More women than men experience strokes, but many don't realize the risk

More women than men experience strokes, but many don’t realize the risk


When Tracy Madsen casually talks to other women about their health concerns, whether they are patients, friends or family members, she is sometimes surprised to hear how afraid they are of getting breast cancer, while they rarely mention a stroke.

“While breast cancer is, of course, a valid concern,” said Madsen, an associate professor of emergency medicine and epidemiology at Brown University, “I don’t think a lot of women know Stroke is the third leading cause of death among women in the United States, and it causes approximately twice as many deaths among women each year as breast cancer.

According to the American Stroke Association, a division of the American Heart Association, stroke kills more than 85,000 women every year, and women experience about 55,000 more cases of stroke per year than men. And although women are more likely to survive a stroke, research shows that they often recover less well, which means they suffer more disability and impaired quality of life than men after a stroke. offensive.

“Women have worse outcomes,” said Cheryl Bushnell, professor of neurology at Wake Forest University School of Medicine, adding that their prognosis often depends on their age – older women have more problems – as well as their condition. functioning before their stroke. “Were they using a walker before their stroke? Are they fragile? Did they have less muscle mass, or did they have heart or kidney disease? The more comorbidities [two or more medical conditions]the worse the result.

Additionally, women are more likely than men to “develop post-stroke depression and cognitive impairment,” said Louise McCullough, Roy M. & Phyllis Gough Huffington Distinguished Chair in Neurology at the Center for Health from the University of Texas at Houston. “There is a direct link between dementia and stroke – if you have a stroke you are much more likely to develop dementia. It is important to know that one of the main reasons people end up in nursing homes is vascular disease and dementia.

Black women are particularly at risk for stroke. “There are definitely disparities by race,” says Kathryn Rexrode, chief of the division of women’s health at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. Part of that is due to hypertension, a stroke risk factor for everyone that’s a more common condition in black people, “but that doesn’t explain everything. Race is also a cultural construct that affects how people are treated, such as access to health care and healthy food. But it’s not all socio-economic or genetic, which suggests that there are other factors influencing the health of these women.

There are two types of stroke: ischemic, when blood clots or other particles block blood vessels to the brain, and hemorrhagic, which occurs when an artery in the brain loses blood or ruptures completely. Most strokes are ischemic.

The ratio of strokes between women and men changes with age, experts say.

During midlife, the age-adjusted incidence of stroke — the rate — is higher in men, but becomes equal or even higher in women after menopause, Madsen says.

“That’s because women live longer and the risk is higher as we get older,” says Madsen. “Thus, the lifetime risk of stroke is higher in women than in men.” It’s important, says Madsen, that “women are aware that this is a common condition for them. The way they should think about it is to talk to their doctor about their risk factors and get screened and treated for any risk factors.

Diabetes, high blood pressure, other risks

Risk factors for stroke are similar for both sexes, although several – including diabetes and atrial fibrillation, a heart rhythm disorder – appear to increase the risk for women in particular, experts say. Some of the risk factors are controllable and treatable, such as high blood pressure – which is the number one preventable cause of stroke – while others, such as age and family history, are not.

In addition to hypertension, diabetes, and atrial fibrillation, other risks include smoking, eating a diet high in saturated and trans fats, cholesterol, and salt (which can raise blood pressure), obesity, and physical inactivity.

Experts say it’s important to keep blood pressure readings below 130/80, get screened and treated for atrial fibrillation and diabetes, quit smoking, eat healthy (they recommend dietary approaches to stopping hypertension, also known as DASH, or the Mediterranean diet), control your weight, and exercise regularly.

“I really encourage everyone to have a blood pressure cuff in their home, even a young one,” because high blood pressure can be asymptomatic, McCullough says. “They should check as often as they floss, but at least once a week.”

Oral contraceptives may also increase the risk, although research suggests they are more dangerous when women have other risk factors; Additionally, current birth control formulations are safer than the old pills, which contained high doses of estrogen.

Pregnancy complications may play a role

Pregnancy complications can also predispose women to strokes even years later. These include preeclampsia, which is a blood vessel disorder during pregnancy, gestational diabetes or diabetes caused by changes in pregnancy, high blood pressure, which can lead to stroke after childbirth , and blood clots, according to the Centers for Disease Control and Prevention.

“Having had preeclampsia or gestational diabetes can lead to stroke even 10 or 20 years after the pregnancy ends,” Madsen says.

Experts theorize that preeclampsia “causes lasting effects on blood vessels, including inflammatory changes and changes in the way blood clots, which later leads to cerebrovascular disease and stroke,” says Madsen. .

Early or premature menopause, such as when the ovaries are surgically removed for medical reasons, is another risk factor. Unlike exogenous hormones, experts believe that natural hormones, such as estrogen, are helpful.

“The number of years a woman is exposed to protective hormones is shortened,” Madsen explains. “Blood vessels start to age faster. If you have menopause at 40 versus menopause at 50, it’s been 10 years since you’ve been exposed to the same level of hormones and the body is aging faster.

Stroke symptoms common to both men and women include numbness or weakness of the face, arm, or leg, especially on one side of the body; sudden confusion or difficulty speaking; vision problems in one or both eyes; and a sudden, severe headache with no known cause. Studies have shown that some women, unlike men, can also experience loss of consciousness and incontinence, Bushnell says.

Doctors say it’s essential to seek help – and fast. Dial 911. Don’t drive to the hospital or let someone else drive, as life-saving care often begins in the ambulance.

“The good news is that men and women respond similarly to the main life-saving treatments available to us,” Bushnell says.

“The most important message to send to women is: ‘control your risk factors,'” says Rexrode. “But if you have a stroke and are treated quickly, a stroke can be reversed. Time is brain. The longer it lasts, the more you damage the brain. The faster you process, the more you protect the brain.

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