Gender Differences in Cerebrovascular Disease Risk and Outcomes

Nencioni Helena^*
*Correspondence: Nencioni Helena, Department of Neurology and Psychiatry, Koc University School of Medicine, Istanbul, Turkey, Email:

Introduction

Cerebrovascular diseases, including stroke, aneurysms and transient ischemic attacks are among the leading causes of mortality and long-term disability worldwide. While both men and women are affected by these conditions, growing evidence highlights significant gender differences in their risk factors, presentation, treatment and outcomes. Addressing these disparities is crucial for enhancing disease prevention strategies and optimizing clinical care [1]. Estrogen's protective effects on the vascular system may contribute to lower stroke risks in premenopausal women. However, the sharp increase in cerebrovascular disease risk post-menopause, attributed to declining estrogen levels, underscores the importance of understanding hormonal changes over the life course. The role of hormone replacement therapy in stroke risk remains controversial, with some studies suggesting it may increase the risk, especially when started later in life. Genetic factors also play a role, with some studies indicating that women might carry genetic variants that predispose them to specific types of strokes, such as subarachnoid hemorrhage. These genetic factors may interact with hormonal and environmental influences, leading to distinct patterns of cerebrovascular disease in men and women. While smoking rates have declined overall, men still tend to smoke more frequently than women, leading to a higher incidence of cerebrovascular diseases in men. However, the adverse effects of smoking may be more pronounced in women, possibly due to differences in metabolism and the interaction with hormonal factors. Similarly, alcohol consumption patterns differ between genders, with men more likely to engage in heavy drinking. Yet, women may be more susceptible to the toxic effects of alcohol on the brain and cardiovascular system [2].

Description

Physical activity is a critical protective factor against stroke, yet older women often report lower levels of physical activity compared to men. Additionally, dietary patterns, including lower consumption of fruits, vegetables and omega-3 fatty acids, may contribute to increased cerebrovascular risk in women. Public health strategies must consider these gender-specific differences to effectively promote healthier lifestyles. Hypertension is a leading risk factor for stroke and while it is more common in men at younger ages, the prevalence in women surpasses men post-menopause. The management of hypertension in women is particularly challenging due to potential interactions with other conditions such as osteoporosis and depression. Diabetes, which is associated with a two- to four-fold increased risk of stroke, has a more detrimental effect on women, potentially due to poorer glycemic control and a higher prevalence of obesity in women [3]. Migraine, particularly migraine with aura, is a significant risk factor for ischemic stroke, especially in younger women. This association is heightened by additional factors such as smoking and oral contraceptive use. Understanding the complex interplay between migraines and stroke risk in women is essential for targeted interventions.

The presentation of stroke symptoms can differ significantly between genders. Women are more likely to experience non-traditional symptoms such as generalized weakness, disorientation and fatigue. These symptoms can be easily overlooked or mistaken for other conditions, leading to delays in seeking medical care. In contrast, men typically present with more classic stroke symptoms, such as sudden onset of weakness on one side of the body, difficulty speaking and loss of vision, which are more readily recognized by both patients and healthcare providers. The under-recognition of atypical symptoms in women may result in delays in diagnosis and treatment, contributing to poorer outcomes. Public awareness campaigns and educational initiatives targeting both the public and healthcare professionals are needed to improve the recognition of stroke symptoms in women [4]. The non-specific nature of stroke symptoms in women can lead to underdiagnosis or misdiagnosis. Studies have shown that women are less likely to receive timely diagnostic imaging, such as CT scans or MRIs, compared to men. This delay can have serious implications for the effectiveness of acute treatments like thrombolysis, which are highly time-sensitive. Additionally, there may be a gender bias in the clinical assessment of stroke, with women less likely to be perceived as candidates for aggressive interventions. Addressing these biases through training and protocols that emphasize gender-specific diagnostic criteria is crucial for improving outcomes [5].

Women tend to have worse outcomes following a stroke compared to men. This includes higher rates of mortality, more severe disability and greater loss of independence. Several factors contribute to these differences, including older age at the time of stroke, a higher likelihood of living alone and the presence of multiple comorbidities such as atrial fibrillation and heart failure. Men, on the other hand, are more prone to experiencing recurrent strokes, which may be attributed to poorer adherence to secondary prevention measures, such as medication adherence and lifestyle changes. These differences highlight the need for tailored post-stroke care strategies that address the unique risks faced by each gender.

Conclusion

Gender differences in post-stroke recovery are profound. Women are more likely to experience depression and anxiety following a stroke, which can hinder their recovery and reduce their quality of life. Social isolation, which is more common in older women, exacerbates these challenges. In contrast, men may benefit from stronger social support networks, which are associated with better recovery outcomes. Rehabilitation services need to be gender-sensitive, recognizing that women may require additional psychological support and interventions that address social determinants of health. Furthermore, efforts to involve family members and caregivers in the rehabilitation process can help improve outcomes for both men and women. Disparities in access to care also play a significant role in the gender differences observed in cerebrovascular disease outcomes. Women are less likely to receive aggressive treatments, such as thrombolysis or endovascular therapy, which are critical for reducing stroke severity and improving recovery. This may be due to a combination of factors, including delayed presentation, differences in symptom recognition and biases in healthcare delivery. Addressing these disparities requires a multifaceted approach, including public health initiatives to improve symptom recognition in women, training healthcare providers to avoid gender biases and ensuring equitable access to advanced treatments for all stroke patients. The recognition of gender differences in cerebrovascular disease risk, presentation and outcomes has important implications for healthcare policy and practice.

Acknowledgement

None.

Conflict of Interest

None.

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