Over the years, there has been a surge in the number of stroke cases. According to the Global Stroke Fact Sheet 2022, the lifetime risk of developing a stroke has increased by 50% over the last 17 years and now 1 in 4 people is estimated to have a stroke in their lifetime.
Stroke occurs when there is a sudden blockage or disruption of blood flow to the brain, causing an ischaemic stroke or if a blood vessel in the brain bursts, leading to a haemorrhagic stroke. Often the condition can cause various neurological symptoms, such as weakness, paralysis, or speech difficulties, making it a leading cause of disability and the second leading cause of death worldwide.
While age remains a major risk factor for stroke, sex and gender are also strong determinators. In fact, studies have highlighted the prevalence of stroke among women due to various reasons. Ahead of World Stroke Day 2023, we at OnlyMyHealth spoke to Dr Apurva Sharma, Consultant Neurologist, Manipal Hospital, Gurugram, to understand these causes and discuss the preventive measures that can reduce the burden of stroke in general.
The Risk Of Stroke In Men Versus Women
According to a study published in the American Heart Association (AHA) Journal, stroke deaths are more prevalent among women than in men throughout the adult life span. The study highlighted that the lifetime risk of stroke - from age 25 onwards - is 25.1% in women and 24.7% in men.
There are several reasons for this discrepancy, says Dr Sharma.
“Hormonal differences, particularly the use of birth control pills and hormone replacement therapy, can elevate the risk in women. Pregnancy-related complications, such as preeclampsia, gestational diabetes, and hypertension, can also increase the likelihood of stroke. Furthermore, women generally live longer, which exposes them to age-related stroke risk factors,” he explains.
As per the US Centers for Disease Control and Prevention (CDC), high blood pressure, also called hypertension, is a primary risk factor for stroke.
"More than 2 in 5 women have blood pressure greater than or equal to 130/80 mm Hg or are taking medicine to control their blood pressure. Only about 1 in 4 of those women have their blood pressure controlled to below 130/80 mm Hg," the US health body elaborates.
Age, Menopause, And Stroke Risk
According to Dr Sharma, age plays a significant role in stroke risk.
He says, “As women age, their risk of stroke increases. The perimenopausal and menopausal transition is a critical period when hormonal changes and other risk factors converge. Oestrogen levels drop during menopause, which can affect blood vessels and increase stroke risk.”
A study published in the AHA Journal found that women with an early menopause are at higher risk of stroke compared with women with a later menopause.
The research analysed data of the UK Biobank and EPIC‐CVD (European Prospective Investigation Into Cancer and Nutrition‐Cardiovascular Diseases) study, which involved a total of 204 244 postmenopausal women without a history of stroke, with a pooled mean baseline age as 58.9 years, and pooled mean age at menopause was 47.8 years. Over a follow‐up of 12.6 years, it was found that 6770 women experienced a stroke (5155 ischemic strokes, 1615 hemorrhagic strokes, 976 intracerebral haemorrhages, and 639 subarachnoid haemorrhages).
Besides age and hormonal fluctuations, Dr Sharma attributes the risk to lifestyle factors like weight gain and decreased physical activity during this life stage.
Also Read: From Fact To Fiction: Expert Debunks Myths About Stroke
Can Pregnancy Contribute To The Risk Of Stroke?
The CDC describes pregnancy as a stress test, adding that it can strain the heart and blood vessels. When it comes to pregnancy, while it does not directly increase the risk of a stroke in women, it can lead to conditions that contribute to the risk. This includes high blood pressure during pregnancy, preeclampsia, which is a severe type of high blood pressure that occurs during pregnancy, and gestational diabetes.
Some pregnant women may also develop blood clots, leading to a stroke.
"This increased risk for clotting happens in part because swelling from pregnancy can reduce blood flow to the lower legs. When blood does not circulate well, it is more likely to clot," the CDC explains.
Adding to the causes, Dr Sharma says, "Postpartum factors like birth control use and hormonal changes can also extend the risk window."
Preventive Measures
“Preventing strokes in women involves managing risk factors,” says Dr Sharma. He recommends maintaining a healthy diet rich in fruits, vegetables, whole grains, and lean proteins, while minimising salt and saturated fats.
Regular exercise, quitting smoking, and limiting alcohol consumption are also extremely essential. In addition, one must manage chronic conditions like high blood pressure and diabetes, whereas women should consult with healthcare providers to discuss their specific risk factors and potential preventive measures, he adds.
