Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Atherosclerosis Reports
Published in: Current Atherosclerosis Reports 4/2010

01-07-2010

Stroke in Women: What is Different?

Authors: Dara G. Jamieson, Maryna Skliut

Published in: Current Atherosclerosis Reports | Issue 4/2010

Login to get access

Abstract

Stroke, a major cause of morbidity and mortality in the general population, varies in incidence in men and women of different age groups: more boys than girls have strokes; the incidence of stroke is greater in men in their 60s and 70s; and stroke is more common in women after age 80 years. These differences are attributed to hormonal (sex-related) changes and variable risk factors in women, as well as lifestyle and environmental (gender-related) co-morbid conditions. A woman, who is more likely to have a stroke in her lifetime than a myocardial infarction, has a different response to primary and secondary prevention as compared with a man. Although response to thrombolysis is similar, older age and more severe strokes in women lead to poorer outcomes in female stroke survivors.
Literature
1.
•• Lloyd-Jones D, Adams RJ, Brown TM, et al.: Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation 2010, 121:e46–e215. This comprehensive updated report outlines the incidence and prevalence of vascular disease in different populations.
2.
Seshadri S, Wolf PA: Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. Lancet Neurol 2007, 6:1106–1114.CrossRefPubMed
3.
Towfighi A, Saver JL, Engelhardt R, Ovbiagele B: A midlife stroke surge among women in the United States. Neurology 2007, 69:1898–1904.CrossRefPubMed
4.
•• Bushnell CD: Stroke and the female brain. Nat Clin Pract Neurol 2008, 4:22–33. This review summarizes the sex differences related to stroke, and the effect of endogenous and exogenous hormones on the vasculature of the female brain.
5.
Bushnell CD, Hurn P, Colton C, et al.: Advancing the study of stroke in women: summary and recommendations for future research from an NINDS-Sponsored Multidisciplinary Working Group. Stroke 2006, 37:2387–2399.CrossRefPubMed
6.
Kurth T, Everett BM, Buring JE, et al.: Lipid levels and the risk of ischemic stroke in women. Neurology 2007, 68:556–562.CrossRefPubMed
7.
Kurth T, Gaziano JM, Cook NR, et al.: Migraine and risk of cardiovascular disease in women. JAMA 2006, 296:283–291.CrossRefPubMed
8.
Kurth T, Gaziano JM, Rexrode KM, et al.: Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation 2005, 111:1992–1998.CrossRefPubMed
9.
Kurth T, Moore SC, Gaziano JM, et al.: Healthy lifestyle and the risk of stroke in women. Arch Intern Med 2006, 166:1403–1409.CrossRefPubMed
10.
• Kurth T, Schurks M, Logroscino G, Buring JE: Migraine frequency and risk of cardiovascular disease in women. Neurology 2009, 73:581–588. The association between migraine and cardiovascular disease varies by migraine frequency. Ischemic stroke is associated with a high frequency of migraine with aura in women.
11.
Rajpathak SN, Wang T, Wassertheil-Smoller S, et al.: Hepatocyte growth factor and the risk of ischemic stroke developing among postmenopausal women. Results from the Women's Health Initiative. Stroke 2010 (in press).
12.
• Berger JS, Brown DL, Burke GL, et al.: Aspirin use, dose, and clinical outcomes in postmenopausal women with stable cardiovascular disease: the Women's Health Initiative Observational Study. Circ Cardiovasc Qual Outcomes 2009, 2:78–87. Aspirin use (81 mg) was associated with significantly lower risk of all-cause mortality, specifically cardiovascular mortality, among postmenopausal women with stable vascular disease.
13.
Kaplan RC, McGinn AP, Baird AE, et al.: Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study. J Stroke Cerebrovasc Dis 2008, 17:344–355.CrossRefPubMed
14.
Rossouw JE, Anderson GL, Prentice RL, et al.: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002, 288:321–333.CrossRefPubMed
15.
Elkind MS, Leon V, Moon YP, et al.: High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 stability before and after stroke and myocardial infarction. Stroke 2009, 40:3233–3237.CrossRefPubMed
16.
Elkind MS, Tai W, Coates K, et al.: Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke. Cerebrovasc Dis 2009, 27:42–50.CrossRefPubMed
17.
Lee JS, Yaffe K, Lui LY, et al.: Prospective study of endogenous circulating estradiol and risk of stroke in older women. Arch Neurol 2010, 67:195–201.CrossRefPubMed
18.
