Morbidity and mortality rates for
stroke are higher in men than women with the exception of
subarachnoid hemorrhage. Temporal trends are similar in the two sexes with a slowdown in the decline in mortality rates and a leveling or increase in morbidity rates. Women are more likely than men to have cervical bruits but less likely to have
carotid stenosis on ultrasonography. Some factors associated with
stroke are unique to women: pregnancy, use of
oral contraceptives, postmenopausal hormonal replacement, and
choriocarcinoma. Postmenopausal hormonal use is associated with a decreased risk of
stroke in observational studies but clinical trials are needed. Control of
hypertension and cessation of smoking to reduce the risk of
stroke is equally effective in both sexes.
Aspirin and
ticlopidine are effective in
secondary prevention of
stroke in women, whereas women may be more sensitive to
warfarin than men.