Stroke and Women

Stroke Women

Also called: Women and Stroke

Summary

A stroke is a potentially life-threatening event in which part of the brain is deprived of adequate oxygen. It is the third-leading cause of death (after heart disease and cancer) among all women in the United States, according to the Centers for Disease Control and Prevention (CDC). Many women who survive a stroke may face permanent losses of movement, speech, clear thinking and other abilities.

There are two primary types of strokes that affect both women and men. Ischemic strokes result from blockages in arteries that supply blood and oxygen to the brain. Hemorrhagic strokes result from a bursting of an artery in the brain.

Women are also vulnerable to a type of stroke related to a condition called fibromuscular dysplasia (FMD), in which ongoing destruction of arterial blood vessels triggers a stroke.

Women and men share many of the same risk factors for stroke. However, research has also identified certain risk factors associated specifically with women, including loss of estrogen following menopause, pregnancy, antiphospholipid syndrome (blood clotting condition that causes miscarriages) and use of birth control pills.

Women and men also share many of the same symptoms of stroke. However, there are several symptoms that may be unique in women experiencing strokes, according to the National Stroke Association. They include face and limb pain, hiccups, weakness, palpitations, nausea and shortness of breath. 

Because the physiology of men’s and women’s bodies varies greatly, many experts believe that treatment and prevention methods are likely to affect the genders in different ways. However, to date there has been little research into these differences. For now, treatments remain similar for both men and women. Stroke is one of the most preventable neurological disorders. Many strokes can be prevented by not smoking and controlling weight, blood pressure, cholesterol levels and other risk factors. One of the best ways for women to prevent a stroke is to learn about these risk factors and to make healthy lifestyle changes accordingly.

About women and strokes

A stroke is a life-threatening event in which part of the brain is deprived of adequate oxygen. Also known as a cerebrovascular accident (CVA) or a “brain attack,” a stroke occurs when a blood vessel in the brain bursts or becomes clogged by a blood clot or other mass.

Stroke is a very real threat to women’s lives and well-being and is the third-leading cause of death (after heart disease and cancer) among all women in the United States, according to the Centers for Disease Control and Prevention (CDC). Though men and women are affected about equally by the 700,000 new or recurrent strokes that occur each year, women comprise more than half of those who die from stroke, according to the CDC.

When a person has a stroke, oxygen and nutrients are prevented from getting to nerve cells (neurons) in the affected area of the brain. Neurons are vital for all aspects of body function because they transmit information to and from various parts of the body to the brain and spinal cord. If they do not receive sufficient oxygen and nutrients, they will die.

Neuron death causes a variety of neurological problems depending on which areas of the brain are affected by the stroke. For example, many people who experience a stroke have problems with speaking and understanding language (aphasia). This is caused by damage to the networks of neurons in the brain that are associated with language. Other symptoms of stroke (e.g., permanent losses of movement, difficulties with clear thinking) may be caused by stroke damage to other parts of the brain.

In the United States, there are more than 4.5 million stroke survivors, over half of them women. Many of these women have been seriously disabled by the strokes.

In addition, 25 percent of women who have suffered a stroke will die within a year, and about 50 percent of female stroke survivors will die within eight years. That means that stroke claims more women’s lives than breast cancer. For every American woman who dies of breast cancer, two more die of stroke.

Studies indicate that women are less likely than men to receive rapid medical assessment and treatment for stroke. Many healthcare professionals believe that the same urgency associated with the prevention, recognition and treatment of breast cancer be applied to the prevention, recognition and treatment of stroke in women.

Types and differences of stroke in women

There are two primary types of strokes that affect both women and men. Ischemic strokes result from blockages in arteries that supply blood and oxygen to the brain. Blood clots are the most common cause of this blockage, but it also can result from narrowing of the arteries (stenosis), which often results from a buildup of plaque known as atherosclerosis.

Hemorrhagic strokes result from a bursting of an artery in the brain. This can occur when a weak spot on an artery wall expands (aneurysm) or when artery walls begin to lose their elasticity, leaving them brittle, thin and prone to cracks. Although hemorrhagic strokes are rare, they are more common in women who are pregnant and are the leading cause of maternal death in the United States, according to the National Institutes of Heath.

