Stroke in women: When gender matters

Area of Science:

• Neurology
• Cardiovascular Medicine
• Public Health

Background:

• Stroke is a leading cause of death in women globally, exhibiting distinct epidemiological, etiological, and outcome profiles compared to men.
• Sex-specific risk factors in younger women include pregnancy, postpartum status, oral contraceptive use, and migraine.
• Hormone replacement therapy is contraindicated in older women due to elevated thromboembolic risk.

Purpose of the Study:

• To highlight the distinct nature of stroke in women.
• To review sex-specific risk factors, pathophysiological mechanisms, and treatment efficacies.
• To address the poorer quality of life experienced by women post-stroke and recent epidemiological shifts.

Main Methods:

• Review of epidemiological data and clinical studies on stroke in women.
• Analysis of sex-specific risk factors and pathophysiological differences.
• Evaluation of treatment outcomes, including thrombolysis and thrombectomy, and post-stroke quality of life.

Main Results:

• While treatments like rtPA thrombolysis and mechanical thrombectomy are equally effective in women and men, women experience worse quality of life post-stroke.
• A concerning trend shows increasing stroke incidence in young women (≤55 years), contrasting with stable rates in older women.
• Unique risk factors such as pregnancy, postpartum, oral contraceptives, and migraine are prevalent in younger women.

Conclusions:

• Stroke in women is a distinct entity requiring tailored public health policies for prevention and pre-stroke health.
• Therapeutic trials must increase female participant representation to develop adequate management strategies.
• Addressing sex-related differences in cardiovascular disorders is crucial for improving stroke outcomes in women.