Table 1.
Summary of Current Knowledge Regarding Sex Differences in Risk Factors for Ischemic Stroke
| Risk Factor | Type | Risk Magnitude and Modifiers (Reference) |
|---|---|---|
| Pregnancy | Sex-specific (female) | Low overall (34:100,000 deliveries) (41) |
| Highest risk postpartum (up to 12 wk) (42) | ||
| Elevated risk in preeclampsia and gestational hypertension (41, 43) | ||
| OCP | Sex-specific (female) | Increased risk (1.4-fold to 2-fold) in women (44) |
| Higher risk correlates to higher dose of estrogens (45) | ||
| Synergistic risk in women who have migraines with aura (46–48) | ||
| Postmenopausal HRT | Sex-specific (female) | Late HRT shows no benefit or increases stroke risk (49–52) |
| Evidence for benefit of early HRT (<6 y from menopause onset) in cardiovascular disease, stroke risk still in follow-up (53) | ||
| AF | Shared | Ischemic stroke risk conferred by AF increases with age (54, 55) |
| Prevalence of AF and cardioembolic stroke higher in women; women tend to be older at onset (56–60) | ||
| AF confers stronger stroke risk in women (61) | ||
| Metabolic syndrome | Shared | Metabolic syndrome confers stronger stroke risk in women (62) |
| Risk factor profile of women with metabolic syndrome dominated by abdominal obesity, which is suggested to confer greater stroke risk in women (63) | ||
| Diabetes | Shared | Type 2 diabetes confers greater risk for stroke in women (64) |
| Risk for fatal stroke higher in diabetic female patients than male patients (65) | ||
| Hypertension | Shared | Hypertension is more common in women and more likely to be poorly controlled (66) |
| Stroke risk conferred by hypertension equivalent between men and women (67) | ||
| Coronary artery disease | Shared | Coronary artery disease is more prevalent in men (16, 68) |
Sexually dimorphic risk factors are identified as sex-specific (pregnancy, OCP use, postmenopausal HRT) or shared (metabolic syndrome, diabetes, hypertension, coronary artery disease). Current evidence for the overall risk, any risk modifiers or synergistic relationships, and any sex differences in the risk magnitude are described with pertinent citations given.
Abbreviations: AF, atrial fibrillation; HRT, hormone replacement therapy; OCP, oral contraceptive pill.