Stroke: Why are women more affected than men?

Every year there are about 130,000 hospital admissions related to stroke in the United Kingdom; about half of them are women. Women tend to be more often affected, as they present more risk factors. 

What is cerebrovascular accident (CVA) and what are its risk factors for women? 

Cerebrovascular accident (CVA), also called stroke, occurs when blood flow towards or inside the brain stops.

There are two types of CVA:

• when the artery is blocked (80% of cases): it is called cerebral infarction,
  
• when the artery bursts (remaining 20% of cases): it is called intracerebral haemorrhage.

The frequency of stroke generally increases after the age of 50. Two incidence peaks are observed in women:

• A significant peak between ages 70 and 75,
• A smaller peak, which is yet increasing, in young women between 30 and 35. This can be explained by the possibility of a stroke during pregnancy or by the combination of tobacco, contraceptive pills and migraines.
  

The main risk factors for stroke are age, smoking, high blood pressure and diabetes. However, the influence of the last two factors (high blood pressure and diabetes) is greater in women than in men.

Some risk factors are specific to women. Thus, hypertension during pregnancy can cause stroke even several years later. Atrial fibrillation, if present, also doubles the risk of stroke in women, compared to men.

Moreover, in terms of lifestyle, women have largely adopted that of men, especially when it comes to smoking, which is one of the causes of stroke.

Higher life expectancy in women is not the only reason that explains the difference in stroke mortality between the two sexes. In fact, the symptoms that women develop are more subtle, therefore they do not see their doctor soon enough.

However, we know that stroke, which is a sudden interruption of blood flow, depriving the brain of oxygen for long minutes or even hours, is an absolute emergency.

It is therefore important to recognise the warning signs of stroke and to be able to act accordingly.

What are the symptoms of CVA, especially in women? 

Some stroke symptoms are common to both women and men.

Here they are:

• loss of mobility, motor impairments and muscle weakness that affect one side of the body (right or left),
• loss of speech and of the ability to understand and to express oneself,
  
• loss of sensitivity on one side of the body
  
• vision loss. It can affect one or both eyes.

These most common symptoms should alert. It is essential to call for help as soon as possible. In fact, the more time passes before the patient is taken care of, the more severe the sequelae.

In women, other signs can alert and require special vigilance:

• Headaches,
• Dizziness
  
• Nausea or hiccups
  
• Chest pain, shortness of breath,
  
• Facial pain,
  
• Disorientation

You shouldn't think of stroke each time you have a headache, but it is nevertheless important to determine the frequency of these subtle symptoms and their possible association with the symptoms mentioned above.

Why is mortality rate from CVA so different between men and women? 

As mentioned above, women are more affected by stroke, on the one hand, because they live longer and on the other hand, because of their physiology that makes them more sensitive.

In fact, certain hormones absent in men are known to influence blood clotting and the ability of blood vessels to develop.

Pregnancy and menopause also permanently mark the vascular profile of women, and the use of oestrogen-based contraceptives is known to slightly increase the risk of stroke.

According to a study led by Professor Charlotte Cordonnier (Inserm, Lille University Hospital), published in the journal Nature reviews neurology, it appears that women are still poorly informed of these risks and remain to this day very poorly represented in clinical trials.

Women are familiar with the symptoms of stroke but consider themselves to be less "at risk" than their male counterparts and do not call for help as quickly if the signs appear.

The diagnosis is made later than for men and this generally results in treatment being less effective.

However, according to Prof. Charlotte Cordonnier, when stroke is of the ischemic type, there is a drug which, if administered within 4h30 of the event, can cure the stroke without sequelae.

These physiological differences need to be taken into account urgently by scientists and health professionals. It is also essential to make sure women are better informed and to encourage pharmaceutical industries to include more women in clinical trials.

Still according to Professor Charlotte Cordonnier, in the latest clinical trials assessing the effect of new oral anticoagulants, less than 40% participants were women.

In 2016, the European Parliament already stressed the need for greater participation of women in clinical trials.

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