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Stroke in Women

While more aware of risk factors and warning signs, women face higher accumulated risk than men By Neelum T. Aggarwal, MD, and Shyam Prabhakaran, MD

Stroke is the fourth leading cause of death and leading cause of disability in the U.S. for both men and women. One in six women will die from stroke, one in three will die from heart disease, and one in 25 will die from breast cancer. Approximately 16% of women but only 8% of men will die of stroke.

For every decade after age 55, the incidence of stroke doubles in both genders. Some statistics show that one in five women (versus one in four men) age 45 can expect to have a stroke if she lives to be 85. Unlike the “10-20 year lag” between sexes for rates of heart attack, stroke incidence rates for both sexes are stable across age groups. But the majority of stroke deaths occur in women.

Why the difference? One thought is the higher frequency of subarachnoid hemorrhage in women can increase the mortality rate. The other is that ischemic strokes in women are of greater severity. Data that support these two observations include:

  • Women have a higher incidence of aneurysm, higher rate of aneurysm rupture, and increased risk of re-bleeding from aneurysms than do men.
  • Women have a higher proportion of cardio-embolic strokes.

Although the prevalence of major risk factors for stroke is similar in women and men, the accumulated risk for a vascular event is higher in women. For example, hypertension is probably the most important stroke risk factor and is associated with a four- to eight-fold stroke risk. Hypertension affects almost more than 50% of all women over age 55 and with increasing age, women tend to develop hypertension at higher rates than men. After age 65, more women than men will have hypertension, especially systolic hypertension. Hypertension is known to be a strong predictor of stroke, more so in women. Some hypertension clinical trials suggest that simply controlling blood pressure can reduce the risk of stroke in up to 60% of women.

What about other risk factors? After age 45, about twice as many women develop diabetes as do men. Diabetes doubles the risk of stroke overall but the risk is thought to be higher in women than in men. Estimates suggest that 51% of adult women are either obese or overweight and have twice the risk of stroke as lean women. Risk of coronary artery disease increases in women by 6% for every kilogram of weight gained after the teenage years, compared to 3% in men who gain the same amount of weight. Elevated cholesterol is noted in 40% of American women over age 55. A higher percentage of women also will have total blood cholesterol of 200 mg/dl or higher than men do. In addition, women have a four-fold increased risk of stroke in the presence of atrial fibrillation.

Although large studies suggest that public awareness is suboptimal in terms of understanding stroke risk (the average person is unable to name at least two stroke risk factors), women appear more aware of stroke risk factors and warning signs than men. This may be due in part to large-scale national studies focusing on women’s health.

The National Stroke Association website offers patient education tools such as the FAST Wallet Card. With pictures and simple reminders on how to recognize stroke symptoms, these wallet-sized printouts can be downloaded at

Dr. Aggarwal is a cognitive neurologist at Rush University Medical Center, and is the clinical core co-leader of the NIA-funded Rush Alzheimer’s Disease Research Center. Dr. Prabhakaran is an associate professor at Northwestern University, Feinberg School of Medicine. His research focuses on acute ischemic stroke, transient ischemic attack, and intracranial stenosis.

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