Stroke journal features womens studies on how gender influences stroke risk, treatment and outcomes

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Stroke Journal Report

February 08, 2018 Categories: ,

Embargoed until 4 a.m. CT / 5 a.m. ET Thurs., Feb. 8, 2018

DALLAS, Feb. 8, 2018 — Many aspects of strokes affect women and men differently, and four articles in the American Heart Association’s journal Stroke highlight recent research and identify future research needs.

“Gender influences all aspects of stroke, from risk factors, treatments and outcomes,” said Marc Fisher, M.D editor in chief of the Stroke journal and professor of neurology at Harvard Medical School in Boston, Massachusetts. “Highlighting these studies, all led by female researchers, in February, a month when the American Heart Association/American Stroke Association focuses on women’s health with Go Red For Women, is important. For too long, gender influences were not adequately studied.”

The studies include:

Stroke risk factors unique to women

Stroke is the third leading cause of death in women in the United States and is a leading cause of disability. Each year 55,000 more women than men have a stroke, a discrepancy largely driven by longer life expectancy in women.

This review highlights stroke risk factors specific to women, including fluctuations in naturally occurring hormone levels over women’s lives; adverse effects of supplemental hormones used as contraception or to treat menopausal symptoms; and pregnancy and pregnancy-related complications. The authors suggest that future research is needed to determine whether stroke risk prediction models should include risk factors specific to women such as supplemental hormones and pregnancy.

Preeclampsia: Association with posterior reversible encephalopathy syndrome and stroke

Preeclampsia is a complication of pregnancy characterized by high blood pressure which can cause damage to the brain, kidneys and liver. Preeclampsia can advance to eclampsia, which is characterized by seizures. Both of these conditions are associated with an increased risk of maternal death, ischemic stroke and hemorrhagic stroke. Preeclampsia is a treatable and possibly preventable condition which complicates up to 5 percent of pregnancies. The treatment for preeclampsia/eclampsia includes anti-hypertensives and magnesium.

According to this review, the risk of future ischemic stroke is approximately 80 percent greater in women with a history of preeclampsia than in those without the condition. Women whose pregnancy is complicated by preeclampsia or eclampsia should be counseled on the signs and symptoms of stroke and monitored closely in the postpartum period. 

A focused update of sex differences in patient reported outcome measures (PROMs) after stroke

This study is an updated review of sex differences in patient reported outcome measures less than 12 months after stroke, using data from studies published since 2007.

The review confirms that after stroke women suffer more activity limitations, worse health related quality of life and more post stroke depression than men, but do not have worse cognitive impairment or challenges in dealing with everyday life compared to men. The authors note that there is a pressing need for high-quality population-based studies of sex differences in patient reported outcome measures after stroke. Studies exploring potential modifiable contributors to these differences are needed so effective interventions to reduce sex disparities in outcomes can be designed.

Impact of Conventional Stroke Risk Factors on Stroke in Women: An Update

Due to increasing stroke risk with age and a longer life expectancy, women experience more strokes and more death from stroke over their lifetime and have worse functional outcomes following stroke. This study reviews current literature (2013 to present) on ischemic strokes, the most common type of stroke caused by narrowing or blockages in the arteries leading to the brain, and the degree to which conventional risk factors affect men and women differently. 

It concludes that risk factors -- including diabetes, metabolic syndrome, atrial fibrillation and migraine -- carry greater ischemic stroke risk for women compared with men. Metabolic syndrome is a cluster of risk factors that significantly raises the risk of heart disease and stroke; atrial fibrillation is a heart rhythm disorder. The association between elevated cholesterol and stroke may be slightly higher among men, and the role of high blood pressure is complicated, with varying effects based on age/race/ethnicity and gender.

The authors also note that treatment disparities between men and women leading to suboptimal stroke prevention in women need to be addressed.

Editorial: Stroke in Women

In this edition of Stroke, the papers by McDermott, Demel, Madsen, Gall/Lisabeth and colleagues argue for further recognition of the factors causing stroke in women as well as for systematic intensification of treatments. Sex differences in stroke burden are most influenced by differences in cardiovascular risk factor burden; thus, the greatest gains in stroke prevention will come from increased screening and treatment of these primary risk factors in women early in life, especially in the obese, women in pregnancy, and those from high-risk ethnoracial groups.

Co-authors, funding sources and author disclosures are on the manuscripts.

Additional Resources:

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Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke –  the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on and .

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit StrokeAssociation.org. Follow us on and .

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