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Stroke in women — from evidence to inequalities

Key Points

  • Hypertension and atrial fibrillation, key risk factors for stroke, are more frequent in women than in men

  • The effect of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women than in men

  • Hypertensive disorders of pregnancy are important causes of stroke in pregnancy, and intracerebral haemorrhage is the leading cause of maternal death

  • Women are under-represented in clinical trials despite governmental actions highlighting the need for inclusive and nondiscriminatory trials that include both men and women

  • Women are more difficult to include in stroke trials than men because they tend to be older at stroke onset, have more comorbidities, and tend to live alone

  • Women living in societies with low access to education and to adequate healthcare have particularly little awareness of stroke

Abstract

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.

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Figure 1: Hypertensive disorders of pregnancy.
Figure 2: Causes of stroke in pregnancy.
Figure 3: Hypertensive disorders of pregnancy are associated with a high risk of stroke.

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All authors helped research data for this Review and made substantial contribution to the discussion of the content. C.C., N.S., E.S., A.P., K.S., V.C. and H.C. wrote the article. C.C., N.S., E.S. and H.C. reviewed and/or edited the manuscript before submission.

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Cordonnier, C., Sprigg, N., Sandset, E. et al. Stroke in women — from evidence to inequalities. Nat Rev Neurol 13, 521–532 (2017). https://doi.org/10.1038/nrneurol.2017.95

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