Among young adults, women 44% more likely to have ischemic stroke vs. men
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In adults aged 35 years or younger, women were 44% more likely to have an ischemic stroke compared with men, according to a systematic review.
The study was published in a Go Red for Women spotlight issue of Stroke.
“Our finding suggests that strokes in young adults may be happening for different reasons than strokes in older adults. This emphasizes the importance of doing more studies of stroke in younger age groups so that we can better understand what puts young women at a higher risk of stroke,” Sharon N. Poisson, MD, MAS, an associate professor of neurology at the University of Colorado, Denver, said in a press release. “Better understanding which young adults are at risk for stroke can help us to do a better job of preventing and treating strokes in young people.”
Poisson and colleagues conducted a systematic review to determine sex differences among young adults with ischemic stroke.
The review included 19 studies of adults aged 45 years or younger, 16 of which concerned ischemic stroke. Of those, nine found no difference by sex in ischemic stroke rates in people aged 45 years or younger, three found a higher rate of ischemic stroke in men among people aged 30 to 35 years and four found a higher rate of ischemic stroke in women among people aged 35 years or younger.
When the researchers analyzed adults from all 16 studies aged 35 years or younger, they determined that women were 44% more likely to have an ischemic stroke compared with men (incidence rate ratio [IRR] = 1.44; 95% CI, 1.18-1.76; I2 = 82%), but when they analyzed adults from all 16 studies aged 35 to 45 years, they found no difference by sex in ischemic stroke likelihood by sex (IRR = 1.08; 95% CI, 0.85-1.38; I2 = 95%).
“The sex difference in the incidence of ischemic strokes was the greatest and most evident among adults younger than age 35 years, with an estimated 44% more women, though there is notable heterogeneity in this effect,” Poisson and colleagues wrote. “This sex difference narrows among adults ages 35 to 45 years, and there is contradictory evidence whether young men may be more at risk of ischemic strokes in this age group.”
Reference:
- Women ages 35 and younger are 44% more likely to have an ischemic stroke than male peers. https://newsroom.heart.org/news/women-ages-35-and-younger-are-44-more-likely-to-have-an-ischemic-stroke-than-male-peers. Published Jan. 24, 2022. Accessed Jan. 24, 2022.
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Gina Lundberg, MD, FACC
The key message is that women under 35 are having strokes when generally women of childbearing age are considered healthy and low risk for such events. The awareness of strokes in young women is limited, and physicians need to be aware to look for signs of strokes in women at reproductive age as well as postmenopause.
As the authors pointed out, migraine headache, oral contraceptives and complications of pregnancy may be to blame for some of the strokes in women of this age. I would also add to the list that untreated hypertension, clotting disorders, autoimmune disorders and rheumatologic disorders are also common in women of these ages and associated with strokes.
The data on sex differences in ischemic stroke risk for people aged 35 to 45 were not more contradictory. I believe they were more limited. There were eight studies done in women under age 35 and only four studies done in women aged 35 to 45. Where there are less data, there is more room for error of interpretation. Definitely, more studies need to be done in this age group.
The key component missing here is what were the comorbidities and other circumstances surrounding the strokes. We do not have any data on recent pregnancy, delivery or miscarriage. There are no data on underlying hypertension and other comorbidities. This is essential to understanding why younger women have strokes.
It is wonderful that attention has been drawn to the data that women of these young ages are having more strokes than men. What we need to understand now is the why of it, which can help lead us to the intervention to correct it.
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