Women and stroke: Risk, recovery, and prevention

⏱ 4 min read, 60 min video

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. 

Download a transcript of this video. 

Download and share a helpful handout about women and stroke.

Highlights of the presentation included:

• 00:00 Introduction and overview of stroke
• 05:38 Sex-based physiological differences
• 07:26 Unique stroke risk factors in women
• 09:51 Role of estrogen in vascular health
• 12:07 Recognizing stroke symptoms and acting FAST
• 16:10 Exercise and stroke prevention
• 18:00 Sex-based risk factors across the lifespan
• 23:16 Gender disparities in rehabilitation and research
• 33:28 Modifiable risk factors and prevention
• 38:04 Post-stroke fitness and community programs
• 43:08 Delayed rehabilitation and recovery potential
• 47:46 Understanding TIAs and silent strokes
• 51:03 Participating in stroke research
• 54:44 Emergency planning for those living alone

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). “We tend to recommend the 24-Hour Movement Guidelines. 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. 

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