Women and Stroke Special Risks, Worse Prognosis

by Heart & Stroke FoundationStrokes kill 45% more women than men in Canada, according to a new data analysis released today by the Heart and Stroke Foundation. And thats why Canadian women have a strong reason to be aware of the warning signs of stroke, says the Foundation.At all ages, a man has a higher risk of having a stroke than a woman. But each year, more women than men die from stroke and the gap is widening. In 1973, there were 8,523 female deaths from stroke compared to 7,702 male deaths a 10% difference. By 2004 (the latest year for which data are available), female deaths increased to 8,667 while male deaths dropped to 5,959. Data suggests that the lifetime risk for a middle-aged woman of having a stroke is 1 in 5, whereas it is 1 in 6 for a middle-aged man.Some of womens increased stroke risk is caused by the fact that women tend to live longer on average than men, and stroke mortality is higher with age. Most risk factors for stroke, such as high blood pressure, diabetes, smoking, inactivity and high cholesterol, are the same for men and women, and can be controlled. But new research is suggesting that there may be some risk factors that are uniquely important for women.MigrainesA review of the research shows that among women age 20-44 years of age, those who have migraines have double the risk of stroke. More recently, a study found that women who have migraines with visual disturbances such as flashing dots or blind spots can be up to 10 times more likely to have a stroke.In the 2003 Canadian Community Health Survey, 15% of women age 30 and over reported migraines, compared to only 6% of men.Pre-eclampsia Pre-eclampsia is a form of pregnancy-associated high blood pressure that occurs in about 5-7% of all pregnancies. Research suggests that women who develop preeclampsia have a 60% greater risk of non-pregnancy-related ischemic stroke, compared to women without a history of pre-eclampsia.Hormone Replacement Therapy (HRT)The massive Womens Health Initiative has shown that although most women who take HRT will not have a stroke, women who take estrogen and progestin HRT for less than two years have a 40% higher risk. Although the risk drops after two years, it is important that women who take or are considering HRT talk to their doctors about both the benefits and the risks.Oral ContraceptivesFor most women, the risk of stroke from taking oral contraceptives (birth control pills) is very small. However, for women who smoke, have high blood pressure, migraines or blood clotting disorders, the risk is much higher. Women who have these risk factors are advised to talk with their doctor before taking oral contraceptives.Women also face other challenges related to stroke. Compared with men, women with stroke are more likely to live alone and less likely to have social supports, notes Heart and Stroke Foundation researcher Dr. Moira Kapral.The good newsThe good news is that Canadian researchers are finding that women are not only benefiting as much as men from new stroke treatments, but they may also even be doing better. In an analysis of the PROACT study, a major study of clot-busting therapy for acute ischemic stroke, neurologist and Heart and Stroke Foundation spokesperson Dr. Michael Hill found that female stroke patients benefited even more from this treatment than male patients.Over the past decade there have been dramatic advances in therapies to decrease death and disability from stroke, agreed Dr. Moira Kapral. But some studies suggest that some effective treatments are under-used in women, and we need to do further research to find out why.Dr. Kapral is involved in the GENESIS project, a national multidisciplinary research team looking at gender differences in heart disease and stroke, which is funded by the Heart and Stroke Foundation and the Canadian Institutes of Health Research.The bottom lineThe bottom line, stresses Dr. Hill, is that it is essential for all Canadians to know the warning signs of stroke and to act immediately when they occur. Too many people hesitate before calling 9-1-1 or their emergency number. But stroke is a medical emergency. The faster you can get to the hospital, the quicker you can be treated and the greater the chances of preventing permanent damage.The Heart and Stroke Foundation estimated that there are between 40,000 to 50,000 strokes in Canada each year, and 300,000 Canadians living with the effects of stroke.According to the Heart and Stroke Foundation, of every 100 people who have a stroke, approximately 15 will die, 10 will recover completely, 25 will recover with a minor impairment or disability, 40 are left with a moderate to severe impairment and 10 will be so severely disabled that they require long-term care.The warning signs of stroke and what to do about themWeakness - Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.Trouble speaking -  Sudden difficulty speaking or understanding or sudden confusion, even if temporary.Vision problems - Sudden trouble with vision, even if temporary.Headache - Sudden severe and unusual headache.Dizziness - Sudden loss of balance, especially with any of the above signs.Call 9-1-1 or your local emergency number immediately. Managing riskThe leading risk factor for stroke is high blood pressure. Over 5 million Canadians have high blood pressure, and of these 42% dont even know that they have it. Over 21% of Canadian women 45-64 years of age have high blood pressure, and nearly 48% of women age 65 or older have high blood pressure.The Heart and Stroke Foundation has developed resources to help Canadians prevent and manage high blood pressure, including a free customized personal action plan, which can be found at www.heartandstroke.ca/bp