Ischemic Stroke in Women: Understanding Sex-Specific Risk Factors, Treatment Considerations, and Outcomes

Abstract

Ischemic stroke is a major cause of mortality and disability and has become a significant public health concern among women. Overall, women have more ischemic stroke events than men, in part due to their longer life span, and also suffer from more severe stroke-related disabilities compared to men. Women are also more likely than men to present with atypical non-focal neurological symptoms, potentially leading to delayed diagnosis and treatment. Female-specific risk factors, especially those related to pregnancy, are often under-recognized. A woman's risk for ischemic stroke evolves throughout her lifespan, influenced by various factors including the age of menarche, pregnancy and its complications (such as parity, pre-eclampsia/eclampsia, and preterm delivery), postpartum challenges, oral contraceptive use, and menopause. Additionally, vascular risk factors like hypertension, diabetes, and atrial fibrillation are more prevalent among older women. Despite comparable treatment efficacies, women generally experience poorer outcomes after stroke. They also face higher rates of post-stroke depression, further complicating recovery. Although significant strides have been made in reducing the incidence of ischemic stroke, our understanding of the unique risks, underlying causes, and long-term consequences for women remains limited. While sex hormones may explain some differences, a lack of awareness regarding sex-related disparities can result in suboptimal care. This review aims to illuminate the unique risks and burdens of ischemic stroke faced by women, advocating for a more nuanced understanding to enhance prevention and treatment strategies.

Keywords: estrogens; gender; ishemic stroke; menopause; risk factors; women.

Figure 1

Multifactorial Risk Pathways for Ischemic Stroke in Women. This figure illustrates the interconnected risk factors contributing to ischemic stroke in women, focusing on hormonal variations throughout life, lipid profiles, and pregnancy-related complications.