Based on an interview with Prachi Mehndiratta, MBBS, FAHA, board-certified neurologist and stroke expert at University of Maryland Medical Center and associate professor of neurology at University of Maryland School of Medicine.
Researchers are currently working hard to understand these sex-specific differences. This deeper understanding is crucial because it’s the key to developing better, more personalized stroke care and ultimately improving outcomes for everyone.
Understanding the Risk Factors
There are significant differences between men and women in all aspects of stroke. This impacts everything from symptoms to risk factors to treatment options. Understanding your risk factors can help you better advocate for your care.
Risk No. 1: Age
The risk for stroke increases with age — for both men and women. However, because women statistically live longer than men, they are more likely to experience a stroke during their lifetime. According to the American Heart Association, a man’s lifetime risk at age 55 is 1 in 7 for men and 1 in 5 for women. The older you are, the more likely you are to have a stroke.
Risk No. 2: Atrial Fibrillation
Atrial fibrillation (AFib) is a common heart condition that causes an irregular or sometimes fast heartbeat. The condition causes the upper and lower chambers of the heart to beat out of sync. As a result, blood can collect inside the heart, increasing the risk of a blood clot forming. A blood clot might travel to the brain and cause a stroke.
Women tend to develop AFib symptoms later in life, partly because their hearts change with age and have unique features. For example, women’s hearts are often smaller and have narrower arteries, which can affect blood flow and the heart’s rhythm. Women with AFib may feel tired, experience chest pain or notice their heart racing. They also tend to have higher levels of inflammation in their bodies, which can make AFib worse and raise their stroke risk.
Risk No. 3: High Blood Pressure
High blood pressure, also known as hypertension, is the measurement of the force of your blood as it flows through your vessels.
Your blood pressure is represented as a fraction, with 120/80 mm Hg being considered a “normal” blood pressure. More than 40% of women have blood pressure 130/80 mm Hg or higher. According to the American Heart Association (AHA), women with an elevated systolic blood pressure (the top number in the blood pressure fraction) of 120–129 have the same stroke risk as a man with a high systolic blood pressure of 140–149.
Risk No. 4: Hormonal Birth Control Use
While birth control is generally considered safe for the majority of healthy young women, you should talk with your health care provider about your risk factors before using options that contain hormones. Birth control pills, vaginal rings and patches that contain both the hormones progestin and estrogen can increase the risk for blood clots that cause heart attacks and strokes, particularly for women who already have high blood pressure or smoke.
Risk No. 5: Pregnancy
During pregnancy, women can develop several stroke risk factors. About 12% of pregnancies result in high blood pressure during pregnancy, with 5%–7% developing preeclampsia, a condition that causes high blood pressure and organ issues. About 1 in 10 women will develop gestational diabetes, a pregnancy-related condition that causes problems with blood sugar control. Preeclampsia and gestational diabetes also increase the risk for stroke later in life.
Regular prenatal care can detect these issues during pregnancy so issues can be addressed early.
What You Can Do to Lower Your Risk
According to the American Stroke Association, about 80% of strokes can be prevented. Lower your risk by taking these steps:
- Control your blood pressure. If your blood pressure is elevated — above 120/80 mmHg — talk with your health care provider about what changes you can make to reduce it. That might include making lifestyle changes or taking blood pressure medications.
- Keep your cholesterol in check. High cholesterol levels often go hand-in-hand with high blood pressure. Have your cholesterol checked during regular appointments with your provider, and talk about cholesterol-lowering medications if your cholesterol is too high.
- Don’t smoke. Smoking harms your cardiovascular system in multiple ways, including by increasing the amount of plaque in your blood, making your blood more likely to clot, and causing your blood vessels to narrow and harden. Even secondhand smoke is dangerous. The Centers for Disease Control and Prevention says that it increases stroke risk by 20%–30%.
- Follow a healthy diet. Choose foods that are low in sodium, and eat a healthy diet full of colorful fruits and vegetables, low-fat protein, whole grains, and low-fat dairy products.
- Exercise more. Aim to get at least 30 minutes of moderate-intensity aerobic exercise most days of the week. Exercise can help lower your blood pressure and help you maintain a healthier weight.
- Partner with your health care provider. See your health care provider at least once a year for checkups, and ask questions about your cholesterol, blood pressure and any other risk factors you have. Understand what you can do to reduce your risks, and ask questions about anything you don’t understand.
What We’re Doing at UMMS
At University of Maryland Medical Center, our neurology team works hard to understand, diagnose and treat brain and nerve conditions, including stroke. We make sure each patient gets care that’s right for them. Our Comprehensive Stroke Center provides expert care for all kinds of strokes, including ischemic strokes (caused by blocked blood flow), hemorrhagic strokes (caused by bleeding in the brain) and TIAs (also called mini-strokes).
After treatment, patients can continue their recovery at University of Maryland Rehabilitation & Orthopaedic Institute, where we offer a variety of therapies to help people regain strength, movement and independence.