Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Ischemic stroke in women

https://doi.org/10.14412/2074-2711-2025-3-127-134

Abstract

Ischemic stroke (IS) affects all population groups, but women bear a greater burden of the disease compared to men. Stroke is the second leading cause of death among women worldwide. Stroke in women is characterized by numerous distinctions from stroke in men, including specific epidemiological and etiological features, different outcomes, and unique pathophysiological mechanisms. IS occurs more frequently in women than in men, which is associated with their longer life expectancy. The risk of IS increases during menstruation, pregnancy, the postpartum period, with the use of oral contraceptives, and during menopause. In older age, women more frequently present with arterial hypertension, diabetes mellitus, and atrial fibrillation. Stroke outcomes are more often unfavorable in women. They are also more likely to develop post-stroke depression.

About the Authors

N. V. Pizova
Department of Nervous Diseases with Medical Genetics and Neurosurgery, Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation

Natalia Vyacheslavovna Pizova

5, Revolitzionnaya St., Yaroslavl 150000


Competing Interests:

There are no conflicts of interest



A. V. Pizov
Department of Medicine, Yaroslavl State Pedagogical University named after K.D. Ushinsky
Russian Federation

108/1, Respublikanskaya St., Yaroslavl 150000


Competing Interests:

There are no conflicts of interest



References

1. Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: A Report from the American Heart Association. Circulation. 2021;143(8):e254e743. doi: 10.1161/cir.0000000000000950

2. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke. 2022 Jan;17(1):18-29. doi: 10.1177/17474930211065917. Erratum in: Int J Stroke. 2022 Apr;17(4):478. doi: 10.1177/17474930221080343

3. Thomas Q, Crespy V, Duloquin G, et al. Stroke in women: When gender matters. Rev Neurol (Paris). 2021 Oct;177(8):881-9. doi: 10.1016/j.neurol.2021.01.012. Epub 2021 Jun 22.

4. Heron M. Deaths: Leading Causes for 2019. Natl Vital Stat Rep. 2021 Jul;70(9):1-114.

5. Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009 Apr;40(4):1082-90. doi: 10.1161/STROKEAHA.108.540781. Epub 2009 Feb 10.

6. Madsen TE, Khoury JC, Leppert M, et al. Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS. Stroke. 2020 Apr;51(4):1070-6. doi: 10.1161/STROKEAHA.120.028910. Epub 2020 Feb 12. Erratum in: Stroke. 2020 Jul;51(7):e141. doi: 10.1161/STR.0000000000000329

7. Vyas MV, Silver FL, Austin PC, et al. Stroke Incidence by Sex Across the Lifespan. Stroke. 2021 Jan;52(2):447-51. doi: 10.1161/STROKEAHA.120.032898. Epub 2021 Jan 25.

8. Leppert MH, Ho PM, Burke J, et al. Young Women Had More Strokes Than Young Men in a Large, United States Claims Sample. Stroke. 2020 Nov;51(11):3352-5. doi: 10.1161/STROKEAHA.120.030803. Epub 2020 Sep 18.

9. Ekker MS, Verhoeven JI, Vaartjes I, et al. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019 May 21;92(21):e2444-e2454. doi: 10.1212/WNL.0000000000007533. Epub 2019 Apr 24.

10. Lloyd-Jones D, Adams R, Carnethon M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009 Jan 27;119(3):480-6. doi: 10.1161/CIRCULATIONAHA.108.191259. Erratum in: Circulation. 2009 Jan 27;119(3):e182.

11. Seshadri S, Beiser A, Kelly-Hayes M, et al.The lifetime risk of stroke: estimates from the Framingham Study. Stroke. 2006 Feb;37(2):345-50. doi: 10.1161/01.STR.0000199613.38911.b2. Epub 2006 Jan 5.

