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Aleksandra Pikula: A Life Course Framework for Preventing Stroke and Dementia in Midlife Women
Aleksandra Pikula/LikedIn
Apr 28, 2026, 04:39

Aleksandra Pikula: A Life Course Framework for Preventing Stroke and Dementia in Midlife Women

Aleksandra Pikula, Jay and Sari Sonshine Chair in Stroke Prevention and Cerebrovascular Brain Health at University Health Network, shared on LinkedIn about a recent article she and her colleagues co-authored, published in Stroke, adding:

”Integrated Life Course Model and Evidence Frameworks for Midlife Women’s Stroke and Dementia Prevention.

Knowing the risks isn’t enough; we need to integrate them into our clinical workflow and take action consistently and long-term to protect brain health and prevent disease in midlife women.

Advocacy and education is great but clinical practice is the only way to support longitudinal women’s brain health through co-design and co development of programs for women.

But we also have to ask at minimum the following questions about:

1. Reproductive history

  • Hypertensive disorders of pregnancy
  • Gestational diabetes
  • Preterm birth
  • Parity

2. Age at menopause

  • Menopausal transition status
  • Stage (early peri, late peri, post)
  • Vasomotor symptoms
  • Sleep disturbance
  • Mood symptoms

3. Cardiometabolic and vascular risk factors

  • Blood pressure
  • Lipid panel
  • Hemoglobin A1c
  • BMI

4. Biomarkers

  • hsCRP
  • Lp(a)
  • LDL cholesterol

5. Lifestyle and behavioural factors

  • Physical activity
  • Nutrition
  • Restorative sleep
  • Positive social connections
  • Avoidance of risky substances
  • Stress management

6. MHT eligibility and risk assessment

  • Symptom profile
  • Time since menopause
  • Baseline cardiovascular risk
  • Thromboembolic risk
  • Stroke risk considerations
  • Route of administration

Only then can we feel confident that we did it well enough.

We recently published a simplified framework for pragmatically addressing the important issues of residual female-specific vascular risks, from pregnancy-related complications (APOs) through midlife changes (cardiometabolic and neuroendocrine shifts during menopause transition) to older age when diseases will manifest.”

Title: Midlife as the Critical Window for Women’s Stroke and Dementia Prevention: Pivotal Advances and Implementation Priorities

Authors: Aleksandra Pikula, Sharon Iziduh, Emine Kocabas, Evy Reinders, Ana Claudia de Souza, Sanjula D. Singh

Aleksandra Pikula: A Life Course Framework for Preventing Stroke and Dementia in Midlife Women

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Aleksandra Pikula Ana Claudia de Souza Emine Kocabas Evy Reinders Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Pregnancy Sanjula D. Singh Sharon Iziduh stroke prevention thrombosis Women’s Stroke
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