Stroke RiskFactors Unique to Women
Stroke is the
third leading cause of death in women in the United States and is a leading
cause of disability. Each year 55 000 more women than men have a stroke, a
discrepancy largely driven by longer life expectancy in women (www.stroke.org).
Although the majority of stroke incidence can be attributed to traditional
vascular risk factors that occur in both men and women, including hypertension,
hyperlipidemia, diabetes mellitus, smoking, and atrial fibrillation, there are
several stroke risk factors that are specific to women. Specifically,
differences in sex hormones, exogenous estrogens, and pregnancy exposures are
factors exclusively experienced by women. In this review, we will summarize the
current state of the literature with regards to women-specific factors, such as
endogenous hormone levels, exogenous hormone therapy, pregnancy, parity, timing
of age at menarche, and menopause in relation to stroke risk.
Methods
The following
terms were searched with women and stroke in PubMed and Google Scholar, mainly
for original articles and meta-analysis/systematic reviews: estrogens,
estradiol, testosterone, DHEAS, menarche, menopause, oophorectomy,
postmenopausal hormone therapy, oral contraception, transgender, transmen,
transwomen, pregnancy, peripartum, postpartum, and parity The following search
was also performed: therapy OR treatment OR secondary prevention AND pregnancy
AND stroke. The resultant literature was reviewed by the authors, and the data
covering the topics outlined below were reviewed in this manuscript.
Endogenous
Estrogen State
Endogenous
Hormone Levels
Data on the
relationship of endogenous sex hormones and risk of stroke in women are
relatively limited. Estrogen levels fluctuate dramatically in women with the
menstrual cycle and then drop dramatically in the menopausal transition and in
post-menopause. In data from the Copenhagen City Study, neither high nor low
estradiol levels were associated with increased risk of ischemic stroke.1 In
premenopausal women, those in the lowest 10th percentile of estradiol had a
>2-fold increased risk of ischemic stroke, but this was based on …
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