12. GBD 2016 Lifetime Risk of StrokeCollaborators; Feigin VL, Nguyen G, Cercy K, et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018 Dec 20;379(25):2429-37. doi: 10.1056/NEJMoa1804492

13. Yoon CW, Bushnell CD. Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes. J Stroke. 2023 Jan;25(1):2-15. doi: 10.5853/jos.2022.03468. Epub 2023 Jan 31.

14. Emerging Risk Factors Collaboration;Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010 Jun 26;375(9733):2215-22. doi: 10.1016/S0140-6736(10)60484-9

15. Peters SA, Huxley RR, Woodward M.Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet. 2014 Jun 7;383(9933):1973-80. doi: 10.1016/S0140-6736(14)60040-4. Epub 2014 Mar 7.

16. Peters SAE, Carcel C, Millett ERC, Woodward M. Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study. Neurology. 2020 Nov 17;95(20):e2715-e2726. doi: 10.1212/WNL.0000000000010982. Epub 2020 Oct 16.

17. Gnatiuc L, Herrington W, Halsey J, et al.; Prospective Studies Collaboration and Asia Pacific Cohort Studies Collaboration. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018 Jul;6(7):538-46. doi: 10.1016/S2213-8587(18)30079-2. Epub 2018 May 8.

18. Huebschmann AG, Huxley RR, Kohrt WM, et al. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia. 2019 Oct;62(10):1761-72. doi: 10.1007/s00125-0194939-5. Epub 2019 Aug 27.

19. Petelina TI, Musikhina NA, Avdeeva KS, et al. Gender characteristics of lipid profile parameters and markers of vascular inflammation in patients with stable angina pectoris in groups with presence and absence of type 2 diabetes. Klin Lab Diagn. 2021 Jun 7;66(6):325-32. doi: 10.51620/0869-2084-2021-66-6-325332

20. Madsen TE, Howard G, Kleindorfer DO, et al. Sex Differences in Hypertension and Stroke Risk in the REGARDS Study: A Longitudinal Cohort Study. Hypertension. 2019 Oct;74(4):749-55. doi: 10.1161/HYPERTENSIONAHA.119.12729. Epub 2019 Aug 13.

21. Zhou B, Carrillo-Larco RM, Danaei G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957-80. doi: 10.1016/S0140-6736(21)01330-1

22. Mills KT, Bundy JD, Kelly TN, et al.Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016 Aug 9;134(6):441-50. doi: 10.1161/CIRCULATIONA-HA.115.018912

23. Ji H, Kim A, Ebinger JE, et al. SexDifferences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiol. 2020 Mar 1;5(3):19-26. doi: 10.1001/jamacardio.2019.5306. Erratum in: JAMA Cardiol. 2020 Mar 1;5(3):364. doi: 10.1001/jamacardio.2020.0173

24. Kroll ME, Green J, Beral V, et al; MillionWomen Study Collaborators. Adiposity and ischemic and hemorrhagic stroke: Prospective study in women and meta-analysis. Neurology. 2016 Oct 4;87(14):1473-81. doi: 10.1212/WNL.0000000000003171. Epub 2016 Sep 7.

25. Sulzgruber P, Wassmann S, Semb AG, et al.Oral anticoagulation in patients with nonvalvular atrial fibrillation and a CHA2DS2VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke. Eur Heart J Cardiovasc Pharmacother. 2019 Jul 1;5(3):171-80. doi: 10.1093/ehjcvp/pvz016. Erratum in: Eur Heart J Cardiovasc Pharmacother. 2020 Sep 1;6(5):309. doi: 10.1093/ehjcvp/pvaa081

26. Kostopoulou A, Zeljko HM, Bogossian H,et al; on the behalf of the DAS-CAM participants-2017-2018. Atrial fibrillation-related stroke in women: Evidence and inequalities in epidemiology, mechanisms, clinical presentation, and management. Clin Cardiol. 2020 Jan;43(1):14-23. doi: 10.1002/clc.23284. Epub 2019 Nov 6.

