NEW STUDY. As the average age of the global population rises, so does the incidence of stroke, particularly among women. To reduce the risk of stroke and improve treatment of women, healthcare professionals and policymakers must acknowledge differences between the sexes and adopt gender-specific guidelines around the world. A new Nature Reviews in Neurology article states the case emphatically.
A group of researchers from Women Initiative for Stroke in Europe (WISE) published the study in the September issue. The article summarizes the factors that are specific to women. The authors discuss future research priorities and urge healthcare policymakers to promote reduction in the incidence of stroke among women worldwide.
Katharina Stibrant Sunnerhagen, Professor of Rehabilitation Medicine at the Institute of Neuroscience and Physiology, is one of the researchers involved. She notes that gender differences with respect to stroke are not as pronounced in Sweden as elsewhere.
“In contrast to other countries, prescriptions of blood thinners for preventive purposes in cases of atrial fibrillation are just as common among both women and men here. Nevertheless, there is no doubt that women who have strokes are older, frequently living alone and more likely to be discharged to a skilled nursing facility.”
Less inclined to call an ambulance
Scientific studies have shown that women are generally more knowledgeable about the symptoms of stroke than men. They are, however, less inclined to seek emergency care. As a result, they arrive at the hospital later. That provides them with access to fewer sophisticated treatments and diagnostic examinations. Charlotte Cordonnier, a Professor of Neurology at Université de Lille and the principal author, argues that some of the gender differences are due to structural factors.“Because women are still underrepresented in clinical trials, the subsequent findings are not as applicable to them. For instance, anticoagulants are less effective in women such that they face a greater risk of developing a post-stroke disability than men. .“Healthcare professionals and policymakers around the world must acknowledge gender differences when it comes to stroke and guidelines need to take them into consideration. Both research and treatment require adaptation to the particular needs of women if their outcomes are to improve.”
Pregnancy increases the risks
Women differ from men in terms of the traditional risk factors associated with stroke. Diabetes and atrial fibrillation, for example, have a greater negative impact on them.
Moreover, imbalances related to pregnancy make it more likely that stroke will develop. Intracerebral hemorrhage, a type of stroke, is the leading cause of maternal mortality during pregnancy. The risk of stroke remains elevated for decades after childbirth. The use of oral contraceptives also increases the risk, though still uncommon, up to 250% among young, healthy women. They are also more apt than men to develop cerebral venous sinus thrombosis, a relatively rare type of stroke that is difficult to either diagnose or treat.
“From an international perspective, stroke treatment clearly works better for men than women,” Dr. Sunnerhagen says. “Additional research will be needed to fully identify the reasons. “Studies require adaptation to include the needs of both sexes. The focus has to be on ensuring that women and men have equal access to both care and rehabilitation.”
Read Stroke in women – from evidence to inequalities (Cordonnier C et al): http://www.nature.com/nrneurol/journal/v13/n9/full/nrneurol.2017.95.html?foxtrotcallback=true
TEXT: ELIN LINDSTRÖM CLAESSEN