AHA/ASA guideline recommendations for prevention of stroke in women overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Overview
The incidence of stroke, especially in women, is fast-rising. Stroke is the third leading cause of death in women and fifth in men.[1] Many studies have documented the fact that women are more adversely affected by stroke and its complications, in terms of functional recovery, quality of life when compared to men.[2][3][4] Therefore, it is important to provide guidelines to identify high-risk women for stroke, and also to provide recommendations regarding prevention of stroke.
Epidemioloogy and Dermographics
Ischemic Stroke
In general, women have a lower incidence of ischemic stroke than men. Women have a longer life expectancy than men, therefore, at ages 85 years and older, women have a higher[5] or similar incidences of stroke with men.[6] A population-based incidence study also noted a ≥2-fold increase in stroke incidence among blacks and Hispanics when compared with whites.[7]
Hemorrhagic Stroke
There is an increased prevalence of subarachnoid hemorrhage in women,[8][9] which has been linked to an increased prevalence of cerebral aneurysms.[10] Conversely, the incidence of intracerebral hemorrhage, in most cases, has been reported to be lower in women when compared with men.[11] The highest incidence of ICH was also observed among the black population as compared with hispanics and white population.
Risk Factors
| Sex-specific | Stronger or commoner in women | Similar to both sexes |
|---|---|---|
| Pregnancy | Migraine with aura | Physical inactivity |
| Preeclampsia | Atrial fibrillation | Age |
| Gestational diabetes | Diabetes mellitus
Prior cardiovascular disease | |
| Oral contraceptives | Hypertension | Obesity |
| Postmenopausal hormone use | Depression | Diet |
| Changes in hormonal status | Psychosocial stress | Smoking |
| Metabolic syndrome |
Table adapted from AHA/ASA guideline recommendations for prevention of stroke in women (2014)[12]
References
- ↑ "Products - Health United States - Tables - 2011 Complete List". Retrieved 11 February 2014.
- ↑ Gall, SL.; Tran, PL.; Martin, K.; Blizzard, L.; Srikanth, V. (2012). "Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life". Stroke. 43 (7): 1982–7. doi:10.1161/STROKEAHA.111.632547. PMID 22569940. Unknown parameter
|month=ignored (help) - ↑ Gargano, JW.; Reeves, MJ. (2007). "Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry". Stroke. 38 (9): 2541–8. doi:10.1161/STROKEAHA.107.485482. PMID 17673706. Unknown parameter
|month=ignored (help) - ↑ Kim, JS.; Lee, KB.; Roh, H.; Ahn, MY.; Hwang, HW. (2010). "Gender differences in the functional recovery after acute stroke". J Clin Neurol. 6 (4): 183–8. doi:10.3988/jcn.2010.6.4.183. PMID 21264198. Unknown parameter
|month=ignored (help) - ↑ Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA (2009). "Gender differences in stroke incidence and poststroke disability in the Framingham heart study". Stroke. 40 (4): 1032–7. doi:10.1161/STROKEAHA.108.542894. PMC 2676725. PMID 19211484.
- ↑ Appelros P, Stegmayr B, Terént A (2009). "Sex differences in stroke epidemiology: a systematic review". Stroke. 40 (4): 1082–90. doi:10.1161/STROKEAHA.108.540781. PMID 19211488.
- ↑ Sacco RL, Boden-Albala B, Gan R, Chen X, Kargman DE, Shea S; et al. (1998). "Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study". Am J Epidemiol. 147 (3): 259–68. PMID 9482500.
- ↑ Shea AM, Reed SD, Curtis LH, Alexander MJ, Villani JJ, Schulman KA (2007). "Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003". Neurosurgery. 61 (6): 1131–7, discussion 1137-8. doi:10.1227/01.neu.0000306090.30517.ae. PMID 18162891.
- ↑ Sacco S, Totaro R, Toni D, Marini C, Cerone D, Carolei A (2009). "Incidence, case-fatalities and 10-year survival of subarachnoid hemorrhage in a population-based registry". Eur Neurol. 62 (3): 155–60. doi:10.1159/000226617. PMID 19571544.
- ↑ Wardlaw JM, White PM (2000). "The detection and management of unruptured intracranial aneurysms". Brain. 123 ( Pt 2): 205–21. PMID 10648430.
- ↑ Nilsson OG, Lindgren A, Ståhl N, Brandt L, Säveland H (2000). "Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden". J Neurol Neurosurg Psychiatry. 69 (5): 601–7. PMC 1763383. PMID 11032611.
- ↑ Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL; et al. (2014). "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. doi:10.1161/01.str.0000442009.06663.48. PMID 24503673.
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