Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

Abstract

Background: Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. Summary: Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.

Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants ― Korean Nationwide Population-Based Study ―

“…The use of oral contraceptives and dependence on tobacco or alcohol, which are well-known risk factors of ischemic stroke, are less prevalent in Asian women than in women in other parts of the world. 34 Last, we cannot exclude the possibility that women have a low stroke awareness and have poorer access to medical care. The present finding, that women have a similar risk of stroke as do men when stratified according to risk factors, needs to be validated in future studies.…”

Menstrual Factors and Stroke Incidence in Japanese Postmenopausal Women: The Ohasama Study

“…Several unique risk factors have been reported for the occurrence of stroke in women [1,2] . Women tend to survive longer and experience stroke at an older age, and this fact suggests an increase in the incidence of stroke in women due to the aging of the population [3] .…”

Sex differences in outcomes after stroke among patients with low total cholesterol levels: a large hospital-based prospective study

“…Consistent with these studies, in the present study, we found that women were more likely than men to have POCI, severe stroke, hypertension, and obesity but less likely to be current smokers and to consume alcohol. The delayed time to hospital admission in women could explain the greater frequency of severe stroke [30]. …”