Stroke in women
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Stroke in Women: Understanding the Unique Risks and Outcomes
Epidemiology and Mortality Rates
Stroke is a significant health concern for women, being the third leading cause of death among them in the United States 36. Women experience more strokes than men, largely due to their longer life expectancy 34. Although stroke rates have declined in both sexes, the age-adjusted stroke risk in women may not be decreasing as rapidly as in men, potentially leading to similar incidence rates between the sexes 4.
Unique Risk Factors for Women
Hormonal Influences and Pregnancy
Several risk factors for stroke are unique to women, including hormonal changes and pregnancy-related conditions. High-dose estrogen, hypertension, and smoking are critical cumulative factors for premenopausal women 2. Pregnancy increases the risk of thrombotic cerebrovascular events, particularly during the second and third trimesters 23. Additionally, hypertensive disorders of pregnancy, such as preeclampsia, can elevate the risk of stroke decades after pregnancy 17.
Menopause and Hormone Replacement Therapy
Postmenopausal women face increased stroke risk, with hormone replacement therapy (HRT) further elevating the risk of ischemic stroke by 40-50% 68. However, observational studies suggest that postmenopausal hormonal use may decrease stroke risk, though clinical trials are needed for confirmation 5.
Conventional Risk Factors
Hypertension and Atrial Fibrillation
Hypertension and atrial fibrillation are significant risk factors for stroke in both men and women, but their impact is more pronounced in women 467. Effective control of hypertension is crucial, yet it remains inadequately managed in older women, contributing to higher stroke rates 6.
Lifestyle Factors
Lifestyle choices, such as smoking and alcohol consumption, also play a role in stroke risk. Cigarette smoking increases the risk of stroke, while heavy drinking quadruples the risk compared to nondrinkers 2. Conversely, light drinking may reduce the risk to half that of nondrinkers 2.
Outcomes and Management
Functional Outcomes and Disability
Women tend to have worse functional outcomes after a stroke compared to men, partly due to older age and more severe strokes at the time of the event 49. Despite higher survival rates, women are more likely to experience disability and poorer quality of life post-stroke 10.
Treatment Disparities
There are notable disparities in the treatment and management of stroke between men and women. Women are more likely to be admitted to acute stroke units but less likely to receive intensive care treatments such as intubation or fever management 10. Additionally, women are more often prescribed antihypertensive agents but less likely to receive antiplatelets, glucose-lowering agents, or lipid-lowering agents 10.
Conclusion
Stroke presents unique challenges for women, influenced by both sex-specific and conventional risk factors. Understanding these differences is crucial for developing effective prevention and treatment strategies tailored to women. Improved management of hypertension, careful consideration of hormone replacement therapy, and addressing lifestyle factors can significantly reduce the burden of stroke in women.
Sources and full results
Most relevant research papers on this topic
Stroke in Women.
Sex differences in stroke epidemiology, care, and outcomes exist, with advances in understanding endovascular therapy benefits, outcomes after stroke, and potential for stroke prevention in women with a history of hypertensive disorders of pregnancy.
Stroke in women.
Stroke risk factors are similar in both sexes, with high dose estrogen, hypertension, and smoking being important factors for premenopausal women, and post menopausal hormone replacement reducing vascular disease risk.
Highly CitedStroke Risk Factors Unique to Women
Women-specific factors, such as endogenous hormone levels, exogenous estrogens, pregnancy exposures, and menopause, may increase their stroke risk.
Systematic Review
Rigorous JournalHighly CitedImpact of Conventional Stroke Risk Factors on Stroke in Women: An Update
Sex differences in stroke risk factors and treatment disparities may exist between women and men.
Systematic ReviewRigorous JournalStroke in women.
Modification, treatment, and better control of risk factors like hypertension, diabetes, and atrial fibrillation can reduce stroke death and disability in women.
Literature ReviewStroke in women — from evidence to inequalities
Women have stronger stroke risk factors than men, but are underrepresented in clinical trials, reducing the generalizability of study results to women.
Literature ReviewHighly CitedStroke in Women.
Sex differences in stroke risk factors and outcomes exist, with factors like age, prestroke functional status, and comorbidities playing a significant role in women's stroke outcomes.
Systematic ReviewStroke in Women: What is Different?
Women are more likely to have strokes in their lifetime than men, have different responses to primary and secondary prevention, and have poorer outcomes in stroke survivors compared to men.
Sex differences in treatment and outcome after stroke
Women with ischemic stroke had better survival but also more disability and poorer quality of life, with variations in hospital and out-of-hospital management potentially contributing to these disparities.
Meta-AnalysisRigorous Journal