Peculiarities of stroke risk in women

Stroke constitutes a serious socioeconomic and health care problem in women because it is the principal cause of incapacity and the first cause of death in this section of the population in several countries. The incidence of cerebral infarction and myocardial infarction is lower in females than in males, but only up to menopause, when, especially after >65 years of age, the differences disappear. This is attributable to the protective role of the natural estrogens during the fertile part of the woman's life. The estrogens have antiatherogenic and neuroprotective effects and, before menopause, account for a risk profile that is less atherogenic. The risk factors that have higher importance in young women are migraine and oral contraceptive use as well as etiologies specifically associated with pregnancy, birth and puerperium, or even diseases that present more commonly in women (systemic lupus erythematosus, fibromuscular dysplasia). These entities lose their relevance after menopause, when the classical vascular-disease risk factors take on their role, and also include others such as hormone replacement therapy. Due to the specific epidemiology of stroke, females are underrepresented in the clinical trials of primary and secondary prevention, the result being that the outcomes measured in these trials are less consistent and do not show as clear a benefit for women as for men.