
  • Blood glucose greater than 110 mg/dL after fasting for at least eight hours

If you have metabolic syndrome, you can take steps to control your risk factors. Your doctor will check your cholesterol, blood pressure, and blood glucose regularly to find out your risk for metabolic syndrome.

Learn more about metabolic syndrome.

Excessive blood clotting

Excessive, or extra, blood clotting is when blood clots form too easily or break apart too slowly. Blood clots can narrow arteries and veins or block blood flow completely. This can lead to stroke, heart attack, or damage to the kidneys, lungs, or other parts of the body.

Women of childbearing age (between 15 and 44) are at higher risk of blood clots than men of the same age.10,11 Some women also have gene mutations (changes in the genes you are born with) that make their blood more likely to clot and put them at higher risk of stroke.

Your family health history, pregnancy, and certain medicines can cause excessive blood clotting. Medicines with the hormone estrogen, such as hormonal birth control or menopausal hormone therapy, can also raise your risk for blood clots. Everyday habits like healthy eating and physical activity can make clots less likely to form. Some people with this condition might also need medicine to prevent clots.

Learn more about excessive blood clotting.

Lupus and rheumatoid arthritis

Lupus and rheumatoid arthritis are health problems that affect more women than men.12,13 Lupus and rheumatoid arthritis are autoimmune disorders. This means that they cause your immune system to attack the tissues and organs in your body, rather than just fighting off infections. Sometimes your heart and blood vessels are the tissues and organs that are attacked.

Because of this damage, you're more likely to have a stroke. If you have lupus or rheumatoid arthritis, treatment can also lower your risk for stroke.

Read more about lupus and rheumatoid arthritis.

C-reactive protein

C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time can mean your arteries are damaged, which puts you at risk for stroke.

Women usually have higher CRP levels than men.14 Also, Hispanic and African-American women have the highest CRP levels.15

If you are at borderline risk of stroke, your doctor might test your CRP levels to use as a "tiebreaker." The test will help your doctor decide whether you need to take steps to lower your CRP levels and help prevent stroke. This may include changing your eating habits, getting more physical activity, or taking medicine to treat high blood pressure or high cholesterol.

Sources

  1. American Heart Association. (n.d.). Heart Disease in African-American Women.
  2. Dolezsar, C.M., McGrath, J.J., Herzig, A.J., Miller, S.B. (2014). Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychology; 33(1): 20-34.
  3. Volgman, A. S., Manankil, M. F., Mookherjee, D., & Trohman, R. G. (2009). Women with atrial fibrillation: Greater risk, less attention. Gender Medicine, 6(3), 419–432.
  4. American Heart Association/American Stroke Association. (2014). Women Face a Higher Risk of Stroke.
  5. Stout, K., Otto, C.M. (2007). Pregnancy in women with valvular heart disease. Heart; 93(5): 552-558.
  6. Roche, M., & Wang, P.P. (2013). Sex differences in all-cause and cardiovascular mortality, hospitalization for individuals with and without diabetes, and patients with diabetes diagnosed early and late. Diabetes Care, 36(9), 2582–2590.
  7. Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014.
  8. Aguilar, M., Bhuket, t., Torres, S., Lui, B., Wong, R.J. (2015). Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA; 313(19): 1973-1974.
  9. Rodriguez-Colon, S.M., Mo, J., Duan, Y., Liu, J., Caulfield, J.E., Jin, X., Liao, D. (2009). Metabolic Syndrome Clusters and the Risk of Incident Stroke. Stroke; 40: 200-205.
  10. Naess, I.A., Christiansen, S.C.,Romundstad, P.,Cannegieter, S.C., Rosendaal, F.R., Hammerstrom, J. (2007). Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost; 5:692–9.
  11. Roach, R.E.J., Cannegieter, S.C., Lijfering, W.M. (2014). Differential risks in men and women for first and recurrent venous thrombosis: the role of genes and environment. J Thromb Haemost;12:1593–1600.
  12. Jacobson, D.L., Gange, S.J., Rose, N.R., Graham, N.M. (1997). Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clinical Immunology and immunopathology; 84(3): 223-43.
  13. Gleicher, N., Barad, D.H. (2007). Gender as risk factor for autoimmune diseases. Journal of Autoimmunity; 28(1): 1-6.
  14. Khera, A., McGuire, D.K., Murphy, S.A., Stanek, H.G., Das, S.R., Vongpatanasin, W., et al. (2005). Race and gender differences in C-reactive protein levels. Journal of the American College of Cardiology; 46(3): 464-9.
  15. Reiner, A.P., Beleza, S., Franceschini, N., Auer, P.L., Robinson, S.G., Kooperberg, C., et al. (2012). Genome-wide association and population genetic analysis of C-reactive protein in African American and Hispanic American women. American Journal of Human Genetics; 91(3): 502-12.