7 things to know about how stroke is different for women

Stroke can be devastating for anyone, but the risks and symptoms differ between women and men. The American Heart Association News consulted experts to outline some of the most significant differences and provide guidance on how women can protect themselves.

Women Have Higher Stroke Risk from High Blood Pressure

Both women and men share many classic stroke risk factors, including high blood pressure, diabetes, and atrial fibrillation, according to Dr. Tracy Madsen, an associate professor of emergency medicine and epidemiology at Brown University. However, high blood pressure is the most significant risk factor, and women may face a higher stroke risk than men for the same level of high blood pressure. Guidelines from the American Heart Association and American College of Cardiology define high blood pressure as a systolic reading of 130 or higher or a diastolic reading of 80 or higher.

Research indicates that a woman with a systolic blood pressure of 120 to 129 has the same stroke risk as a man with a reading of 140 to 149, said Dr. Cheryl Bushnell, a professor of neurology at Wake Forest University School of Medicine. This suggests that treatment for elevated blood pressure might need to differ between men and women.

Pregnancy Complications Increase Long-Term Stroke Risk

Certain risk factors are unique to women. Dr. Bushnell highlighted pregnancy as a significant one. Pregnancy increases blood volume and cardiac output by about 45%, posing potential complications like preeclampsia, which can lead to immediate or lifelong stroke risk. Around 20% of pregnant women experience adverse outcomes like premature labor or gestational diabetes, which can increase the risk of both ischemic and hemorrhagic strokes later in life.

Early menopause, defined as occurring before age 45, also raises stroke risk. A 2020 study found that stroke risk is higher among young women aged 25 to 44 compared to their male peers.

Women Exhibit Different Stroke Symptoms

The classic stroke symptoms—face drooping, arm weakness, speech difficulty, and time to call 911 (remembered by the acronym FAST)—are common to both sexes. However, women may also experience additional symptoms such as nausea, loss of consciousness, or confusion. Women are more likely to suffer from migraines, which can double their risk of ischemic stroke. Migraines with aura, involving visual disturbances or loss of vision, are particularly linked to higher stroke risk and can complicate diagnosis due to symptom overlap.

Racial and Ethnic Disparities in Stroke Outcomes

Stroke death rates are generally similar between men and women across most racial and ethnic groups in the U.S., but disparities exist. Black women, while having lower stroke death rates than Black men, face a significantly higher rate compared to other racial and ethnic groups. Black women are also twice as likely to have a stroke as non-Hispanic white women and experience higher rates of pregnancy complications related to high blood pressure.

Post-Stroke Outcomes for Women

Women are more likely to suffer a stroke later in life than men, often about six years older at the time of their first stroke. This older age at onset may contribute to strokes being more debilitating for women. Post-stroke, women generally have a lower quality of life and are less likely to recover fully compared to men.

Preventive Measures for Women

Women should monitor their blood pressure and work with healthcare providers to manage it if necessary. Following the American Heart Association's Life's Essential 8—avoiding smoking, maintaining a healthy weight, staying active, eating a nutritious diet, getting enough sleep, and keeping blood pressure, glucose, and cholesterol levels in check—is crucial for stroke prevention.

Pregnant women need to be particularly vigilant about high blood pressure and collaborate with their OB-GYN to manage it. Safe medications are available, and the risks of high blood pressure continue beyond pregnancy.

Ongoing Research and Understanding

Dr. Bushnell and Dr. Madsen emphasized that women have been underrepresented in stroke studies, but current research is striving to understand the sex differences in stroke risk, including hormonal influences. The stroke research community is actively working to fill these knowledge gaps.