SLU professor reveals why women have higher rates of strokes than men, suggests steps to reduce risk

Each year, around 55,000 more women than men will have a stroke. Longer lifespans, pregnancies and hormones all contribute to the disparity, as do illnesses that tend to strike women more frequently. Crunch the numbers and the math adds up to more strokes for women, making it important for women monitor their risk.

Eli Feen, M.D., an associate professor of neurology at Saint Louis University and a SLUCare physician, says that one reason that stroke affects more women is simply because they live longer than men. The risk of stroke rises with age, and the longer a woman lives, the higher her risk for stroke.

Other factors are tied to increased risk during pregnancy and from hormones. Eclampsia or pre-eclampsia during pregnancy contributes to a higher risk of developing high blood pressure (hypertension) later in life. Hypertension is one of the most significant risk factors for stroke.

Certain kinds of oral contraceptive pills, hormone replacement therapy, or hormones taken as treatments for other health conditions also contribute to higher risk for stroke.

In addition, women more frequently are diagnosed with certain health conditions that are associated with stroke. Migraines, for instance, are linked to increased stroke risk.

"More women than men have migraines in the U.S.," Feen said. "And some studies suggest that migraines with visual auras, when people see spots or various other kinds of changes in their vision associated with their headaches, put a person at a higher stroke risk.

"We don't know specifically how frequently they have to occur to really create a significant risk for stroke, but in general, if these migraines with visual auras are very frequent, the risk of stroke is higher."

Women also are more likely to suffer from certain types of inflammatory and auto-immune disease, like lupus, that create an increased risk of blood clots, which, in turn, increases the risk of stroke.

How can stroke risk be managed?
"Any woman who is concerned about her risk of stroke should take the first, most important step of initiating a conversation with her primary healthcare provider," Feen said. "I cannot overstate the importance of this!"

Though managing stroke risk will vary from person to person, the following six steps are a good starting point to reduce your risk.

1.) Stop smoking.
Smoking is one of the most significant, yet controllable risk factors for stroke. Smoking doubles your risk of stroke, so avoiding or quitting the habit is one of the best ways to keep your risk low.

"If you smoke, stop completely, as soon as possible," Feen said. "Today is not too early to stop."

2.) Manage high blood pressure.
Everyone should know their average blood pressure. Hypertension is called "the silent killer" for a reason. It develops in a person long before there are symptoms or problems that would prompt a person to go to the doctor.

"Checking it at least once a year before the age of 55 will allow you to more quickly identify when your blood pressure is going up," Feen said. "If you have an elevated reading, it doesn't mean you definitely have hypertension, but it should prompt you to discuss it with your primary healthcare provider."

For women with a family history of hypertension, for those with eclampsia or pre-eclampsia during any of their pregnancies, and for women who are considering oral contraception, it's important to screen for hypertension, followed by a discussion with your healthcare provider.

If you are diagnosed with hypertension, your doctor may recommend lifestyle changes, like increasing exercise and lowering salt consumption and may prescribe medications that can help manage the condition.

3.) Know your individual risk.
Individual risk depends on a wide range of factors, some of which are within your control, like smoking, and some of which aren't, like age. This is why it is important to talk to your healthcare provider about your individual risk and how you can manage it.

4.) Monitor during pregnancy.
Pregnant women need to monitor their blood pressure throughout their entire pregnancy. For women who have a history of high blood pressure, pre-eclampsia or eclampsia during a pregnancy, blood pressure needs to be watched closely later in life, as well.

5.) If taking hormones, monitor and offset risk.
Hormone replacement therapy and hormonal contraception mainly increase stroke risk through a mechanism related to estrogen. Exogenous or "extra" estrogen appears to interact with a woman's physiology to increase the risk of causing blood clots.

While there is a statistically increased risk, the risk in general is still very low. When using these medications, women can offset the increased risk of blood clots by reducing other risk factors such as smoking, obesity and high blood pressure.

"Before beginning oral contraceptive pills or hormone replacement therapy, a woman should be screened for high blood pressure," Feen said. "If she finds that her blood pressure is elevated above 135/85 mm Hg, she should speak with her primary healthcare provider."

6.) Act immediately if you or someone nearby shows signs of a stroke.
If a stroke does occur, the single most important thing to remember is that time is of the essence in seeking treatment. Medications can limit damage, but they must be administered very quickly.

Common symptoms in women or men who are experiencing a stroke include slurred speech, difficulty speaking, double vision, blurred vision, weakness or numbness on one side of the face or in an arm or leg, dizziness, or difficulties walking. The sudden onset of these symptoms is the biggest signal that a stroke is occurring.

The American Heart Association recommends thinking FAST to remember the major symptoms of stroke:

F - Face Drooping
Does one side of the face droop or is it numb? Ask the person to smile. Is their smile uneven?

A - Arm Weakness
Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S - Speech Difficulty
Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like, "The sky is blue." Is the sentence repeated correctly?

T - Time to call 9-1-1
If someone shows any stroke symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately.

"If you or someone you know is showing any sign of a stroke happening, don't wait," Feen said. "Call 911 immediately for emergent medical help."

"And, next time you visit your doctor, be sure you understand your own risk of stroke by discussing your personal risk factors and how best to manage them."