27. Emdin CA, Wong CX, Hsiao AJ, et al.Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ. 2016 Jan 19;532:h7013. doi: 10.1136/bmj.h7013

28. Scowcroft AC, Cowie MR. Atrial fibrillation: improvement in identification and stroke preventive therapy – data from the UK Clinical Practice Research Datalink, 2000-2012. Int J Cardiol. 2014 Feb 1;171(2):169-73. doi: 10.1016/j.ijcard.2013.11.086. Epub 2013 Dec 6.

29. Thompson LE, Maddox TM, Lei L, et al. Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR®) PINNACLE Registry. J Am Heart Assoc. 2017 Jul 19;6(7):e005801. doi: 10.1161/JAHA.117.005801

30. Yong CM, Tremmel JA, Lansberg MG, et al. Sex Differences in Oral Anticoagulation and Outcomes of Stroke and Intracranial Bleeding in Newly Diagnosed Atrial Fibrillation. J Am Heart Assoc. 2020 May 18;9(10):e015689. doi: 10.1161/JAHA.120.015689. Epub 2020 May 12.

31. Avgil Tsadok M, Gagnon J, Joza J, et al.Temporal trends and sex differences in pulmonary vein isolation for patients with atrial fibrillation. Heart Rhythm. 2015 Sep;12(9):1979-86. doi: 10.1016/j.hrthm.2015.06.029. Epub 2015 Jun 18.

32. Cheng X, Hu Q, Gao L, et al. Sex-relateddifferences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace. 2019 Oct 1;21(10):1509-18. doi: 10.1093/europace/euz179

33. Darden D, Duong T, Du C, et al. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JAMA Cardiol. 2021 Nov 1;6(11):1275-84. doi: 10.1001/jamacardio.2021.3021. Erratum in: JAMA Cardiol. 2021 Dec 1;6(12):1469. doi: 10.1001/jamacardio.2021.4489

34. Abusnina W, Latif A, Al-Abdouh A, et al. Sex Differences in the Clinical Outcomes After Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med. 2022 Aug;41:29-34. doi: 10.1016/j.carrev.2021.12.013. Epub 2021 Dec 21.

35. Pappan N, Awosika AO, Rehman A. Dyslipidemia. 2024 Mar 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available at: https://pubmed.ncbi.nlm.nih.gov/32809726

36. Li Z, Zhu G, Chen G, et al. Distribution of lipid levels and prevalence of hyperlipidemia: data from the NHANES 2007-2018. Lipids Health Dis. 2022 Oct 28;21(1):111. doi: 10.1186/s12944-022-01721-y

37. Kurth T, Everett BM, Buring JE, et al. Lipidlevels and the risk of ischemic stroke in women. Neurology. 2007 Feb 20;68(8):556-62. doi: 10.1212/01.wnl.0000254472.41810.0d

38. Gu X, Li Y, Chen S, et al. Association of Lipids With Ischemic and Hemorrhagic Stroke: A Prospective Cohort Study Among 267 500 Chinese. Stroke. 2019 Dec;50(12):3376-84. doi: 10.1161/STROKEAHA.119.026402. Epub 2019 Oct 29.

39. Cholesterol Treatment Trialists' (CTT) Collaboration; Fulcher J, O'Connell R, Voysey M, et al. Efficacy and safety of LDLlowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015 Apr 11;385(9976):1397-405. doi: 10.1016/S0140-6736(14)61368-4. Epub 2015 Jan 9.

40. Nanna MG, Wang TY, Xiang Q, et al. Sex Differences in the Use of Statins in Community Practice. Circ Cardiovasc Qual Outcomes. 2019 Aug;12(8):e005562. doi: 10.1161/CIRCOUTCOMES.118.005562. Epub 2019 Aug 16.

41. Schürks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009 Oct 27;339:b3914. doi: 10.1136/bmj.b3914

42. Lee MJ, Lee C, Chung CS. The Migraine-Stroke Connection. J Stroke. 2016 May;18(2):146-56. doi: 10.5853/jos.2015.01683. Epub 2016 May 31.

