Stroke Risk Factors Unique to Women
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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.
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 …