Stroke in Women: Recognizing Opportunities for Prevention and Treatment.

Abstract

Women have long been underrepresented in cardiovascular disease research. In 1970, women comprised 9% of participants within cardiovascular trials.1 It has now been 3 decades since the landmark 1985 Task Force on Women’s Health Issues,2 first calling for expanded consideration of women in health, yet only one third of trial participants informing current cardiovascular guidelines are women.1 Progress continues, however, with both women-exclusive randomized control trials3 and observational prospective studies currently being conducted.4 The information generated from this research has increased our understanding of the determinants of and medical therapies to prevent stroke in women, yet some questions remain, and ongoing surveillance of stroke incidence and outcomes after stroke is required. In high-income countries, like the United States, women have a greater lifetime risk of stroke than men. Further, stroke rates differ by ethnoracial origin with a higher stroke rate occurring in Black and Hispanic women living in the United States. The major risk factors for stroke and the strength of association of the risk factors are similar in women and men, with preeclampsia, pregnancy, and use of exogenous hormones as the few exceptions. However, the frequency of each risk factor, and therefore the population attributable risk, differs between the sexes. As shown in the international INTERSTROKE case–control study,5 hypertension, abdominal obesity, and adverse lipid profile are the most impactful causes of stroke in women worldwide, with smoking, cardiac causes, and lifestyle factors (ie, diet quality, exercise, alcohol use) remaining as important, but not as frequent, risk factors. It is through screening and treatment of these common risk factors where the greatest gains in stroke prevention can occur. After a stroke occurs, ensuring equal access to health care and evidence-based stroke management will equalize stroke outcomes by sex. Although progress has been made, with …