Strokes Are More Common and Serious in Women

Cindy W. Yoon, Department of Neurology, Inha University School of Medicine, Incheon, Korea wrote an article about Strokes in Women in 2023. Strokes result from a disruption in brain oxygen and nutrient supply. Hemorrhagic strokes occur when blood vessels weaken and rupture, while ischemic strokes are more common, caused by blood vessel blockages with clots or plaque. Both types can cause severe damage or death.

Stroke continued to rank third globally in terms of both mortality and disability combined in 2019 and as the second most common cause of death worldwide. Given that women make up over half (56% in 2019) of all stroke victims, stroke is a particularly serious issue for them. Compared to males, women had a greater lifetime risk (LTR) and a worse prognosis from stroke. Women vary from males in the distribution of certain risk variables and the stroke risk associated with those risk factors. In addition, women have particular risk factors that males do not. We provide an updated and targeted overview of the epidemiology, risk factors, and outcomes of stroke in women in this study.

Over 6.6 million people worldwide die from strokes annually, with a concerning increase in young and middle-aged individuals.

Stroke survivors often grapple with long-term disability, an elevated risk of depression, memory issues, and more.

Several common global risk factors for stroke, such as high blood pressure, elevated cholesterol, and smoking, are treatable. However, stroke risk varies among populations, with women having some unique risk factors.

In the United States, around 795,000 people suffer from strokes annually, and women are disproportionately affected, with about 55,000 more female cases. Women also face a higher risk of stroke-related mortality.

Women's increased risk can partially be attributed to their longer life expectancy. Ageing is a significant stroke risk factor due to factors like high blood pressure, elevated cholesterol, arterial plaque buildup, and deteriorating blood sugar control, all of which contribute to strokes.

Additionally, the biological changes during perimenopause and menopause play a crucial role for women. Many women experience blood pressure issues during this transition. This may be linked to the hormone estrogen, which helps maintain relaxed blood vessels and balanced cholesterol levels. When the body stops producing estrogen, the risk of stroke and other heart diseases rises.

Studies show a clear link between early menopause and an increased risk of stroke in women. Those who experience premature menopause before 40 have a 98 percent higher risk, while early menopause between 40 and 44 leads to a 49 percent higher risk, compared to women undergoing menopause between ages 50-51.

Interestingly, hormone therapy in the form of excess estrogen might also elevate stroke risk during perimenopause and menopause. Research indicates that the benefits of hormone therapy outweigh the risks only if started at a younger age or closer to menopause when hormone levels align more closely with the body's natural production.

Certain types of hormonal birth control can increase stroke risk, particularly in women with high blood pressure, smokers, or those with migraines. Studies also suggest that infertility treatments and estrogen use in transgender women might raise the risk of stroke.

Women face specific stroke risks during and after pregnancy due to increased blood volume, which can lead to higher clotting risk. Excessive weight gain during pregnancy, pre-eclampsia, and gestational diabetes can further increase the risk of clots and stroke later in life.

To prevent strokes, women can take several proactive steps:

  1. Manage Blood Pressure: Keeping blood pressure under control is crucial. Treating high blood pressure can reduce stroke risk significantly.

  2. Regular Wellness Exams: Starting in your 20s, have regular wellness exams to monitor blood pressure, cholesterol levels, and diabetes. Early detection and management of these conditions can help reduce stroke risk.

  3. Quit Smoking: Smoking is a major risk factor for stroke. Quitting smoking can have a significant positive impact on your overall health.

  4. Physical Activity: Aim for at least 150 minutes of exercise per week. Regular physical activity helps maintain overall health and can reduce stroke risk.

  5. Healthy Diet: Reduce saturated fat, trans fat, and sodium in your diet. Consider adopting a Mediterranean diet or a DASH (Dietary Approaches to Stop Hypertension) diet, which have strong evidence for reducing stroke risk and other health benefits.

  6. Family History: Be aware of your family history of heart disease and stroke. Use the American Stroke Association's assessment form to assess your risk.

  7. Birth Control: If you are at a high risk of stroke, discuss alternative birth control options with your doctor.

  8. Monitoring: Women should monitor their blood pressure closely during certain life stages, such as pregnancy and menopause.

  9. Ankle-Brachial Index Test: Starting in your 60s, consider an ankle-brachial index test to check for plaque buildup in leg arteries, which can be a sign of increased stroke risk.

  10. Know the Signs: Familiarise yourself with the FAST acronym to recognize the warning signs of a stroke:

  • F: Face drooping or numbness

  • A: Arm weakness

  • S: Speech difficulty

  • T: Time to call 911

Getting medical help promptly if you suspect a stroke can save your life and prevent long-term disability.(IK)