Stroke disproportionately affects more women than men.
Investigators from Brigham and Women’s Hospital and their colleagues are
exploring the effects of potential risk factors that are unique to women,
including hormone levels, hormone therapy, hormonal birth control, pregnancy
and time of menarche and menopause. In a paper this week in Stroke as part of a special issue
focused on women’s health in honour of the American Heart Association’s Go Red
month, the team highlights risk factors with strong support in the scientific
literature as well as important areas where future research needed, including
the effects of hormone therapies for transgender people.

“Many people don’t realize that women suffer stroke
more frequently than men, and mortality is much higher among women. As women
age, they are much more likely to have a stroke as a first manifestation of
cardiovascular disease rather than heart attack,” said corresponding
author Kathryn Rexrode, MD, MPH, of the BWH Department of Medicine. “We
want to better understand susceptibility: why do more women have strokes than
men? What factors are contributing and disproportionately increasing women’s

Rexrode led a team that delved into the scientific
literature to investigate evidence about risk factors that are unique to women.
The researchers report on several factors that elevate stroke risk among women

Early age of menarche (less than 10 years old)

Early age at menopause (less than 45 years old)

Low levels of the hormone dehydroepiandrosterone

Taking oral oestrogen or combined oral

The team notes that while many of these factors are
extremely common – only a fraction of women who have one or more will have a
stroke in their lifetimes. However, Rexrode emphasises that it is important for
clinicians to consider these factors and others – including women who have a
history of pregnancy complications including gestational diabetes,
pre-eclampsia or hypertension during or immediately following pregnancy.

“These women should be monitored carefully and they
should be aware that they are at higher risk, and motivated to adhere to the
healthiest lifestyle behaviours to decrease the risk of hypertension and
subsequent stroke,” Rexrode said.

Certain risk factors – such as taking transdermal oestrogen
or progestogen-only contraception – need further research, according to the authors.
The team also conducted a search of the literature for studies on stroke risk
factors unique to transgender people, but report that data on the effects
medical treatment with oestrogens, anti-androgens, or a combination of both is


Reference: Stacie
L, et al. Stroke Risk Factors Unique to Women. Stroke, 2018. Published 8
February. 10.1161/STROKEAHA.117.018415