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why stroke affects women differently—and what researchers are doing about it
5 minute read
women who experience stroke are on average older than men when it occurs. generally, they live longer than men because they tend to take better care of their health.
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despite the progress to improve women’s cardiovascular health in the last decade, heart conditions and stroke are still the leading cause of preventable, premature death among women in canada.
one of the hurdles is that two-thirds of all heart disease and stroke clinical research has focused on men. the bulk of the science doesn’t take into account factors like the female heart is smaller and beats faster than a male heart, hormones differ, and female arteries are smaller, so they’re more prone to blood clots and blockages.
stroke neurologist dr. amy yu, with the help of $5 million in funding from the heart and stroke foundation of canada, brain canada and the canadian institutes of health research’s institute of gender and health, is looking to create a level playing field for research and drug development for women focused on stroke. she spoke at the recent canadian women’s heart health summit in ottawa about her work and healthing followed up with her to talk about changing care for women and why it’s important.
why are women disproportionately affected by stroke?
when you look at the prevalence, someone has stroke in canada every five minutes and half of those people are women, she says, stressing that women are disproportionately affected by stroke and deserve better care.
“we know by looking at the data that women have more disability after stroke, they’re more likely to go into long-term care like a nursing home, and we really need to think about how we can make things better for women,” says yu, who is an associate professor of medicine at the university of toronto and senior scientist with sunnybrook research institute.
she also stresses that care should not just focus on what happens after stroke but address the different risk factors between women and men. “how can we prevent stroke better? how can we diagnose a stroke more accurately and quickly, especially minor strokes or what we call transient ischemic attack (tia).” she explains that tias are often called ministrokes, caused by brief blockages of blood flow to the brain, but don’t result in long-term damage. they should be considered red flags.
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“this is a warning of something bigger that’s going to happen and our opportunity to really make a difference.” according to the mayo clinic, about one in three people who has a tia will eventually have a stroke, with about half occurring within a year after the tia.
the funding supports yu’s leadership of strokegored, the first formal research network in canada dedicated to studying stroke in women. the network represents a diverse group, including clinicians, researchers, people with lived experience, engineers, computer scientists, data scientists and more, tapping into the potential of ai, for example, to extract data from imaging and identify women at risk of stroke. they’ve launched a series of sex and gender studies to understand the differences in stroke and ensure more women participate along with men. paying it forward, the network also aims to provide training and mentorship to the next generation of researchers and clinicians working with patients who’ve experienced stroke.
the name strokegored is a nod to heart and stroke’s red-themed health equity campaigns and stands for stroke in women: growing opportunities to realize optimal evaluation, diagnosis and outcomes.
“for a long time, the poster person of somebody who experienced heart disease has been an older man, but we now know that that it’s really half of the people who experience vascular disease of the brain or stroke of the brain are women,” says yu, with a reminder of the fast symptoms for women to watch for: facial weakness, arm weakness, slurred speech and time to call 9-1-1.
why are women disproportionately affected by stroke? yu says there are a number of reasons, including baseline function. women who experience stroke are on average older than men when it occurs. generally, they live longer than men because they tend to take better care of their health. but as they age, they might accumulate other conditions like arthritis that has been linked to higher risk of stroke.
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rising numbers of young women experiencing stroke
also, there are increasing numbers of younger people in their 30s and 40s with stroke, and more women than men in this population are at risk. younger women are exposed to hormones in the oral contraceptive pill, whether it’s prescribed for contraception, managing periods or skin conditions. hormonal contraceptives are associated with increased stroke risk as swiss researchers reported in the european stroke journal.
yu has studied stroke in pregnancy, why it happens and what it means for long-term health of mothers. “we know that pregnancy is a very special time with different risk factors, particularly for people who have had high blood pressure during pregnancy or diabetes are at risk of vascular events in the long-term,” she says, adding women with these complications are not being screened for vascular risk factors, like high blood pressure, in an optimal way. pregnancy is considered a stress test on the body. it can strain the heart and blood vessels, so women should have an early assessment to mitigate risk.
as well, perimenopause and menopause symptoms can raise the risk of stroke but are often dismissed. “we take a lot of these symptoms of menopause and say, ‘well, that’s natural, so it’s ok.’ but we know that people are having sleep disruption, and sleep is really important for vascular health. so, there’s so much more discover.”
strokegored has a goal to understand why stroke happens more severely to women, and what transpires throughout the full continuum of care, from clinic prevention all the way to hospital and rehab. yu wants to create awareness of the issues and empower women to advocate for their health.
“if you have pregnancy complications, do seek care. if you are going to take hormone replacement or the oral contraceptive pill, get advice on whether or not it’s right for you,” she says. “it’s important to empower the public about this knowledge so that they can take charge of their health.”
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yu’s job is on the hospital ward, in the clinic and in the emergency department seeing patients. her scientific work looks at how people fare after stroke and if health systems are robust, supporting people so they get accurate and timely diagnosis and care. her insights hit home.
“i think the women story is something that you just can’t turn away from because it really affects the population. and when studies worldwide and in canada throughout the last two decades have shown that women are not functioning well and going into nursing homes, i don’t think we can ignore that. the status quo isn’t good enough.”
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