Mid-Life Stroke More Common in Women than Men

Patient Expert

by Teri Robert, MyMigraineConnection Lead Expert

Many Migraineurs have become aware that having Migraine disease increases our risk of stroke. In women with Migraine, there is an average of 2.16 times greater risk of stroke. An increase in cardiovascular events, including stroke, in men with Migraine has also been established. A new study published in Neurology, the medical journal of the American Academy of Neurology, provides more incentive for female Migraineurs to manage their Migraine disease and stoke risk factors.

According to a study published June 20, 2007, in the online edition of Neurology®, more women than men appear to be having a stroke in middle age. Researchers say heart disease and increased waist size may be contributing to this apparent mid-life stroke surge among women.

Study Objective:

This study had a twofold objective:

  1. To assess gender differences in stroke prevalence rates in midlife years and to identify potentially determining factors that influence these differences.
  2. To assess stroke and other vascular risk factor rates across successive decades of midlife years in both genders and determine independent predictors of stroke.

Study Methods:

Data analyzed was collected from 1999 - 2004 from 17,061 people over the age of 18 who participated in the National Health and Nutrition Examination Survey (NHANES), which was conduced by the Centers for Disease Control (CDC). The data was analyzed to assess gender differences in stroke prevalence and to identify independent predictors of stroke occurrence among middle-aged men and women.

Study Results:

  • Of the 17,061 participants, 606 people experienced a stroke.
  • Women in the 45 to 54 age range were more than twice as likely as men in the same age group to have had a stroke.
  • There were no gender differences in stroke rates in the 35 to 44 and the 55 to 64 age groups.

Study Conclusion:

"A higher prevalence of stroke may exist among women aged 45 to 54 years compared

with similarly aged men. This potential disparity could be due in part to inadequate stroke

risk factor modification in women and is deserving of further study."

The majority of strokes occur in people over the age of 65. Still, younger persons, particularly those aged 35 to 64 years, are also at risk of stroke. In particular, women under 65 years have unique risk factors for stroke, including

  • pregnancy,
  • use of oral contraceptives,
  • higher prevalence of Migraines, and
  • use of hormone replacement therapy.

Comments from the study authors:

"While our analysis shows increased waist size and coronary artery disease are predictors of stroke among women aged 45 to 54, it is not immediately clear why there is a sex disparity in stroke rates among this age group... While further study is needed, this mid-life stroke surge among women suggests prompt and close attention may need to be paid to the cardiovascular health of women in their mid-30s to mid-50s with a goal of mitigating this burden."

study author Amytis Towfighi, MD;

Stroke Center and Department of Neurology,

University of California at Los Angeles;

member of the American Academy of Neurology.

In addition, Towfighi says several vascular risk factors including systolic blood pressure (upper number) and total cholesterol levels increased at higher rates among women compared to men in each older age group:

"For instance, with each decade, men's blood pressure increased by an average of four to five points, whereas women's blood pressure increased by eight to 10 points. Similarly, men had significantly higher total cholesterol levels than women at age 35 to 44, but men's total cholesterol remained stable while women's total cholesterol increased by 10 to 12 points with each decade, so that by age 55 to 64, women had significantly higher total cholesterol than men."

Towfighi says the study also found a greater than expected stroke surge among men who were nearing the end of middle age. Men aged 55 to 64 were three times more likely than men aged 45 to 54 to have had a stroke. Towfighi says the reasons behind this increase warrant further investigation.

Implications and summary:

This study gives us a better assessment of stroke risk at different ages as well as the difference in risk between the genders. It was quite helpful that the authors identified some of the specific risk factors for women between the ages 35 to 64. Although it's not welcome news to see Migraine listed among those risk factors, it is heartening to see that Migraine is being taken seriously and not overlooked.

The implications of this study are not reason to panic or become overly concerned. They are reason to have a frank discussion with our doctors about our personal risk factors for stroke and what we can do to reduce those factors. Migraineurs should view this information as cautionary and empowering rather than frightening.

See related content:


Resources:

Press Release. "More Women than Men Having Mid-Life Stroke." American Academy of Neurology. St. Paul, Minnesota. June 20, 2007.

Towfighi, Amytis, MD; Saver, Jeffrey L., MD; Englehardt, Rita, DrPh; Ovbiangele, Bruce, MD. "A midlife stroke surge among women in the United States." Neurology 2007; 69:1-1. June 20, 2007.

Acknowledgement: Special thanks to the American Academy of Neurology for making a copy of the journal "A midlife stroke surge among women in the United States" article available for the purpose of researching this article.

Last updated June 20, 2007.