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3.02.2018

Neurologists Contribute to Special Article Series on Stroke in Women

Nearly two-thirds of stroke deaths occur in women, yet women have long been underrepresented in cardiovascular disease research. Now the journal Stroke is publishing a special four-article series with an accompanying overview editorial on the latest scientific findings related to opportunities for prevention and treatment of stroke in women.

Seemant Chaturvedi, M.D., professor of clinical neurology at the University of Miami Miller School of Medicine and an assistant editor of Stroke, coordinated the publication of the series and co-authored one of the four articles. His colleague, Tatjana Rundek, M.D., Ph.D., professor of neurology and public health sciences and a consulting editor of Stroke, co-authored one of the others. The series, “Focused Update in Cerebrovascular Disease: Stroke in Women,” was published online on February 8 and will appear in print in the March issue of Stroke.

“This series of focused articles provides important updates on best practices for the prevention of stroke in women,” said Chaturvedi. “This topic is of great public health importance, since about 60 percent of stroke deaths occur in women. With the aging of the population, the toll of stroke-related disability and death will be substantial in women. Therefore, clinicians need to be aware of the optimal treatment strategies for stroke prevention in women.”

Chaturvedi and researchers from several other medical institutions published “Impact of Conventional Stroke Risk Factors on Stroke in Women,” an update that focuses on ischemic stroke because the risk factors and pathophysiology differ from those relevant to hemorrhagic stroke. The risk factors examined in this article include hypertension, atrial fibrillation, dyslipidemia, diabetes mellitus, migraine and cognitive impairment.

Recent evidence indicates that all of those risk factors, with the exception of dyslipidemia, have a greater association with stroke in women than in men, according to the article. Evidence also suggests that treatment disparities in key stroke risk factors continue to exist.

“Moving forward, it is imperative that future research examines sex-specific risk estimates of stroke risk factors,” write the authors. “In addition, contributors to treatment disparities leading to suboptimal stroke prevention in women need to be addressed. Greater attention to sex-specific risks and treatment strategies has the potential to improve the effectiveness of stroke prevention in women and ultimately reduce stroke-related death and disability.”

Rundek and her co-authors published “Preeclampsia: Association with Posterior Reversible Encephalopathy Syndrome and Stroke.” Preeclampsia, which can be associated with premature birth, placental abruption and stillbirth, is a systemic, multiorgan endotheliopathy, affecting the kidneys, heart, liver and brain. Pregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic stroke.

Risk factors examined in this article include venous or arterial thrombosis because of estrogen-related hypercoagulability; cerebral hypoperfusion related to acute blood loss; cardioembolism because of peripartum cardiomyopathy; and endotheliopathy, vasospasm, and hypertensive intracerebral hemorrhage related to hypertensive disorders of pregnancy.

The authors emphasized the importance of the findings that women with preeclampsia/eclampsia have the highest risk of stroke in the postpartum period. They have also recommended that women whose pregnancy is complicated by preeclampsia or eclampsia be counseled on the signs and symptoms of stroke and monitored closely in the postpartum period.

“Preeclampsia is a sex-specific risk factor for future stroke that is likely under-recognized,” they write. “The risk of future ischemic stroke is approximately 80 percent greater in women with a history of preeclampsia than in those without it, suggesting a critical need to increase awareness among women with this condition and their providers, so they can make risk factor modifications and lifestyle changes needed to reduce their risk of stroke.”

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