Lowering the Risks of Stroke in Women (and Men)
By Leslie Ritter, PhD, RN, and Bruce Coull, MD
Every year, more women (425,000) than men (375,000) suffer a stroke. Why is this? Women live longer and stroke rates increase substantially with age. As an increasing proportion of women reach their eighth and ninth decades, an even greater number are expected to be affected by stroke.
Women are an average of four years older than men when they have a stroke. They also are more likely to have significant risk factors, such as atrial fibrillation (an irregular heart rhythm) and hypertension (high blood pressure). Treating these conditions can significantly reduce the risk of first or recurrent stroke.
If you are an African, Mexican or Native American woman, unfortunately your stroke risks are higher than your Caucasian counterparts. Several studies of hormone replacement therapy (HRT) have focused on whether HRT can prevent cardiovascular disease in postmenopausal women. While some debate continues, the general consensus is that HRT is not beneficial in preventing stroke in postmenopausal women who are healthy or have had a previous stroke.
In women of child-bearing age, the use of oral contraceptives is associated with an increased stroke risk, particularly among smokers. This makes screening for stroke risk prior to the use of oral contraceptives extremely important.
The vast majority of strokes in both women and men are ischemic strokes (see figure below) in which an artery supplying the brain is blocked, depriving it of oxygen and nutrients. However, women are at higher risk for the other major type of stroke: called hemorrhagic stroke, a rupture of an artery in the brain. The triad of female gender, cigarette smoking and hypertension increases the risk of hemorrhagic stroke.
A transient ischemic attack (TIA) has all the symptoms of a stroke, but the symptoms disappear, usually within an hour (therefore transient), with no permanent brain damage. However a stroke with permanent brain damage often follows a TIA. Seeking prompt medical attention is essential, even if stroke symptoms resolve.
When an ischemic stroke or transient ischemic attack does happen, women and men experience similar symptoms. They also seek help in comparable numbers, but unfortunately they often do not seek help fast enough. Therapy to dissolve the clot in the artery is only effective during the early hours of a stroke. Unfortunately, the total number of people seeking treatment for ischemic stroke within this “therapeutic window” remains low, often leading to permanent damage. This is why it is important to educate and remind people about the signs and symptoms of stroke and the need to call 9-1-1 at the onset of symptoms. A “brain attack” is a medical emergency just like a “heart attack.”
Hospital care for women and men with stroke is the same. For ischemic stroke, care includes clot-busting treatment to open the blocked artery to supply blood to the brain. Extensive research demonstrates that when stroke care is delivered according to best practices, patient outcomes improve. In March 2009, University of Arizona Medical Center obtained Joint Commission Primary Stroke Center certification, the first to do so in Southern Arizona. This designation ensures a team approach to the delivery of quality stroke care from the time the patient enters the emergency department through the time of discharge.
The trip to the emergency department and the hospital stay are usually a brief period in the life of a stroke victim. Disability and reduced quality of life after stroke may affect a person for years. Unfortunately, both of these outcomes are likely to be more intense in women than in men, but the reasons for this are not clear. Post-stroke depression also is greater in women than men. Clearly, more research is needed to examine how we can prevent stroke and improve outcomes after stroke in women, as well as men.
While the overall incidence, risk factors and outcomesfor stroke are different in women than in men, attention to risk reduction and formalized stroke care has the potential to reduce these disparities.
Leslie Ritter, PhD, RN, FAAN, is a coordinator of the Banner - University of Arizona Medical Center Tucson Primary Stroke Center, and a faculty member of the UA College of Nursing, Department of Neurology and the Sarver Heart Center.
Bruce Coull, MD, is a faculty member of the UA Department of Neurology at the UA College of Medicine - Tucson, and member of the Sarver Heart Center.
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