White RE, Gerrity R, Barman SA, Han G: Estrogen and oxidative stress: a novel mechanism that may increase the risk for cardiovascular disease in women. Steroids 2010 (in press).
19.
Bos MJ, Schuit SC, Koudstaal PJ, et al.: Variation in the estrogen receptor alpha gene and risk of stroke: the Rotterdam Study. Stroke 2008, 39:1324–1326.CrossRefPubMed
20.
Corrado E, Rizzo M, Muratori I, et al.: Older age and markers of inflammation are strong predictors of clinical events in women with asymptomatic carotid lesions. Menopause 2008, 15:240–247.CrossRefPubMed
21.
Johnsen SH, Mathiesen EB, Joakimsen O, et al.: Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromso Study. Stroke 2007, 38:2873–2880.CrossRefPubMed
22.
Halvorsen DS, Johnsen SH, Mathiesen EB, Njolstad I: The association between inflammatory markers and carotid atherosclerosis is sex dependent: the Tromso Study. Cerebrovasc Dis 2009, 27:392–397.CrossRefPubMed
23.
Wassertheil-Smoller S, Kooperberg C, McGinn AP, et al.: Lipoprotein-associated phospholipase A2, hormone use, and the risk of ischemic stroke in postmenopausal women. Hypertension 2008, 51:1115–1122.CrossRefPubMed
24.
Williams JE, Chimowitz MI, Cotsonis GA, et al.: Gender differences in outcomes among patients with symptomatic intracranial arterial stenosis. Stroke 2007, 38:2055–2062.CrossRefPubMed
25.
Chimowitz MI, Lynn MJ, Howlett-Smith H, et al.: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005, 352:1305–1316.CrossRefPubMed
26.
Galimanis A, Mono ML, Arnold M, et al.: Lifestyle and stroke risk: a review. Curr Opin Neurol 2009, 22:60–68.CrossRefPubMed
27.
Boden-Albala B, Elkind MS, White H, et al.: Dietary total fat intake and ischemic stroke risk: the Northern Manhattan Study. Neuroepidemiology 2009, 32:296–301.CrossRefPubMed
28.
Winter Y, Rohrmann S, Linseisen J, et al.: Contribution of obesity and abdominal fat mass to risk of stroke and transient ischemic attacks. Stroke 2008, 39:3145–3151.CrossRefPubMed
29.
Myint PK, Luben RN, Wareham NJ, et al.: Combined work and leisure physical activity and risk of stroke in men and women in the European prospective investigation into Cancer-Norfolk Prospective Population Study. Neuroepidemiology 2006, 27:122–129.CrossRefPubMed
30.
Lakshman R, Forouhi NG, Sharp SJ, et al.: Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab 2009, 94:4953–4960.CrossRefPubMed
31.
Jung SY, Bae HJ, Park BJ, Yoon BW: Parity and risk of hemorrhagic strokes. Neurology 2010 (in press).
32.
Kittner SJ, Stern BJ, Feeser BR, et al.: Pregnancy and the risk of stroke. N Engl J Med 1996, 335:768–774.CrossRefPubMed
33.
Bateman BT, Schumacher HC, Bushnell CD, et al.: Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome. Neurology 2006, 67:424–429.CrossRefPubMed
34.
Baillargeon JP, McClish DK, Essah PA, Nestler JE: Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab 2005, 90:3863–3870.CrossRefPubMed
35.
Kemmeren JM, Tanis BC, van den Bosch MA, et al.: Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) study: oral contraceptives and the risk of ischemic stroke. Stroke 2002, 33:1202–1208.CrossRefPubMed
36.
Slooter AJ, Rosendaal FR, Tanis BC, et al.: Prothrombotic conditions, oral contraceptives, and the risk of ischemic stroke. J Thromb Haemost 2005, 3:1213–1217.CrossRefPubMed
37.
Grodstein F, Stampfer MJ, Manson JE, et al.: Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996, 335:453–461.CrossRefPubMed
38.
Ouyang P, Michos ED, Karas RH: Hormone replacement therapy and the cardiovascular system lessons learned and unanswered questions. J Am Coll Cardiol 2006, 47:1741–1753.CrossRefPubMed
39.
Grady D, Herrington D, Bittner V, et al.: Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002, 288:49–57.CrossRefPubMed
40.
Arana A, Varas C, Gonzalez-Perez A, et al.: Hormone therapy and cerebrovascular events: a population-based nested case-control study. Menopause 2006, 13:730–736.CrossRefPubMed
41.
Viscoli CM, Brass LM, Kernan WN, et al.: A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med 2001, 345:1243–1249.CrossRefPubMed
42.
Bigal ME, Kurth T, Santanello N, et al.: Migraine and cardiovascular disease: a population-based study. Neurology 2010, 74:628–635.CrossRefPubMed
43.
Ridker PM, Cook NR, Lee IM, et al.: A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005, 352:1293–1304.CrossRefPubMed
44.
Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Committee of the Physicians’ Health Study Research Group. N Engl J Med 1989, 321:129–135.
45.
Berger JS, Roncaglioni MC, Avanzini F, et al.: Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 2006, 295:306–313.CrossRefPubMed
