Eng Pei Chia, Tan Lyeann Li Ying, Kimball Tamara N, Prapiadou Savvina, Tan Benjamin Y Q
Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119074, Singapore.
Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK.
J Cardiovasc Dev Dis. 2024 Nov 29;11(12):382. doi: 10.3390/jcdd11120382.
Ischemic stroke is a major cause of mortality and disability and has become a significant public health concern among women. Overall, women have more ischemic stroke events than men, in part due to their longer life span, and also suffer from more severe stroke-related disabilities compared to men. Women are also more likely than men to present with atypical non-focal neurological symptoms, potentially leading to delayed diagnosis and treatment. Female-specific risk factors, especially those related to pregnancy, are often under-recognized. A woman's risk for ischemic stroke evolves throughout her lifespan, influenced by various factors including the age of menarche, pregnancy and its complications (such as parity, pre-eclampsia/eclampsia, and preterm delivery), postpartum challenges, oral contraceptive use, and menopause. Additionally, vascular risk factors like hypertension, diabetes, and atrial fibrillation are more prevalent among older women. Despite comparable treatment efficacies, women generally experience poorer outcomes after stroke. They also face higher rates of post-stroke depression, further complicating recovery. Although significant strides have been made in reducing the incidence of ischemic stroke, our understanding of the unique risks, underlying causes, and long-term consequences for women remains limited. While sex hormones may explain some differences, a lack of awareness regarding sex-related disparities can result in suboptimal care. This review aims to illuminate the unique risks and burdens of ischemic stroke faced by women, advocating for a more nuanced understanding to enhance prevention and treatment strategies.
缺血性中风是导致死亡和残疾的主要原因，已成为女性群体中一个重大的公共卫生问题。总体而言，女性发生缺血性中风的事件比男性更多，部分原因是她们的寿命更长，而且与男性相比，她们遭受的与中风相关的残疾也更严重。女性比男性更有可能出现非典型的非局灶性神经症状，这可能导致诊断和治疗延迟。女性特有的风险因素，尤其是与妊娠相关的因素，往往未得到充分认识。女性患缺血性中风的风险在其一生中不断变化，受到多种因素影响，包括初潮年龄、妊娠及其并发症（如产次、先兆子痫/子痫和早产）、产后挑战、口服避孕药的使用以及绝经。此外，高血压、糖尿病和心房颤动等血管危险因素在老年女性中更为普遍。尽管治疗效果相当，但女性中风后的总体预后通常较差。她们还面临更高的中风后抑郁症发生率，这进一步使康复复杂化。尽管在降低缺血性中风发病率方面已取得显著进展，但我们对女性特有的风险、潜在原因和长期后果的了解仍然有限。虽然性激素可能解释一些差异，但对性别相关差异缺乏认识可能导致治疗不够理想。这篇综述旨在阐明女性面临的缺血性中风的独特风险和负担，倡导更细致入微的理解，以加强预防和治疗策略。
