Many aspects of strokes affect women and men differently, and four articles in the American Heart Association’s journal Stroke highlight recent research and identify future research needs.

“Gender influences all aspects of stroke, from risk factors, treatments, and outcomes,” said Marc Fisher, MD, editor-in-chief of the Stroke journal and professor of neurology at Harvard Medical School in Boston, Massachusetts. “Highlighting these studies, all led by female researchers, in February, a month when the American Heart Association/American Stroke Association focuses on women’s health with Go Red For Women, is important. For too long, gender influences were not adequately studied.”

The studies include:

Stroke risk factors unique to women

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.

This review highlights stroke risk factors specific to women, including fluctuations in naturally occurring hormone levels over women’s lives; adverse effects of supplemental hormones used as contraception or to treat menopausal symptoms; and pregnancy and pregnancy-related complications. The authors suggest that future research is needed to determine whether stroke risk prediction models should include risk factors specific to women, such as supplemental hormones and pregnancy.

•After Feb. 8, view the manuscript online.

Preeclampsia: Association with posterior reversible encephalopathy syndrome and stroke

Preeclampsia is a complication of pregnancy characterized by high blood pressure which can cause damage to the brain, kidneys, and liver. Preeclampsia can advance to eclampsia, which is characterized by seizures. Both of these conditions are associated with an increased risk of maternal death, ischemic stroke, and hemorrhagic stroke. Preeclampsia is a treatable and, possibly, preventable condition, which complicates up to 5% of pregnancies. The treatment for preeclampsia/eclampsia includes anti-hypertensives and magnesium.

According to this review, the risk of future ischemic stroke is approximately 80% greater in women with a history of preeclampsia than in those without the condition. Women whose pregnancy is complicated by preeclampsia or eclampsia should be counseled on the signs and symptoms of stroke and monitored closely in the postpartum period.

•After Feb. 8, view the manuscript online.

A focused update of sex differences in patient-reported outcome measures after stroke

This study is an updated review of sex differences in patient-reported outcome measures less than 12 months after stroke, using data from studies published since 2007.

The review confirms that after stroke, women suffer more activity limitations, worse health-related quality of life, and more post-stroke depression than men, but do not have worse cognitive impairment or challenges in dealing with everyday life compared to men. The authors note that there is a pressing need for high-quality, population-based studies of sex differences in patient-reported outcome measures after stroke. Studies exploring potential modifiable contributors to these differences are needed so effective interventions to reduce sex disparities in outcomes can be designed.

•After Feb. 8, view the manuscript online.

Impact of conventional stroke risk factors on stroke in women: An update

Due to increasing stroke risk with age and a longer life expectancy, women experience more strokes and more death from stroke over their lifetime and have worse functional outcomes following stroke. This study reviews current literature (2013 to present) on ischemic strokes, the most common type of stroke caused by narrowing or blockages in the arteries leading to the brain, and the degree to which conventional risk factors affect men and women differently.

It concludes that risk factors—including diabetes, metabolic syndrome, atrial fibrillation, and migraine—carry greater ischemic stroke risk for women compared with men. Metabolic syndrome is a cluster of risk factors that significantly raises the risk of heart disease and stroke; atrial fibrillation is a heart rhythm disorder. The association between elevated cholesterol and stroke may be slightly higher among men, and the role of high blood pressure is complicated, with varying effects based on age/race/ethnicity and gender.

The authors also note that treatment disparities between men and women leading to suboptimal stroke prevention in women need to be addressed.

•After Feb. 8, view the manuscript online.

Editorial: Stroke in women

In this edition of Stroke, the papers by McDermott, Demel, Madsen, Gall/Lisabeth, and colleagues argue for further recognition of the factors causing stroke in women as well as for systematic intensification of treatments. Sex differences in stroke burden are most influenced by differences in cardiovascular risk factor burden; thus, the greatest gains in stroke prevention will come from increased screening and treatment of these primary risk factors in women early in life, especially in the obese; women in pregnancy; and those from high-risk ethnoracial groups.

•After Feb. 8, view the manuscript online.