Women and stroke: Differing risks and outcomes compared with men

Liz Meszaros, MDLinx | April 06, 2018

Stroke affects women differently than men, according to four separate studies published in the journal, Stroke. Specifically, researchers found that women have unique risk factors for stroke, with preeclampsia being a significant one, and suffer more disability and significantly higher lifetime risks for stroke and mortality than men.

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Studying stroke in women

Women experience more strokes and more stroke mortality over a lifetime due to the increased stroke risk with age and longer life expectancies compared with men.

“Gender influences all aspects of stroke, from risk factors, treatments, and outcomes,” said Marc Fisher, MD, editor-in-chief of Stroke and professor of neurology, Harvard Medical School, Boston, MA. “For too long, gender influences were not adequately studied.”

Unique risk factors

In the United States, stroke is the third leading cause of mortality in women and a leading cause of disability, according to researchers of a recent review, led by Stacie L. Demel, DO, PhD, assistant professor, Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI.

Dr. Demel and colleagues searched PubMed and Google Scholar for primarily original articles as well as meta-analyses and systematic reviews. Upon reviewing the studies, they concluded that most strokes were attributable to traditional vascular risk factors, including hypertension, hyperlipidemia, diabetes, smoking, and atrial fibrillation, which occur in both women and men. But several risk factors were specific to women, they found, including differences in sex hormones, exogenous estrogens, and pregnancy.

Preeclampsia is a risk

Upon a review of 11 studies published from 1990 to January 2017, researchers of a second review led by Mollie McDermott, MD, clinical assistant professor, Department of Neurology, University of Michigan, Ann Arbor, MI, found that stroke is most common in the peripartum and postpartum periods, affecting an estimated 30 in 100,000 pregnancies. Increased risk for stroke in women was due to venous or arterial thrombosis due to estrogen-related hypercoagulability; cardioembolism caused by peripartum cardiomyopathy; and hypertensive pregnancy disorders associated with endotheliopathy, vasospasm, and hypertensive intracerebral hemorrhage. 

Dr. McDermott and fellow researchers also found that the risk for future ischemic stroke is approximately 80% greater in women with a history of preeclampsia or eclampsia than in those who did not have preeclampsia. They concluded that women who develop preeclampsia during pregnancy should be counseled on the signs and symptoms of stroke and monitored closely after giving birth.

Stroke more disabling in women

A third review updated findings of sex differences in patient-reported outcome measures less than 12 months after a stroke with data from studies published since 2007. The researchers, led by Seana Gall, BSc, PhD, senior research fellow, cardiovascular epidemiology, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, confirmed that women typically have more limitations on their activity, worse health-related quality of life, and more post-stroke depression than men. Their cognitive impairment and challenges in everyday life, however, were not worse compared with men. 

Women live longer, have higher lifetime stroke and mortality risks

In the final review, Tracy E. Madsen, MD, ScM, assistant professor, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, and fellow researchers found that, compared with men, women experience more strokes and more stroke mortality over a lifetime due to the increased stroke risk associated with age and longer life expectancies. They reviewed the literature on ischemic stroke from 2013 to the present and concluded that factors such as diabetes, metabolic syndrome, atrial fibrillation, and migraine all carry greater ischemic stroke risk for women than men. In addition, treatment disparities between men and women may cause less than optimal stroke prevention in women. These disparities need to be addressed, they stressed. 

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