Stroke in Women

Mister chairman, members and guests of this annual meeting, dear colleagues, ladies and gentlemen, it is a great honor and privilege for me to present the Paul Dudley White International Lecture during this 70th Scientific Session of the American Heart Association. I have chosen to talk about “Stroke in Women” not so much because I am one of the few representatives of this (up to now) rare species of female neurologists, but because stroke in women is a major health issue that has been somewhat neglected in the past but is now attracting more and more attention, as illustrated by the creation of the AHA Web site “Take Wellness to Heart.”Although many aspects of stroke, particularly with regard to clinical presentation, neuroimaging, and management, are similar in both sexes,1 there are also some differences and specificities that I would like to highlight in considering the following 4 main issues: (1) the burden of stroke, which is increasing more rapidly in women than in men; (2) stroke prevention and the role of postmenopausal hormone replacement therapy (HRT); (3) pregnancy and stroke; and (4) stroke in young women.Misperceptions still exist that cardiovascular disease is not a real problem for women, who are far more fearful of breast or ovarian cancers than of stroke or myocardial infarction. Yet it is estimated that 1 in 3 women will die of heart disease and 1 in 6 of stroke, whereas 1 in 9 will develop breast carcinoma at any time during adult life and 1 in 25 will eventually die of it.2 The Global Burden of Disease Study has shown that ischemic heart disease and cerebrovascular disease are, respectively, the first and second causes of …