Stroke in Women - Diagnosis, Treatment and Prevention

Dateline: 05/31/98

Heart Disease in Women is a very important, unique and exciting topic. This article is a part of a series that focuses on the special problems of Heart Disease in Women. You can find the others in the archives.

DIAGNOSIS, TREATMENT AND PREVENTION OF STROKE IN WOMEN

Stroke is an injury to the brain caused by an obstruction to its blood supply. Stroke represents a significant healthcare burden for our society. It is the third leading cause of death in the United States and the leading cause of disability, with an estimated direct cost of $41 billion per year. It is estimated that approximately 3,890,000 stroke victims are alive today, 52 percent of whom are women.

The overall prevalence of stroke is higher in men than in women but increases with age in both gender groups. Results from the Cardiovascular Health Study show that prevalence for women aged 70 to 74 is 2.1% and increases to 7.8% for those aged 85 and older.

Although the lifetime risk of stroke is higher in men, women are more likely to die of stroke. Over an entire lifetime, about 16% of women will die of stroke, whereas only 8% of men will die of stroke. This is probably due to

• the older age of women at occurrence of stroke

• the longer life expectancy of women

Risk Factors for stroke

Many identifiable risk factors for stroke in both men and women have been fairly consistent over different studies. They include high blood pressure, smoking, diabetes, coronary artery disease, atrial fibrillation, and transient ischemic attacks (TIAs).

In addition, there are some risk factors or conditions, some of which are rare but nonetheless uniquely associated with stroke in women:

• fibromuscular dysplasia

• choriocarcinoma

• mitral annular calcification

• current pregnancy

• migraine

• mitral valve prolapse

• antiphospholipid syndrome

• Takayasu's arteritis

• retinocochleocerebral vasculopthathy

• systemic lupus erythematosus

Hypertension

High blood pressure is clearly a major risk factor for stroke, with a 46% increase in stroke risk for every 7.5 mm Hg increase in diastolic blood pressure. In black women the risk of developing hypertension is more than twice that of white women. Treatment or control of high blood pressure in women may not offer the same protection against stroke that it does in men, and further studies are needed to specifically address treatment issues in women.

Diabetes

Diabetes mellitus is associated with a doubling of ischemic stroke risk. One study among stroke patients with hypertension has shown diabetes is a significant predictor of ischemic stroke (caused by a block of a blood vessel to the brain) compared with hemorrhagic stroke (caused by a rupture of a blood vessel in the brain) in women but not in men.

Other Risk Factors

Studies also indicate that risk of stroke associated with atrial fibrillation is greater in women than in men. A number of risk factors for coronary heart disease also convey an increased risk for ischemic stroke.

Treatment of Stroke in Women

To date there are no specific recommendations for treatment of stroke in women, and recommendations for acute interventions for women and men appear to be the same. Although treatment after the acute stage should focus on the patient's particular risk factor profile and the pathogenesis of the stroke, most care will include the use of antiplatelet aggregating or antithrombotic agents such as aspirin, ticlopidine, or warfarin. Secondary prevention may include aspirin for both men and women. Women who have symptomatic carotid stenosis of 70% to 99% may benefit from the combination of carotid endarterectomy and aspirin therapy.

Next week : Women, Hormones and the Heart.