Women are also vulnerable to a type of stroke known as stroke secondary to fibromuscular dysplasia (FMD). FMD is an inherited condition in which the patient experiences ongoing destruction of arterial blood vessels, including those in the neck that supply blood to the brain and arteries in the brain itself. This vascular damage can interrupt blood flow to the brain, resulting in a stroke. Stroke related to fibromuscular dysplasia primarily affects women, especially those over the age of 50.

Risk factors of stroke in women

Women and men share many of the same risk factors for stroke, although there are several risk factors that may be more prevalent in women than in men.

High blood pressure (hypertension) significantly raises any person’s risk of stroke. African-American and Alaska Native women are particularly likely to have high blood pressure. Consistent systolic/diastolic blood pressure levels over 120/80 mmHg (milligrams of mercury) increases stroke risk.

High levels of LDL (“bad”) cholesterol also raise the risk of stroke in both men and women. However, cholesterol levels in women tend to remain lower than men until after menopause, when women’s cholesterol may increase significantly. This places post-menopausal women at a higher risk of stroke.

Other risk factors that affect both women and men include age, family history, diabetes, smoking, coronary artery disease, atrial fibrillation (heart rhythm disorder), lack of exercise, obesity, head injury, excessive alcohol use, previous stroke or heart attack and history of transient ischemic attack (short-term interruptions in blood flow to the brain).

Research has identified a number of additional risk factors that may play a role in the development of strokes in women. They include:

  • Loss of estrogen. After menopause, women’s lower estrogen levels can gradually increase the risk of stroke over time. Hormone replacement therapy (HRT) is used by millions of women to help replace the estrogen deficit that naturally occurs after menopause.

    However, some evidence suggests that use of HRT may also increase the risk of stroke. Therefore, many experts do not recommend that estrogen replacement therapy be used for the prevention of stroke. These findings match similar results from the Women’s Health Initiative, which found that HRT appeared to increase the risk of blood clots and stroke. Raloxifene – a drug used for the prevention and treatment of osteoporosis (loss of bone density) – appeared to significantly cut the risk of stroke among women at high risk for heart disease in post-menopausal women. Research continues on raloxifene and on the potential impact of hormone replacement therapy on stroke risk.
  • Birth control pills. The low-dose oral contraceptives currently prescribed for birth control carry a much lower risk than earlier pills. However, they still carry an increased risk of stroke. The risk is more pronounced among smokers, women with a history of migraines and women over the age of 40.
  • Pregnancy. Women’s risk of stroke increases during pregnancy and in the weeks just after delivery. During this time, women are particularly at risk for a hemorrhagic stroke.
  • Antiphospholipid syndrome. Some women who have had frequent miscarriages suffer from a condition called antiphospholipid syndrome, which is a disorder that causes excessive blood coagulation. It also increases the risk of stroke.
  • Migraines. Women who experience migraines have a 3 to 6 fold increase in stroke risk. Migraines occur more frequently in women than in men.

In addition, women of certain demographic groups may be more likely to have certain risk factors and to be at increased vulnerability for stroke. For example, studies show that African-American women tend to have substantially higher lipid (fat) profiles than women in other demographic groups. Lipid profiles are blood tests that measure a woman’s total cholesterol, HDL (“good”) cholesterol, LDL (“bad”) cholesterol and triglycerides. High readings indicate a substantial risk of blood-vessel blockage (e.g., coronary artery disease) that could result in stroke.

Overall, the risk of stroke in African-American/Black and Hispanic women is  higher than in Caucasian women, according to the American Heart Association. In fact, stroke and other diseases involving blood supply to the brain (cerebrovascular diseases) are the leading cause of death among African American women in the United States, according to the U.S. Department of Health and Human Services.

Signs and symptoms of strokes in women

In general, men and women experience the same symptoms of stroke (e.g., sudden weakness, confusion, headache, dizziness). However, there are a few symptoms that may be unique in women experiencing strokes, according to the National Stroke Association. These symptoms may develop suddenly and include:

  • Face and limb pain
  • Hiccups
  • Nausea
  • General weakness
  • Chest pain
  • Shortness of breath
  • Heart palpitations

A stroke is a true medical emergency and the following steps are strongly advised by healthcare professionals:

  • Do not take aspirin unless directed by your physician. Although chewing adult-strength aspirin can be helpful for people who are having a heart attack, people who are having a hemorrhagic stroke can greatly worsen the situation by taking aspirin. However, only one out of every 10 strokes are hemorrhagic and patients who are at risk for the most common type of stroke (ischemic stroke) may be directed to take aspirin or other antiplatelet medicine by their physicians.
  • Call 9-1-1 immediately. Studies have shown that stroke patients who arrived at a hospital by ambulance were seen by a physician 55 percent faster than those who arrived by private car. Women are encouraged to do everything they can to be seen as soon as possible. Recent studies have suggested that, in comparison with men having a stroke, women having a stroke take longer to get to a hospital and wait longer in the emergency room to see a physician. Recovery success from stroke is closely tied to rapid medical intervention, so it is important that all stroke sufferers get immediate medical attention.
  • Note the time when the symptoms began and keep track of any symptoms as they appear or worsen.

