Which women are most at risk of stroke?

A paper published this week outlines stroke risk factors that are specific to women. The authors hope that increasing awareness will help identify people who should be monitored more closely.

Strokes kill an estimated 140,000 people in the United States each year. That accounts for around 1 in 20 deaths.

Breaking that statistic down further, someone dies of stroke in the U.S. every 4 minutes.

Such a huge health concern has garnered significant interest from health authorities, governmental bodies, and scientists.

Over the years, studies have found a range of risk factors associated with stroke. For instance, risk of stroke increases with age, and individuals with high blood pressure, heart disease, or diabetes also have increased risk.

Ethnicity makes a difference, too — strokes occur more often in African American adults than in white, Hispanic, or Asian American adults, for instance.

Certain lifestyle factors also play their part — activities such as smoking tobacco, drinking alcohol, taking certain illegal drugs, being obese, and eating an unhealthful diet are all known to take their toll.

Women and stroke risk

One risk factor for stroke that many people are not aware of is sex — women are more likely to experience stroke than men. They are also more likely to die as a result. Every year, around 425,000 women have a stroke, which is 55,000 more than men.
The reason for the increased risk and mortality is not fully fleshed out, but a study published in the journal Stroke this week takes an in-depth look and fills in some of the blanks.


The new study paper is part of a special edition of the journal that focuses specifically on women’s health, which is timed to coincide with the American Heart Association’s (AHA) Go Red month.

The corresponding author of the new study, Dr. Kathryn Rexrode — from the Brigham and Women’s Hospital Department of Medicine in Boston, MA — explains the importance of this study.

“As women age,” she notes, “they are much more likely to have a stroke as a first manifestation of cardiovascular disease rather than heart attack. We want to better understand susceptibility: why do more women have strokes than men? What factors are contributing and disproportionately increasing women’s risk?”

Female-specific stroke risk factors

Dr. Rexrode and her team took a deep dive into the existing literature. They wanted to get a fuller understanding of the risk factors for stroke that are unique to women. They concluded that the following were most significant:

  • starting periods before the age of 10
  • starting menopause before the age of 45
  • having low dehydroepiandrosterone levels
  • taking oral estrogen or combined oral contraceptives


Also, women who had a history of pregnancy-related complications, such as gestational diabetes, hypertension during or just after pregnancy, and preeclampsia, had an increased risk.

Other factors that, according to the team, need further investigation include taking transdermal estrogen or progestogen-only contraception.

Many U.S. women fit into the categories above, but it is important to note that only a small fraction of those who have one or more of them will experience a stroke. It is awareness that is key.

“These women should be monitored carefully, and they should be aware that they are at higher risk, and motivated to adhere to the healthiest lifestyle behaviors to decrease the risk of hypertension and subsequent stroke.”

Dr. Kathryn Rexrode
As an extension to the study, the researchers looked at potential stroke risk factors for transgender people. It is common for them to be prescribed anti-androgens, estrogens, or a combination of the two.

Although there is the potential that this could alter the level of stroke risk, to date, the literature is too sparse to make any solid conclusions.

As stated above, the importance of this work is to raise awareness of the subgroups of women who might be at a greater risk of stroke in later life. It might mean that a closer eye can be kept on certain individuals who slot into a number of the higher-risk categories.

Because there is still much ground to cover, more research will be needed to firm up and extend these conclusions. Now, as ever, limiting modifiable risk factors should be everyone’s priority…

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