Stroke isn’t the same for everyone. In this webinar recording, Drs. Ada Tang and Kevin Moncion explore the unique risks, symptoms, and recovery challenges women face. Learn about the sex and gender risk factors for stroke, including how stroke presents differently in women and how to reduce your risk.

Overview

A new stroke occurs every five minutes in Canada.
While often associated with older adults, one in four strokes occurs in
individuals under 50. Although “mortality
rates are declining, disability from stroke is increasing.
Stroke is a significant health issue, not just in Canada, but globally”,
says Dr. Tang.

Stroke is categorized into two main types: ischemic
(caused by a blood clot blocking blood flow to the brain) and hemorrhagic
(caused by a ruptured artery leading to bleeding in the brain). Ischemic
strokes account for about 80% of all cases. Both types can result in long-term
disability and require different medical treatments, though rehabilitation
approaches are often similar.

Stroke prevalence is rising, with projections indicating
a near doubling of cases in Canada within 20 years. “So once somebody has a
stroke, their stroke risk is 26% within 5 years of that first stroke
and 40% within 10 years. So having one stroke can increase the risk of another
stroke”,
says Dr. Tang. Women represent
56% of global stroke cases and are more likely to experience recurrent strokes.
Stroke-related deaths increase with age and are more prevalent in older women
than men, prompting the need for further research into gender differences in
stroke risk.

Unique stroke risk factors in women

Women face unique stroke risks, including older age at
first stroke, higher likelihood of living alone, and increased pre-stroke
disability. Conditions like obesity, atrial fibrillation, diabetes, and
hypertension are more strongly linked to stroke in women. Pregnancy-related
risks include preeclampsia (a pregnancy complication with high blood pressure
and signs of organ stress, like protein in the urine) and gestational diabetes (a
type of diabetes that develops during pregnancy, causing high blood sugar that
usually goes away after delivery).

Role of estrogen and vascular health

Estrogen plays a protective role in vascular health by
aiding blood vessel flexibility. As women age and estrogen levels decline
during menopause, the risk of atherosclerosis increases. This loss of vascular
protection may contribute to the higher stroke risk in older women.

Role
of gender

In
addition to the biological or sex-based factors, gender-based factors (such as
social and cultural factors) affect stroke risk and recovery. Research has
shown that gender roles, identity, and societal expectations influence how
individuals experience and respond to stroke, including access to and
participation in rehabilitation. “And there might be lots of different
reasons for that, suggesting things like the
roles that women tend to play in caregiving, women might prioritize that higher
than participating
in rehabilitation for themselves. ‘I can’t
go to rehab. I can’t be in the
hospital for another 6 weeks because I
need to get home. My husband is home. My grandchildren are home. I need to get
home to take care of them’”, says Dr. Tang.

Research
studies
frequently
underrepresent women, leading to gaps in evidence-based care. Dr. Tang uses the
example of crash test dummies to illustrate how male-centric research can
overlook female needs. “Crash test dummies have been around since the ‘70s, and
they’ve done lots and lots of studies… but the first female crash test dummies
were not used in research until 2023”.

Efforts
are underway to understand why women participate
less in stroke research and how to encourage greater involvement. Inclusive
research is essential for developing effective treatments for all.

Lifespan vs. healthspan

Lifespan
is defined as the time between birth and death, and “across the lifespan, women
will have different risk factors that can affect their risk for stroke and
heart disease”, says Dr.
Tang. Healthspan
—the period of life spent in good health—is distinct from lifespan. “Your healthspan
may be longer or shorter depending on what’s happening in a person’s life”.
Strategies like exercise and social engagement can extend healthspan
and improve quality of life, even in the face of disability.

Exercise and stroke prevention

Exercise is a powerful tool for preventing stroke and
improving outcomes. Regular physical activity enhances cardiovascular fitness,
reduces blood pressure, and improves mobility. It is a key strategy for both
primary and secondary stroke prevention (i.e., stop
a first stroke from happening as well as prevent another stroke
after you’ve
already had one). So, around 150 minutes
of moderate to vigorous physical activity is associated with improvements
in risk factors.
Whether
that’s reductions in blood pressure, or improvements in cholesterol levels, or
even improvements in blood sugar control, there’s
plenty of evidence supporting exercise as a lifestyle factor”,
says Dr. Moncion.

Post-stroke fitness and community programs

Programs like Fit for Function, TIME, and FAME offer
evidence-based community rehabilitation options. These programs are designed to
be accessible and safe, even for individuals with heart conditions. Resources
from the Heart and Stroke Foundation provide additional
support.

Delayed rehabilitation and recovery potential

Even delayed rehabilitation can yield significant
benefits. Recovery is possible years
after a stroke, and new studies
are exploring the impact of strength training on long-term outcomes. Breaking
the cycle of inactivity can lead to improved function and health. It’s
never too late to start rehab.

Recognizing stroke symptoms and acting FAST

The acronym FAST—Face
drooping, Arm weakness, Speech difficulty, Time to call emergency
services—is a guide for recognizing
stroke and emphasizing
the need to act quickly. (Remember: Time is brain.
Every minute counts and quick action can save brain function and improve
recovery.) While the
most common stroke symptoms are generally
the
same for both women and
men, women
may
be
more likely to experience ‘non-traditional’
symptoms
like nausea,
vertigo,
loss of consciousness or confusion.

For individuals living alone, emergency alert systems,
accessible phones, and smart home technologies can provide critical support.
“Having a telephone that is easily accessible and low to the floor… if you do
fall and need to crawl or maneuver to a telephone…is an easy solution”,
says Dr. Moncion. Planning ahead can ensure timely
medical intervention in the event of
a stroke.