Among young people, women are 44% more likely to have th
University of Colorado School of Medicine faculty members Michelle Leppert, MD, and Sharon Poisson, MD, had a hunch that younger people were more likely to have stroke than most health professionals thought, but when they looked at the numbers, they were the evenly balanced results surprised her: Among adults under the age of 35, women are 44% more likely than men to suffer an ischemic stroke – strokes caused by blood clots traveling to the brain.
Although the researchers – both in the Department of Neurology – only looked at occurrences and not causes, they noted in their study that “more research is needed to better define the etiological sex differences in ischemic stroke in young adults and the non-traditional contributions.” Risk factors such as pregnancy, childbirth and hormonal contraceptives play a role in the overall burden of ischemic stroke in young women.”
We spoke to Poisson about the research, the team’s findings and next steps.
Q: Did you go into research expecting this inequality between men and women? Or was that a surprise result?
A: It’s a bit surprising when put in the context of stroke literature of the past. We’ve seen some evidence of this in recent years – Dr. Leppert actually did one of the large administrative studies included in this paper where she found this difference – but it was a study. The question was, can we draw a broader conclusion by combining more studies? We’ve seen evidence that this might be the case, but this confirms that it seems to be true when you’re assembling many large datasets.
Q: Have you looked at the reasons why women are at such a higher risk? Or was it more about defining the problem?
A: We would like to investigate causes. This really only confirms that women in the youngest age groups had a higher incidence of stroke than men. It doesn’t tell us why. That’s the work that needs to be done. It’s hard to take anything from this study and make it actionable. It’s kind of like, ‘We understand the problem, so now we can design studies to fix the problem.’ It’s important to remember that strokes happen in young people, strokes in young women. Realizing that is really crucial. Now that we understand the issue better, we can continue working to resolve it.
Q: What is the next step in this research?
A: The next step, now that we see that there is a difference in the incidence of stroke in young women and young men, is to conduct a more detailed clinical study where we can gather more detailed information about each of these strokes. To study what led to the stroke so we can better identify young adults at risk of stroke and better prevent those strokes. That’s the ultimate goal.
Q: Would you use the same data you used for this study or start from scratch?
A: Administrative records are great because they contain many people, making it easier to study a less common disease, but they are limited in terms of the information they contain. We cannot collect all desired information from these data sets. We could try to link clinical data to some of these large datasets, but the other way, which is more time-consuming, is to collect prospective data on many young people with stroke. This is something that really needs to be a large, multi-center study because it’s a less common disease. It would be like a register where every time a young person comes in with a stroke, that information is collected. There are people out there trying to do that now, it’s just limited. We still have a long way to go.
Q: What is the biggest takeaway for young people from this study?
A: The most important thing to understand is that stroke can occur at any age. Sometimes, when young people have stroke-like symptoms, no one thinks, “This could be a stroke.” They will try to sleep it off, not realizing, “This is an emergency and I need to go to the emergency room to get it can treat a stroke.” Stroke can happen to anyone and it is really important to know the symptoms of a stroke. We know that things like high blood pressure, diabetes, smoking and high cholesterol are risk factors for stroke and can contribute to stroke even in young people. Preventing these risk factors is vital for everyone.
Q: What are the stroke symptoms to look out for?
A: We use the acronym “BE FAST”: The B is balance, E is eyes, f is face, ONE is poor S is language, and T is about time. So sudden changes in balance, vision, drooping on one side of the face, sudden weakness on one side – when you put your arms up and one drifts down – or a sudden change in speech, either slurred speech or difficulty finding the right words come out to find. These are the most common stroke symptoms. The “T is time” is meant to remind us that time is brain. The sooner we treat stroke, the better off people are. So the most important thing is to call 911 and go to the emergency room if someone suddenly has these new symptoms.
Q: What is the treatment for a stroke when you take someone to the emergency room?
A: We have a few different types of treatments. There is an anti-clotting drug called TPA that goes into the IV and dissolves blood clots. If there is a blood clot in the brain, it can help dissolve that blood clot to try to save the brain that hasn’t had a stroke yet. In some strokes, if there is a clot in a large artery in the brain that we can see on a scan, our interventional neurosurgeons or neurologists can pull the clot out from inside the artery.
Q: Can strokes be fatal?
A: Most ischemic strokes are not fatal (about 15% kill within the first 30 days), but they are the leading cause of adult disability in the United States. Most people survive their ischemic stroke, but often those with disabilities, such as a disability, survive. B. Difficulty speaking or difficulty moving one side of the body. We know that the sooner we treat stroke victims, the more likely we can stop the stroke, and the more likely someone is to return to normal, or near normal, after the stroke.
Systematic review of sex differences in ischemic stroke in young adults: are young women disproportionately at risk?
Article publication date
January 24, 2022
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