Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke

Welten, Sabrina J.G.C.; Onland‐Moret, N. Charlotte; Boer, Jolanda M. A.; Schouw, Yvonne T. van der

doi:10.1161/strokeaha.120.030558

Cited by 33 publications

(38 citation statements)

References 38 publications

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“…51 These data are consistent across recent prospective studies. 46,[52][53][54] Other reproductive health variables associated with stroke risk include parity and breastfeeding. Data on parity suggest elevated stroke among women with ≥5 live births compared with 1 or 2 live births, though in some studies, adjusting for confounding variables, particularly body mass index, eliminated this association.…”

Section: Female-specific Risk Factorsmentioning

confidence: 99%

“…Notably, there are known sex-specific vascular risk factors, such as hypertensive disorders of pregnancy and premature menopause, that are not routinely included in the history-taking for a vascular event. 52,100 Further studies are needed to understand whether there are differences in how women describe their symptoms compared with men, providerlevel biases when evaluating symptoms described by women and men, and whether sex-specific cardiovascular disease guidelines may reduce gaps in care. 133 Even with a detailed history of physical examination, ambiguous clinical scenarios are unavoidable.…”

Section: Stroke Presentation and Diagnosismentioning

confidence: 99%

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The Impact of Sex and Gender on Stroke

Rexrode

Madsen

et al. 2022

Circulation Research

231

143

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Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.

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Section: Female-specific Risk Factorsmentioning

confidence: 99%

Section: Stroke Presentation and Diagnosismentioning

confidence: 99%

The Impact of Sex and Gender on Stroke

Rexrode

Madsen

et al. 2022

Circulation Research

231

143

View full text Add to dashboard Cite

show abstract

“…57 In line with these findings, a recent study found that earlier menopause increased risk of ischemic stroke in a linear fashion with a 2% reduction in stroke risk for each year menopause was delayed. 58 It has been hypothesized that early loss of estrogen paired with increased inflammatory markers influences the risk of future cardiovascular disease, but this is still an active area of investigation. 56 Age at menopause is not something a woman can control but can some of this effect be reversed with hormone therapy (HT)?…”

Section: Hormone Therapymentioning

confidence: 99%

Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women

Manwani

Finger

Lisabeth

2022

Stroke

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Stroke risk and prevalence increase with advanced age and women tend to be older than men at the time of their first stroke. Advanced age in women confers unique stroke risks that are beyond reproductive factors. Previous reviews and guidelines have largely focused on risk factors specific to women, with a predominant focus on reproductive factors and, therefore, younger to middle-aged women. This review aims to specifically describe stroke risk factors in elderly women, the population of women where the majority of strokes occur, with a focus on atrial fibrillation, hormone therapy, psychosocial risk factors, and cognitive impairment. Our review suggests that prevention and management of stroke risks that are unique or more prevalent in elderly women needs a coordinated system of care from general physicians, general neurologists, vascular and cognitive neurologists, psychologists, cardiologists, patients, and their caretakers. Early identification and management of the elderly woman–specific and traditional stroke risk factors is key for decreasing stroke burden in elderly women. Increased education among elderly women regarding stroke risk factors and their identification should be considered, and an update to the guidelines for prevention of stroke in women is strongly encouraged.

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“…Menopause is a key event in a woman's life, and age at natural menopause has been associated with cardiovascular disease, 12 dementia, 13 stroke, 14 and all-cause mortality. 15,16 In addition, it has been suggested that postmenopausal status is associated with higher WMH burden in women.…”

mentioning

confidence: 99%

Relation Between Sex, Menopause, and White Matter Hyperintensities

et al. 2022

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Background and ObjectivesMounting evidence implies that there are sex differences in white matter hyperintensity (WMH) burden in older people. Questions remain regarding possible differences in WMH burden between men and women of younger age, sex-specific age trajectories and effects of (un)controlled hypertension, and the effect of menopause on WMH. Therefore, our aim was to investigate these sex differences and age dependencies in WMH load across the adult life span and to examine the effect of menopause.MethodsThis cross-sectional analysis was based on participants of the population-based Rhineland Study (30–95 years) who underwent brain MRI. We automatically quantified WMH using T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images. Menopausal status was self-reported. We examined associations of sex and menopause with WMH load (logit-transformed and z-standardized) using linear regression models while adjusting for age, age-squared, and vascular risk factors. We checked for an age × sex and (un)controlled hypertension × sex interaction and stratified for menopausal status comparing men with premenopausal women (persons aged 59 years or younger), men with postmenopausal women (persons aged 45 years or older), and premenopausal with postmenopausal women (age range 45–59 years).ResultsOf 3,410 participants with a mean age of 54.3 years (SD = 13.7), 1,973 (57.9%) were women, of which 1,167 (59.1%) were postmenopausal. We found that the increase in WMH load accelerates with age and in a sex-dependent way. Premenopausal women and men of similar age did not differ in WMH burden. WMH burden was higher and accelerated faster in postmenopausal women compared with men of similar age. In addition, we observed changes related to menopause, in that postmenopausal women had more WMH than premenopausal women of similar age. Women with uncontrolled hypertension had a higher WMH burden compared with men, which was unrelated to menopausal status.DiscussionAfter menopause, women displayed a higher burden of WMH than contemporary premenopausal women and men and an accelerated increase in WMH. Sex-specific effects of uncontrolled hypertension on WMH were not related to menopause. Further studies are warranted to investigate menopause-related physiologic changes that may inform on causal mechanisms involved in cerebral small vessel disease progression.

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Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke

Cited by 33 publications

References 38 publications

The Impact of Sex and Gender on Stroke

The Impact of Sex and Gender on Stroke

Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women

Relation Between Sex, Menopause, and White Matter Hyperintensities

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