Each year in Canada, about 32,000 men and 30,000 women have a stroke. But one-third more women die from stroke: 59% compared to 41% of men. Women’s disability from stroke is more severe too -- almost twice as many end up in nursing homes, compared to men.
Why is this? Stroke treatment, awareness and research has increased over the past 20 years but fewer women are involved in the studies, so the reasons are not well understood. However some researchers have thoughts on what some of the reasons might be...
Risk factors for Stroke
First, researchers found that seventy percent of women don’t know any of the risk factors for stroke. They could be at increased risk but they don’t know it, and don’t do anything to prevent it. Time for more public education directed at women. So, read on, ladies (and gents too…)
Some risk factors can’t be controlled: increased age, family history, being of South Asian, African or Indigenous descent, or just being female! Other risk factors can be changed, like high blood pressure (an important one!), diabetes, unhealthy diet, physical inactivity, unhealthy weight, smoking, stress and excess alcohol.
High cholesterol is often included in risk factors for stroke: it’s accepted as being a risk factor for heart disease, and established heart disease puts you at higher risk of a stroke. But low cholesterol was identified as a risk factor for bleeding stroke in Japan decades ago, so there’s some controversy about this one. Read my earlier blog, The Cholesterol Controversy, for more information on that ongoing discussion.
Atrial fibrillation, an irregular beat in the upper part of the heart, is another important risk factor for stroke. In this condition, blood tends to pool in the upper chambers of the heart instead of being sent through to the lower chambers, promoting formation of blood clots that can later be sent to the brain, causing a stroke.
Women are also at increased risk of stroke during pregnancy (3 times increased risk), during the menopausal change and in their elderly years. So, although stroke is more common in older women, it can occur in adult women of all ages. Both birth control pills and hormone replacement therapy can increase risk of stroke, just as our own hormones do during pregnancy, by making blood clots form more easily. Blood clots are at the root of the majority of both strokes and heart attacks. Some people refer to a stroke as a “brain attack” because the process is often similar.
What exactly is a stroke?
There are two main types of stroke plus a few other less common types:
Ischemic stroke, where a blood clot or other type of material blocks an artery in the brain. This accounts for 90% of strokes.
Hemorrhagic (bleeding) stroke, where a blood vessel in the brain bursts, allowing blood to leak rather than travelling to supply an area of the brain.
Transient Ischemic Attack (TIA), is caused by a small clot that temporarily blocks an artery in the brain, giving temporary symptoms. Sometimes it precedes a major stroke.
A tumor, infection or brain swelling from an injury can also cause a stroke in rare occasions.
Signs that a stroke is happening
A Heart and Stroke Foundation survey found that only 60% of women knew exactly what a stroke is, and only 8% knew all 3 signs that a stroke was occurring. Use the acronym FAST to remember them:
Face - Is it drooping?
Arms - Can they raise both?
Speech - It is slurred or jumbled?
Time - Time to call 9-1-1 right away!
Act FAST because the quicker you act, the more of the person’s brain you save!
Poorer outcomes in women
The emergency treatment for a stroke is to unblock the artery (for a blood clot stroke) or to stop the bleeding (for a bleeding stroke). Because brain damage is caused by lack of blood to an area of the brain, the more quickly the artery is unblocked (or the bleeding is stopped), the less damage and disability that will occur.
But women’s stroke symptoms are not always as clear as those in men, so strokes are sometimes not identified as quickly. Cases diagnosed as a TIA (a temporary stroke) in some women have later been discovered to be a full stroke. Studies have found, on average, women receive treatment more slowly than men.
Researchers looked at the “door to needle” time - the amount of time from when women arrived at hospital until she received an injection of a clot-busting drug to open the blocked artery in an ischemic stroke. On average, this time was 12% longer in women. Women are also less likely to be sent for the specialized surgery to remove a blood clot. And more women live alone, so often no-one is there to help them call for emergency transport to hospital when a stroke occurs.
Recovery from stroke is possible
The good news is that the brain can continue to recover and improve for several years after a stroke, if you do have one. Rehab and physiotherapy services can help improve function and mobility greatly. And the harder you work, the better your results.
However, women have been found to be 2 to 3 times more likely to have a poor outcome from rehab after a stroke than men. Experts suspect that women may have more difficulty getting to therapy sessions, or return to family and work responsibilities before they are fully recovered, but we need more research to find out why women don’t recover as well as men. Then we can work to change these factors and help women to better stroke recovery.
Conclusion…
So, know your risk factors for stroke, and work to reduce your risk. Know the FAST warning signs for a stroke and act quickly to get treatment to reduce damage to the brain: call 9-1-1-! When the ambulance arrives, tell them you think you might be having a stroke, even if the signs are not completely clear. Symptoms are not always as clear in women as in men.
If you do have a stroke, know that rehab and physio exercises will help you improve, and you can keep improving for several years. But you have to do the work, take the time, and stay determined to heal and recover as much as possible. The brain can reorganize itself and make new connections, but you need to stay in training mode to make it happen!
Read the link below (“Lives Disrupted”, for stories of women of all ages who have recovered well from stroke and returned to normal life...
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