43. Peters SA, Huxley RR, Woodward M.Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes. Stroke. 2013 Oct;44(10):2821-8. doi: 10.1161/STROKEAHA.113.002342. Epub 2013 Aug 22.

44. Pan B, Jin X, Jun L, et al. The relationshipbetween smoking and stroke: A meta-analysis. Medicine (Baltimore). 2019 Mar;98(12):e14872. doi: 10.1097/MD.0000000000014872

45. Swartz RH, Cayley ML, Foley N, et al. The incidence of pregnancy-related stroke: A systematic review and meta-analysis. Int J Stroke. 2017 Oct;12(7):687-97. doi: 10.1177/1747493017723271

46. Rexrode KM, Madsen TE, Yu AYX, et al.The Impact of Sex and Gender on Stroke. Circ Res. 2022 Feb 18;130(4):512-28. doi: 10.1161/CIRCRESAHA.121.319915. Epub 2022 Feb 17.

47. Parikh NI, Gonzalez JM, Anderson CAM,et al; American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation. 2021 May 4;143(18):e902-e916. doi: 10.1161/CIR.0000000000000961. Epub 2021 Mar 29.

48. Sondergaard MM, Hlatky MA, Stefanick ML, et al. Association of Adverse Pregnancy Outcomes With Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women. JAMA Cardiol. 2020 Dec 1;5(12):1390-8. doi: 10.1001/jamacardio.2020.4097

49. Hung SK, Lee MS, Lin HY, et al. Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time. Stroke. 2022 Feb;53(2):338-44. doi: 10.1161/STROKEAHA.121.034109. Epub 2022 Jan 5.

50. Grandi SM, Filion KB, Yoon S, et al.Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation. 2019 Feb 19;139(8):1069-79. doi: 10.1161/CIRCULATIONAHA.118.036748. Erratum in: Circulation. 2019 Aug 27;140(9):e544. doi: 10.1161/CIR.0000000000000718

51. Riise HKR, Sulo G, Tell GS, et al.Association Between Gestational Hypertension and Risk of Cardiovascular Disease Among 617 589 Norwegian Women. J Am Heart Assoc. 2018 May 13;7(10):e008337. doi: 10.1161/JAHA.117.008337

52. Wu P, Gulati M, Kwok CS, et al. PretermDelivery and Future Risk of Maternal Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018 Jan 15;7(2):e007809. doi: 10.1161/JAHA.117.007809

53. Xu Z, Li Y, Tang S, et al. Current use of oralcontraceptives and the risk of first-ever ischemic stroke: A meta-analysis of observational studies. Thromb Res. 2015 Jul;136(1):52-60. doi: 10.1016/j.thromres.2015.04.021. Epub 2015 Apr 25.

54. Xu Z, Yue Y, Bai J, et al. Associationbetween oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies. Arch Gynecol Obstet. 2018 May;297(5):1181-91. doi: 10.1007/s00404-0184723-7. Epub 2018 Feb 19.

55. Li F, Zhu L, Zhang J, et al. OralContraceptive Use and Increased Risk of Stroke: A Dose-Response Meta-Analysis of Observational Studies. Front Neurol. 2019 Sep 23;10:993. doi: 10.3389/fneur.2019.00993

56. Johansson T, Fowler P, Ek WE, et al. OralContraceptives, Hormone Replacement Therapy, and Stroke Risk. Stroke. 2022 Oct;53(10):3107-15. doi: 10.1161/STROKEAHA.121.038659. Epub 2022 Jun 23.

