Women ages 35 and younger are 44% more likely to have an ischemic stroke than male peers

By the American Heart Association

Women ages 35 years and younger were 44% more likely to have an ischemic stroke than their male counterparts, according to a new review of more than a dozen international studies on sex differences in stroke occurrence, published in a Go Red for Women® 2022 spotlight issue of Stroke, a peer-reviewed journal of the American Stroke Association, a division of the American Heart Association.

In the article, “Systematic Review of Sex Differences in Ischemic Strokes Among Young Adults- Are Young Women Disproportionately at Risk?” (Leppert et al.), researchers looked at the differences in stroke incidence among women and men in various young adult age groups. The authors’ analysis identified the sex differences 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 than men in this age group experiencing ischemic strokes.

This sex difference narrowed among adults ages 35 to 45 years. Sex differences in older age groups were more difficult to determine due to wide variability in the way data was presented among the studies in this systemic review. The researchers were also not able to identify specific causes behind the higher prevalence of strokes in young women compared to young men.

According to the researchers, the incidence of ischemic stroke increases exponentially with age, and only 15% of all ischemic strokes occur in adults younger than age 50 years.

Based on their analysis, the researchers concluded, “Traditional atherosclerotic risk factors are a major contributor to ischemic strokes in both young men and women and become increasingly important with age. However, these risk factors are less prevalent in younger women and may not account for the observed higher incidence of ischemic strokes in women younger than age 35. Young women who are survivors of ischemic stroke also have worse outcomes, with 2 to 3 times higher risk of poorer functional outcomes compared to their male counterparts.”

The researchers said more research is needed to better define the sex differences of ischemic stroke in young adults and the contributions that non-traditional risk factors, such as pregnancy, postpartum and hormonal contraceptives, may play in the overall burden of ischemic strokes in young women.

“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,” said study co-author Sharon N. Poisson, M.D., M.A.S., an associate professor of neurology at the University of Colorado, Denver. “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.”

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