Taking a Second Look at Stroke in Women: You Can Help Save Lives by Learning How Stroke Symptoms and Risk Factors Differ in Women and Men

By Ennen, Kathleen A. | American Nurse Today, May 2013 | Go to article overview
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Taking a Second Look at Stroke in Women: You Can Help Save Lives by Learning How Stroke Symptoms and Risk Factors Differ in Women and Men


Ennen, Kathleen A., American Nurse Today


ONCE CONSIDERED primarily a man's disease, stroke is now emerging as a major health risk for women. In the United States, roughly 795,000 people have a stroke each year--about 60,000 more women than men. But 70% of women aren't aware that they're more likely than men to have a stroke.

From age 55 to 75, men have a higher annual incidence and short-term risk of stroke than women. But women generally live about 10 years longer than men, so their lifetime stroke risk is higher and they account for a larger fraction (about 61%) of stroke deaths each year. (See Stroke facts.)

Stroke management is similar in both sexes. The latest guidelines from the American Heart Association (AHA) and American Stroke Association (ASA) recommend that patients with a suspected ischemic stroke receive clot-busting drugs, such as tissue plasminogen activator (tPA), and other treatments within 1 hour of arrival in the emergency department (ED) to minimize brain damage and speed recovery. For optimal effectiveness, tPA should be given within 4.5 hours after symptom onset.

Risk factors

Stroke risk factors differ somewhat between the sexes. Women have unique risks linked to pregnancy and menopause. Pregnancy increases the stroke risk threefold. (See Comparing stroke risk factors in women and men.)

For both sexes, unmodifiable risk factors include gender, age, race, ethnicity, and family history. The most important modifiable risk factors are hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking, atrial fibrillation, obesity, and physical inactivity. Other modifiable risk factors include heavy alcohol consumption, sleep apnea, and illicit drug abuse.

AHA and ASA have identified metabolic syndrome as a secondary risk factor for stroke. Metabolic syndrome is a constellation of interrelated risk factors--high blood pressure, increased blood glucose level, elevated serum triglyceride and low high-density lipoprotein levels, and increased waist circumference. To help reduce stroke risk, primary care providers should treat each individual syndrome component.

Recognizing stroke

Stroke must be recognized as quickly as possible to prevent disability and death. Unfortunately, many people don't know the signs and symptoms of stroke. Delayed recognition delays effective, time-sensitive treatment, including specific pharmacologic and endovascular treatments.

Because stroke injures the brain, victims may be unable to verbalize symptoms--or even recognize them. So the burden of quick, efficient action shifts to alert by-standers (such as family members, friends, neighbors, and coworkers) and healthcare providers. That's why education about stroke symptoms is so important.

It's also important to realize that stroke symptoms may differ somewhat in women and men. Symptoms common to both sexes include sudden onset of:

* numbness or weakness of the face, arm, or leg (especially on one side of the body)

* difficulty speaking or understanding

* confusion

* difficulty seeing in one or both eyes

* difficulty walking

* dizziness

* loss of balance or coordination

* severe headache with no known cause.

Symptoms that seem to be unique to women include sudden onset of:

* facial and limb pain

* nausea

* general weakness

* chest pain

* shortness of breath

* palpitations

* hiccups.

A transient ischemic attack (TIA) starts like a stroke but resolves within 24 hours, usually leaving no noticeable symptoms or deficits. With both TIA and stroke, symptoms arise suddenly. In many cases, multiple symptoms arise at the same time.

Women-specific issues

Several stroke-related issues are specific to women:

* increasing stroke burden in women

* role of postmenopausal hormone replacement therapy (HRT)

* pregnancy and stroke

* stroke in young women.

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