Gurmeen Kaur, MBBS
Leppert MH, Ho PM, Burke J, Madsen TE, Kleindorfer D, Sillau S, Daugherty S, Bradley CJ, Poisson SN. Young Women Had More Strokes than Young Men in a Large, United States Claims Sample. Stroke. 2020.
Ekker MS, de Leeuw F-E. Higher Incidence of Ischemic Stroke in Young Women Than in Young Men: Mind the Gap. Stroke. 2020.
Strokes are a leading cause of disability in the United States. This is especially important for strokes in the young because those are individuals at the peak of their economic and professional productivity.
In this paper by Leppert et al., using PharMetrics, a commercial administrative database, the authors report very interesting findings. There is a higher incidence of strokes in young women between the ages of 25-34 years. The risk of new diagnosis of stroke is higher in men from ages 45-74 years, and there is no significant difference in the incidence rates among men and women at both extremes of age. This is contrary to the existing literature which shows that while the stroke incidence rate is higher in men even at older age, after the age of 85 years significantly more women suffer strokes than men because of the higher life expectancy in women.
Higher incidence of strokes in younger women is of special importance because women aged 25-34 years have been shown to have lower cardiovascular morbidity, as well as risk factors, as compared to men in the same age group, except for obesity. However, pregnancy, oral contraceptive use, migraines, and autoimmune diseases are more common in young women in the childbearing ages. Studies have also demonstrated a higher incidence of PFO and atrial septal defects in women as compared to men, which may contribute to the overall stroke incidence.
According to the authors, future studies are needed to focus on women-specific risk factors for developing ischemic strokes at a much younger age. In an accompanying editorial by Ekker and de Leeuw, the authors have suggested that recognizing higher stroke incidence rates in younger women may be the first step geared towards gender-tailored management of ischemic stroke.
A few limitations of this study by Leppert et al. are that the results are derived using a commercial administrative database that does not include Medicaid and Medicare patients. It is possible that younger working women, who can afford to have insurance, may have higher representation in this study. Additionally, it is possible that stroke mimics were initially coded and captured as ischemic strokes but later proven to be secondary to other etiologies. Future studies looking at nationally representative databases, with emphasis on racial and ethnic differences, would be useful in further proving the existence of these trends.
As described by Ekker and de Leeuw, “a better understanding of the underlying etiological differences of ischemic stroke between men and women will provide stepping stones for the development of personalized, sex specific therapy.” Recognition of the higher incidence of ischemic stroke in young women is the first step in closing the gender gap and modifying primary and secondary risk factors to mitigate this higher stroke risk in young women.