Egido Jose-Antonio, Alonso de Leciñana María
Stroke Unit, Department of Neurology, University Hospital Clínico San Carlos, Madrid, Spain.
Cerebrovasc Dis. 2007;24 Suppl 1:76-83. doi: 10.1159/000107381. Epub 2007 Nov 1.
Stroke constitutes a serious socioeconomic and health care problem in women because it is the principal cause of incapacity and the first cause of death in this section of the population in several countries. The incidence of cerebral infarction and myocardial infarction is lower in females than in males, but only up to menopause, when, especially after >65 years of age, the differences disappear. This is attributable to the protective role of the natural estrogens during the fertile part of the woman's life. The estrogens have antiatherogenic and neuroprotective effects and, before menopause, account for a risk profile that is less atherogenic. The risk factors that have higher importance in young women are migraine and oral contraceptive use as well as etiologies specifically associated with pregnancy, birth and puerperium, or even diseases that present more commonly in women (systemic lupus erythematosus, fibromuscular dysplasia). These entities lose their relevance after menopause, when the classical vascular-disease risk factors take on their role, and also include others such as hormone replacement therapy. Due to the specific epidemiology of stroke, females are underrepresented in the clinical trials of primary and secondary prevention, the result being that the outcomes measured in these trials are less consistent and do not show as clear a benefit for women as for men.
中风在女性中构成了一个严重的社会经济和医疗保健问题，因为在一些国家，它是导致女性丧失能力的主要原因，也是该人群中首要的死亡原因。女性脑梗死和心肌梗死的发病率低于男性，但仅在绝经前如此，在绝经后，尤其是65岁以后，这种差异就消失了。这归因于天然雌激素在女性生育期所起的保护作用。雌激素具有抗动脉粥样硬化和神经保护作用，在绝经前，其风险状况的动脉粥样硬化程度较低。在年轻女性中，较为重要的危险因素包括偏头痛、使用口服避孕药以及与妊娠、分娩和产褥期特别相关的病因，甚至还包括女性中更常见的疾病（系统性红斑狼疮、纤维肌发育异常）。绝经后，这些因素不再重要，此时经典的血管疾病危险因素开始起作用，这些危险因素还包括激素替代疗法等。由于中风的特殊流行病学情况，女性在一级和二级预防的临床试验中所占比例较低，结果是这些试验中所衡量的结果不太一致，而且对女性显示出的益处不如对男性那么明显。