46.
Kapral MK, Ben-Yakov M, Fang J, et al.: Gender differences in carotid imaging and revascularization following stroke. Neurology 2009, 73:1969–1974.CrossRefPubMed
47.
Dorigo W, Pulli R, Marek J, et al.: Carotid endarterectomy in female patients. J Vasc Surg 2009, 50:1301–1306, discussion 1306–1307.
48.
Marquardt L, Fairhead JF, Rothwell PM: Lower rates of intervention for symptomatic carotid stenosis in women than in men reflect differences in disease incidence: a population-based study. Stroke 2010, 41:16–20.CrossRefPubMed
49.
Hugl B, Oldenburg WA, Neuhauser B, Hakaim AG: Effect of age and gender on restenosis after carotid endarterectomy. Ann Vasc Surg 2006, 20:602–608.CrossRefPubMed
50.
De Rango P, Parlani G, Caso V, et al.: A comparative analysis of the outcomes of carotid stenting and carotid endarterectomy in women. J Vasc Surg 2010, 51:337–44, discussion 344.
51.
Goldstein LJ, Khan HU, Sambol EB, et al.: Carotid artery stenting is safe and associated with comparable outcomes in men and women. J Vasc Surg 2009, 49:315–323, discussion 323–324.
52.
Park B, Aiello F, Dahn MS, et al.: No gender influences on clinical outcomes or durability of repair following carotid angioplasty with stenting and carotid endarterectomy. Vasc Endovascular Surg 2008, 42:321–328.CrossRefPubMed
53.
Foerch C, Misselwitz B, Humpich M, et al.: Sex disparity in the access of elderly patients to acute stroke care. Stroke 2007, 38:2123–2126.CrossRefPubMed
54.
Prehospital and hospital delays after stroke onset--United States, 2005-2006. MMWR Morb Mortal Wkly Rep 2007, 56:474–478.
55.
Caso V, Paciaroni M, Agnelli G, et al.: Gender differences in patients with acute ischemic stroke. Womens Health (Lond Engl) 2010, 6:51–57.
56.
Gall SL, Donnan G, Dewey HM, et al.: Sex differences in presentation, severity, and management of stroke in a population-based study. Neurology 2010, 74:975–981.CrossRefPubMed
57.
Knauft W, Chhabra J, McCullough LD: Emergency department arrival times, treatment, and functional recovery in women with acute ischemic stroke. J Womens Health (Larchmt) 2010 (in press).
58.
Gray LJ, Sprigg N, Bath PM, et al.: Sex differences in quality of life in stroke survivors: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Stroke 2007, 38:2960–2964.CrossRefPubMed
59.
Lisabeth LD, Brown DL, Morgenstern LB: Barriers to intravenous tissue plasminogen activator for acute stroke therapy in women. Gend Med 2006, 3:270–278.CrossRefPubMed
60.
Kent DM, Price LL, Ringleb P, et al.: Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke 2005, 36:62–65.CrossRefPubMed
61.
• Elkind MS, Prabhakaran S, Pittman J, et al.: Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke. Neurology 2007, 68:842–848. Men were approximately three times as likely to have good functional outcomes after tissue plasminogen activator treatment, despite elevated mortality. Even after receiving thrombolytic treatment, women were found to have worse functional outcomes after stroke than men.
62.
Arnold M, Kappeler L, Nedeltchev K, et al.: Recanalization and outcome after intra-arterial thrombolysis in middle cerebral artery and internal carotid artery occlusion: does sex matter? Stroke 2007, 38:1281–1285.CrossRefPubMed
63.
Shobha N, Sylaja PN, Kapral MK, et al.: Differences in stroke outcome based on sex. Neurology 2010, 74:767–771.CrossRefPubMed
64.
Forster A, Gass A, Kern R, et al.: Gender differences in acute ischemic stroke: etiology, stroke patterns and response to thrombolysis. Stroke 2009, 40:2428–2432.CrossRefPubMed
Metadata
Title
Stroke in Women: What is Different?
Authors
Dara G. Jamieson
Maryna Skliut
Publication date
01-07-2010
Publisher
Current Science Inc.
Published in
Current Atherosclerosis Reports / Issue 4/2010
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-010-0118-3

Other articles of this Issue 4/2010

Current Atherosclerosis Reports 4/2010 Go to the issue

ReviewPaper

Emergency Management of Acute Ischemic Stroke

ReviewPaper

Novel Genetic Mechanisms for Aortic Aneurysms

ReviewPaper

Hyperlipidemia and Primary Prevention of Stroke: Does Risk Factor Identification and Reduction Really Work?

ReviewPaper

Lipidomics: A Tool for Studies of Atherosclerosis

ReviewPaper

Patent Foramen Ovale and Stroke: Should PFOs Be Closed in Otherwise Cryptogenic Stroke?

ReviewPaper

Current Recommendations for Endovascular Interventions in the Treatment of Ischemic Stroke
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits