Women’s Stroke Risk is Greater Than They May Realize

People are familiar with the “go red” dresses, scarves and sweaters women wear to promote heart health and cardiovascular awareness.

Stroke is part of that cardiovascular campaign, but it’s sometimes overlooked in the push to make women recognize their risk of heart attacks.

Physicians and advocacy groups increasingly share these points to convince women they also need to be aware of stroke and guard against it:

‒ One in 5 women will have a stroke in her lifetime.

‒ Women have 55,000 more strokes a year than men do.

‒ Stroke is the third leading cause of death in women, compared to fifth for men.

‒ Hormones and pregnancy-related complications give women added risk factors for stroke, along with the standard ones they share with men.

‒ Women (like men) need to realize they could have a stroke and seek treatment quickly if they suspect they are.

“Women talk about breast cancer and mammograms,” said Dr. Fakhir Elmasri, an interventional radiologist at Radiology and Imaging Specialists.

“I tell them more women die from stroke than breast cancer.”

Many women don’t realize their greater lifetime risk of stroke or the added risk from pregnancy complications like high blood pressure, gestational diabetes and pre-eclampsia, said Dr. Shuchi Chaudhary, vascular neurologist and medical director of the stroke program at Heart of Florida Regional Medical Center.

Obstetricians recognize the lingering effect of those conditions, Chaudhary said, but it’s important for women to make sure their primary care doctors know whether they had any of them during pregnancy.

It took decades to get the message about women’s heart attack risk across, Elmasri said, and now there’s a need to do the same with stroke. “People do not realize how debilitating stroke is,” he added. Likelihood of having a stroke increases with age.

Women’s life expectancy is longer than men’s, a key reason their total number of strokes is higher. Age also affects stroke treatment.

Blood vessels in older patients are more likely to have bends or curvatures and there is more plaque along the arteries, said Dr. Tsz Lau, a neurosurgeon and neurointerventionalist at Lakeland Regional Health Medical Center.

Recognizing your risks

High blood pressure, high cholesterol, diabetes and circulation problems are medical risks for stroke in women and men.

Lifestyle risk factors for both include smoking, drinking too much alcohol, being inactive, being obese and unhealthy eating habits.

Which affect women the most?

High blood pressure, abdominal obesity and a bad lipid profile, according to a study of modifiable risk factors linked to acute stroke in 32 countries.

An article earlier this year in Stroke magazine on preventing stroke in women lists those top risks. They previously were reported in Lancet.

“Prevention is the key,” Lau said. “Preventive medicine is always better than interventional.”

Obstetricians work to prevent their pregnant patients from having complications like gestational diabetes, but complications can’t always be prevented.

Chaudhary said she developed gestational diabetes and pre-eclampsia during pregnancy.

“I had no idea I could have it because I was small, I was healthy,” she said.

Pregnant women who get pre-eclampsia have an 80 percent greater chance of having a stroke later in their lives, she said. High blood pressure is one characteristic of pre-eclampsia.

Migraines and stroke 

Migraine headaches are far more common in women.

Those who get migraines with aura (attacks of neurological symptoms) have an increased risk of stroke. Risk of stroke caused by a blood clot increases more when migraine-affected women use combined oral contraceptives containing estrogen. Adding smoking to those risks “dramatically” raises their risk, researchers have found.

Women with migraines can reduce their risk of stroke by controlling other risks like smoking and high blood pressure.

“Smoking affects women way more than men because their vessels are smaller and plaque builds up,” Elmasri said.

Transient ischemic attacks, called a TIA or mini stroke, can cause a brief loss of vision that seems like “drapes falling,” Lau said. TIAs often precede a full stroke.

Since neurological symptoms of an aura can affect vision, women may fail to detect symptoms indicating they’re having a stroke or TIA.

“A lot of them will think they’re having a migraine and don’t realize they’re having a stroke,” said Kaylen O’Leary, Lakeland Regional’s stroke program coordinator.

If visual disturbances are new or different than normal, they should call 911.

“You’d rather have them come in than wait,” Lau said.

More information is available at www.goredforwomen.org or www.stroke.org.

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