Treatment and prevention of stroke in women

Because the physiology of men’s and women’s bodies differs, many experts believe that treatment and prevention methods are likely to vary in their effectiveness between the genders. However, to date little research has been performed into these differences. For now, treatments remain similar for both men and women. More research is needed to develop a more complete understanding of female physiology and stroke risk.

A stroke is a medical emergency. Immediately after a stroke, the patient may be treated using medications designed to dissolve any blood clots that may be causing the stroke. Surgery may also be recommended to remove blockages or repair immediate damage.

Women who survive a stroke may experience mild to severe damage to certain parts of the brain. This may result in symptoms ranging from memory loss to paralysis. Some of the after-effects of a stroke can be treated using a combination of medications and rehabilitation (e.g., speech therapy, physical therapy, counseling). Some women require long-term care following a stroke. Women are more likely than men to be transferred to a long-term care facility after stroke than to return home. In addition, women are more likely than men to experience more significant disability after stroke.

Women should be aware of the lifestyle factors that generally increase the risk of stroke, including high blood pressure (hypertension), smoking (increases stroke risk up to three fold), lack of exercise and obesity.

For most women, the number one prevention method against stroke is to reduce, control or eliminate as many risk factors as possible. Specific prevention strategies include:

  • Getting regular exercise. Regular physical activity can greatly reduce the risk of stroke. Studies have found that the risk of dying from stroke declined as physical activity increased across all age groups, strengthening the evidence that physical activity is an important part of any strategy to prevent stroke in women at any age.
  • Not smoking. Smoking is particularly dangerous for women, especially if they are also taking birth control pills.
  • Eating a heart-healthy diet. People who eat at least five servings of fruit and vegetables every day are less likely to suffer from ischemic stroke (the most common form) than those who eat less than three servings a day. Eating foods rich in vitamins, antioxidants, fiber and other heart-healthy substances is also important. Eating foods rich in omega-3 fatty acids, such as fish, helps increase levels of HDL (“good”) cholesterol and may help reduce the risk of stroke. Research has demonstrated that women who ate at least five servings of fish a week had a 62 percent lower risk of stroke, compared with those who ate fish less than once a month. Researchers have also noted that women who eat large amounts of whole-grain foods have lower risk of ischemic stroke as compared to women who ate little or no whole-grain foods.
  • Avoiding excessive alcohol use. Moderate alcohol use for women is typically defined as no more than one drink per day. One drink means 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.
  • Controlling blood pressure. High blood pressure is a major cause of strokes. This disease usually can be effectively treated. However, many women and men do not receive the screening necessary to catch this silent but potentially deadly condition. Some groups of women are particularly unlikely to receive screening. About 73 percent of all American Indian/Alaska Native women have not had blood pressure screening in the past 12 months, according to the U.S. Department of Health and Human Services. The same study found that 27 percent of Asian American women, 26 percent of Hispanic women, 20 percent of white women and 18 percent of African-American women had also not been screened in at least one year.  

Questions for your doctor on strokes in women

Preparing questions in advance can help patients to have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions related to strokes and women:

  1. As a woman, am I at increased risk for a stroke?
  2. Do I have any other risk factors for stroke?
  3. Do I have any underlying conditions that put me at increased risk for a stroke? Which ones?
  4. Are there any lifestyle changes I can make to reduce my chances of having a stroke?
  5. Are there any medications or procedures available that can reduce my chances of having a stroke? Would you recommend any of these?
  6. Should I learn the symptoms of a stroke so I can quickly identify one if it occurs?
  7. What should I do if I think I am having a stroke?
  8. Are there any medications I should or should not take if I think I may be having a stroke?
  9. Am I at increased risk for a stroke if I am pregnant?
  10. How will I know if I am at risk for stroke secondary to fibromuscular dysplasia?
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