57. Grodstein F, Manson JE, Stampfer MJ,Rexrode K. Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy. Arch Intern Med. 2008 Apr 28;168(8):861-6. doi: 10.1001/archinte.168.8.861

58. Manson JE, Chlebowski RT, Stefanick ML,et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013 Oct 2;310(13):1353-68. doi: 10.1001/jama.2013.278040

59. Renoux C, Dell'aniello S, Garbe E, Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ. 2010 Jun 3;340:c2519. doi: 10.1136/bmj.c2519

60. Nudy M, Chinchilli VM, Foy AJ. A systematic review and meta-regression analysis to examine the 'timing hypothesis' of hormone replacement therapy on mortality, coronary heart disease, and stroke. Int J Cardiol Heart Vasc. 2019 Jan 18;22:123-31. doi: 10.1016/j.ijcha.2019.01.001

61. Academic Committee of the Korean Societyof Menopause; Lee SR, Cho MK, Cho YJ, et al. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med. 2020 Aug;26(2):69-98. doi: 10.6118/jmm.20000

62. Mishra SR, Chung HF, Waller M, et al.Association Between Reproductive Life Span and Incident Nonfatal Cardiovascular Disease: A Pooled Analysis of Individual Patient Data From 12 Studies. JAMA Cardiol. 2020 Dec 1;5(12):1410-8. doi: 10.1001/jamacardio.2020.4105

63. Poorthuis MHF, Yao P, Chen Y, et al; ChinaKadoorie Biobank Collaborative Group. Risks of Stroke and Heart Disease Following Hysterectomy and Oophorectomy in Chinese Premenopausal Women. Stroke. 2022 Oct;53(10):3064-71. doi: 10.1161/STROKEAHA.121.037305. Epub 2022 Jul 13.

64. Gargano JW, Wehner S, Reeves M. Sex differences in acute stroke care in a statewide stroke registry. Stroke. 2008 Jan;39(1):24-9. doi: 10.1161/STROKEAHA.107.493262. Epub 2007 Nov 29.

65. Basu E, Salehi Omran S, et al. Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack. Eur Stroke J. 2021 Dec;6(4):367-73. doi: 10.1177/23969873211058568. Epub 2021 Nov 9.

66. Chung JY, Lee BN, Kim YS, et al. Sex differences and risk factors in recurrent ischemic stroke. Front Neurol. 2023 Jan 26;14:1028431. doi: 10.3389/fneur.2023.1028431

67. Xu M, Amarilla Vallejo A, CantalapiedraCalvete C, et al. Stroke Outcomes in Women: A Population-Based Cohort Study. Stroke. 2022 Oct;53(10):3072-81. doi: 10.1161/STROKEAHA.121.037829. Epub 2022 Jun 23.

68. Phan HT, Blizzard CL, Reeves MJ, et al. Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data. Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2):e003436. doi: 10.1161/CIRCOUTCOMES.116.003436. Epub 2017 Feb 22.

69. Carcel C, Wang X, Sandset EC, et al. Sexdifferences in treatment and outcome after stroke: Pooled analysis including 19,000 participants. Neurology. 2019 Dec 10;93(24):e2170e2180. doi: 10.1212/WNL.0000000000008615. Epub 2019 Nov 12. Erratum in: Neurology. 2021 Jun 8;96(23):1106. doi: 10.1212/WNL.0000000000011946

70. Gall S, Phan H, Madsen TE, et al. Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke. 2018 Mar;49(3):531-5. doi: 10.1161/STROKEAHA.117.018417. Epub 2018 Feb 8.

71. Poynter B, Shuman M, Diaz-Granados N,et al. Sex differences in the prevalence of post-stroke depression: a systematic review. Psychosomatics. 2009 Nov-Dec;50(6):563-9. doi: 10.1176/appi.psy.50.6.563

72. Dong L, Briceno E, Morgenstern LB,Lisabeth LD. Poststroke Cognitive Outcomes: Sex Differences and Contributing Factors. J Am Heart Assoc. 2020 Jul 21;9(14):e016683. doi: 10.1161/JAHA.120.016683. Epub 2020 Jul 7.


Review

For citations:


Pizova NV, Pizov AV. Ischemic stroke in women. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2025;17(3):127-134. (In Russ.) https://doi.org/10.14412/2074-2711-2025-3-127-134

Views: 17


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)